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Flashcards in Haematology Deck (82)
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1
Q

Most common type of autoimmune haemolytic anaemia?

A

Warm

2
Q

Antibody in warm haemolytic anaemia?
Where does haemolysis tends to occur?

A

IgG
Extravascularly (e.g. spleen)

3
Q

Antibody in cold haemolytic anaemia?
Where does haemolysis tends to occur?

A

IgM
Intravascualrly

4
Q

Drug that can cause warm AI haemolytic anaemia?

A

Methyldopa

5
Q

Drugs that can cause aplastic anaemia?

A

Cytotoxic agents
Phenytoin
Gold
Sulphonamides

6
Q

Feature of autoimmune haemolytic anaemia (not just haemolytic)?

A

Positive direct Coomb’s test

7
Q

Management of hereditary spherocytosis?

A

Folate supplementation
Splenectomy
Cholecystectomy if gallstones are problematic

8
Q

Inheritance of spherocytosis/ellipotocytosis?

A

Autosomal dominant

9
Q

Most common inherited haemolytic anaemia (Northern Europeans)?

A

Spherocytosis

10
Q

Inheritance of G6PD deficiency?

A

X-linked recessive

11
Q

Blood film in G6PD deficiency?

A

Heinz bodies
Bite and blister cells

12
Q

Diagnosis of G6PD deficiency?

A

G6PD enzyme assay

13
Q

Triggers of crisis in G6PD deficiency?

A

Fava beans
Anti-malarials (primaquine)
Sulphonlyureas, Sulphasalazine, other sulphonamides
Ciprofloxacin

14
Q

What are patients with paroxysmal nocturnal haemaglobinuira predisposed to?

A

VTE - PE, DVT, hepatic vein thrombosis
Muscle dystonia - oesophageal dysmotility, erectile dysfunction

15
Q

Causes of microangiopathic haemolytic anaemia?

A

Haemolytic Uraemic Syndrime
Disseminated Intravascular Coagulopathy
Thrombotic thrombocytopenia purpura
Systemic Lupus Erythematous
Cancer

16
Q

Hyposplenism features?
(biochemical)

A

Howell-Jolly bodies
Siderocytes
Target cells
Pappenhiemer bodies
Acanthocytes

17
Q

Criteria for diagnosis of acute chest syndrome in sickle cell anaemia?

A
  1. Fever or respiratory symptoms
  2. New infiltrates seen on CXR
18
Q

Definitive diagnosis of sickle cell anaemia?

A

Haemaglobin electrophoresis

19
Q

Vaccines in sickle cell anaemia?

A

Should receive pneumococcal vaccine every 5 years

19
Q

Haemophillia biochemistry?

A

Prolonged APTT
Prothrombin and thrombin time normal
Bleeding time normal

20
Q

Inheritance of thalassaemia?

A

Autosomal recessive

21
Q

Features of thalassaemia major?

A

Severe microcytic anaemia
Bone deformities
Splenomegaly

22
Q

Complication in thalassaemia (due to lots of transfusions)?

A

Iron overload
Require iron chelation

23
Q

Iron chellating agent?

A

Desferrioxamine

24
Q

FBC in beta thalassaemia trait?

A

Microcytosis is characteristically disproportionate to the anaemia

25
Q

Most common cause of thrombophilia?

A

Factor V Leiden (activated protein C resistance)

26
Q

Evan’s syndrome ?

A

Immune thrombocytopenia with associated autoimmune haemolytic anaemia

27
Q

Management of immune thrombocytopenia (adults)?

A

Prednisolone (oral)

28
Q

Deficiency in thrombotic thrombocytopenia Purpura?

A

ADAMTS13 protein
(this protein inactivates vWF)

29
Q

Diagnosis of myelodysplastic syndrome?

A

Bone marrow aspiration and biposy

30
Q

Blood film for myelodysplastic syndrome?

A

May be blasts

31
Q

Progression of myelodysplastic syndrome?

A

Increased risk of acute myeloid leukaemia

32
Q

Philadelphia chromosome translocation association?

A

Acute Lymphoid Leukaemia
(30% adults, 3-5% children)

9 to 22 translocation = CML

33
Q

Blood film in CLL?

A

Smudge or smear cells

34
Q

Richeter’s transformation?

A

CLL to high grade (non-Hodgkin) lymphoma
Patient become very suddenly unwell

35
Q

Complication of CLL?

A

Warm autoimmune haemolytic anaemia

36
Q

Phases of CML?

A

Chronic: 5 years, usually asymptomatic
Accelerated: 10-20% blast cells, symptomatic
Blast: >30% blast cells, sever symptoms, can be fatal

37
Q

CML features?

A

Increased granulocytosis at different stages of maturation
Thrombocytosis
Decreased leukocyte alkaline phosphatase

38
Q

Blood film AML?

A

Blast cells with Auer rods (rods in cytoplasm)

39
Q

Side effects of Erythropoietin ?

A

Flu-like symptoms
Bone aches
Rashes

40
Q

Tumour Lysis Syndrome scoring system?

A

Cairo-Bishop
2 or more of the following (within 3 days before and 7 days post chemotherapy):
1. Uric acid > 475 or 25% increase
2. Potassium > 6 or 25% increase
3. Phosphate > 1.125 or 25% increase
4. Calcium < 1.75 or 25% decrease

41
Q

Following initial investigations where myeloma is suspected?

A

BLIP
Bence-Jones protein (urine electrophoresis)
Serum free Light chain assay
Serum Immunoglobulins
Serum Protein electrophoresis

Bone marrow biopsy is necessary to confirm diagnosis of myeloma

42
Q

Initial investigation is myeloma is suspected?

A

FBC (low WCC)
Calcium (raised)
ESR (raised)
Plasma viscosity (raised)

if any of these are positive must urgent serum electrophoresis and urine Bence-Jones protein

43
Q

Which symptoms = a poor prognosis of in lymphoma?

A

B symptoms

44
Q

Mutation in polycythaemia vera?

A

JAK2

45
Q

Management of polycythaemia vera?

A

Aspirin (75mg daily)
Venesection to maintain haematocrit < 0.45

46
Q

Management if INR is between 5-8 (patient is not bleeding)?

A

Withold 1 or 2 doses of Warfarin

47
Q

Richter’s transformation?

A

CLL to non-hodgkin lymphoma

48
Q

Features of thrombotic thrombocytopenic purpura? (pentad)

A
  1. Fever
  2. Neuro signs
  3. Throbocytopenia
  4. Haemolytic anaemia
  5. Renal failure
49
Q

What are haptoglobin?

A

Binds to haemoglobin, decrease in HUS

50
Q

When should vaccines be given to a patient going for elective splenectomy?

A

2 weeks prior to surgery

51
Q

1st line management in warm acute haemolytic anaemia ?

A

Steroids +/- rituximab

52
Q

Why is there increased risk of VTE in factor V Leiden ?

A

Activated factor V is inactivated more slowly by Protein C

53
Q

Description of Reed-Sternberg cell?

A

Mirror image nuclei

54
Q

Management of antiphospholipid syndrome after first VTE?

A

Life long warfarin

55
Q

Warfarin PT and APTT?

A

Prolonged PT
Normal APTT

56
Q

Most common type of lymphoma in the UK?

A

Diffuse large B cell lymphoma

57
Q

Which transfusion product has the highest risk of bacterial contamination compared to other types of blood products?

A

Platelets

58
Q

Blood film in DIC?

A

Schistocytes

59
Q

What needs careful monitoring in use of unfractioned heparin ?

A

APTT
Unpredictable anticoagulant effect

60
Q

Which heparin is high risk for HIT?

A

Unfractioned

61
Q

Monitoring in LMWH?

A

Anti Xa assay

62
Q

Which pathway does warfarin mostly affect?

A

Extrinsic (PT)

63
Q

What is raised in beta thalassaemia major?

A

HbA2

64
Q

DIC typical blood picture?

A

Low platelets
Low fibrinogen
Increased PT and APTT
Increased fibrinogen degradation products

65
Q

Blood film in autoimmune haemolytic anaemia?

A

Spherocytes can be found in AIHA as well as hereditary spherocytosis

66
Q

Management of KIT positive tumours (GI stromal tumours/CML)?

A

Imatinib

67
Q

What forms the major criteria for cryoprecipitate use?

A

Fibrinogen level (low)

68
Q

When is irradiated blood required ?

A

Severe immunodeficiency
History of Hodgkin lymphoma
Exposure to certain drugs (bendamustine)
Following stem cell transplant (allogenic for longer)

69
Q

Starry sky appearance on lymph node biopsy?

A

Burrkit’s lymphoma

70
Q

C-myc gene translocation?

A

Burkitt’s lymphoma

71
Q

Blood film iron deficiency anaemia ?

A

Target clue
Pencil poikilocytes

72
Q

Myelofibrosis bloodfilm?

A

Tear drop piokilocytes

73
Q

Intravascular haemolysis blood film?

A

Schistocytes

74
Q

Megalobiastic anaemia blood films?

A

Hyper segmented neutrophils

75
Q

Diagnosis of hereditary spherosytosis?

A

EMA binding

76
Q

Drugs causing haemolysis in G6PD deficiency?

A

Ciprofloxacin
Sulphon drugs
Anti malarial drugs

77
Q

Type of haemolysis in G6PD deficiency?

A

Intravascular

78
Q

Type of haemolysis in spherocytosis?

A

Extravascular

79
Q

Blood film in lead poisoning?

A

Microcytic anaemia and basophilic stippling

80
Q

Most common type of Hodgkin lymphoma?

A

Nodular sclerosing

81
Q

Best prognosis in Hodgkin ?

A

Lymphocyte predominant