Haematology

Question 1

What investigation should you do next for macrocytic anaemia?

Answer 1

Blood film - do see if megaloblastic anaemia

Question 2

What are the possible causes of megaloblastic and non-megaloblastic anaemia?

Answer 2

Megaloblastic - B12 deficiency, folate deficiency, drug-induced eg.methotrexate
Non-megaloblastic - Alcohol abuse, hypothyroidism, pregnancy

Question 3

What are the possible causes of vitamin B12 deficiency?

Answer 3

Most common: Pernicious anaemia (autoimmune antibodies against intrinsic factor or parietal cells)
Other causes: atrophic gastritis, gastrectomy, malnutrition

Question 4

What are the blood features of someone with hypospenism?

Answer 4

Howell-Jolly bodies
siderocytes

Question 5

What causes multiple myeloma?

Answer 5

Uncontrolled plasma cell proliferation

Question 6

What are the features of multiple myeloma?

Answer 6

CRABBI
hyperCalcaemia
Renal dysfunction (due to light chain deposition)
Anaemia
Bleeding (thrombocytopenia)
Bone lesions
Infection (reduced normal antibodies)

Question 7

What will bloods and urine show in multiple myeloma?

Answer 7

Anaemia, ROUEAUX formation, deranged U&E’s and hyper calcaemia
Urine: BENCE JONES proteins

Question 8

What is the first line investigations for multiple myeloma?

Answer 8

FBC, U&E & peripheral blood film
1st line imaging: whole body MRI

Question 9

What is the classical finding on blood film in CLL?

Answer 9

Smear cells (also called smudge cells)

Question 10

What X-ray finding may be found in multiple myeloma?

Answer 10

rain-drop skull’

Question 11

What causes alpha-thalassaemia?

Answer 11

2 genes for ⍺ globin are located on chromosome 16
Occurs if 1-4 of the genes are deleted

Question 12

What are the different types of alpha-thalassaemia?

Answer 12

1-2 alleles affected = carrier, may be asymptomatic or have Normal haemoglobin but hypo chromic microcytic cells
3 alleles affected = haemoglobin H disease
4 alleles deleted = hydrops fetalis & death in utero

Question 13

What treatment should be given for those with a suspected/confirmed DVT and for how long?

Answer 13

DOAC (apixaban or rivaroxaban)
For 3 months if provoked or 6 months if unprovoked

Question 14

What earns a point in the Wells score?

Answer 14

COP PASSED
Cancer
Oedema (pitting)
Paralysis/plaster

Pain (localised to vein)
Asymmetrical swelling
Surgery (major)
Superficial veins (non-varicose)
Entire leg swollen
DVT previously

Question 15

What should you do if a Wells score <2?

Answer 15

Order D-dimer (done within 4 hrs)
+ = vein ultrasound within 4 hrs

Question 16

What should you doit a Wells score ≥2?

Answer 16

Vein ultrasound within 4hrs

Question 17

What Neutrophil count is consistent with neutropenic sepsis?

Answer 17

neutrophil count of < 0.5 * 10^9

Question 18

What is associated the Philadelphia chromosome associated with?

Answer 18

Present >95% of CML patients
Poor prognosis in ALL

Question 19

What is Acute promyelocytic leukaemia ?

Answer 19

Subtype of AML, t(15;17) translocation which causes mutation of retinoic acid receptor - results in lots of Auer rods which increase risk DIC!!!

Question 20

What are the features of CML?

Answer 20

Long history & age 60-70
Anaemia/lethargy
weight loss & sweating
splenomegaly
On film granulocytes at different stages maturation + high platelets

Question 21

What is the first-line treatment for CML?

Answer 21

imatinib (inhibitor of the tyrosine kinase)

Question 22

What is the platelet count cut off for a platelet transfusion?

Answer 22

10 x 109 for patients not bleeding
30 x 109/L for bleeding patients or patients having invasive procedure

Question 23

What is the typical blood test results in DIC?

Answer 23

↓ platlets & fibrinogen
↑ PT & APTT
Schistocytes

Question 24

What is the most common causative agent of neutropenic sepsis?

Answer 24

Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis

Question 25

What is the reversal agent for rivaroxaban and apixaban?

Answer 25

Andexanet alfa

Question 26

What are the five key features of TTP?

Answer 26

Fever Altered mental state (headache, confusion, excess tiredness, seizure) Thrombocytopenia Haemolytic anaemia Reduced renal function

Question 27

What are irradiated blood products and why are they sometimes required?

Answer 27

Irradiated blood products are depleted of T-lymphocytes Used to avoid transfusion-associated graft versus host disease (TA-GVHD)

Question 28

What are the clinical marks on blood test that indicate G6PD deficiency?

Answer 28

Heinz bodies Bite and blister cells

Question 29

Which system is used for staging lymphoma?

Answer 29

Ann-Arbor

Question 30

What are the different stages of the Ann-Arbor staging?

Answer 30

I = single lymph node II = 2 or more on the same side of diaphragm III = Nodes on both sides diaphragm IV = beyond lymph nodes

Question 31

What are the features of lymphoma?

Answer 31

Lymphadenopathy Alcohol induced lymph pain = Hodgkins B syptoms Mediastinal mass

Question 32

What are the features of tumour lysis syndrome?

Answer 32

High potassium and phosphate Low calcium Increase in uric acid and creatinine

Question 33

What prophylaxis should be given to those at high risk of tumour lysis syndrome?

Answer 33

IV allopurinol or IV rasburicase

Question 34

What is Factor V Leiden?

Answer 34

Inherited thrombophilia Mutation in factor V (clotting factor) means it is inactivated slower by activated protein C ↑ risk blood clots