Haematology

Question 1

myeloma CRAABI

Answer 1

• hyperCa
• Renal (light chain deposition)
• Anaemia
• Bleeding
• Bones (fractures)
• Infection

Question 2

myeloma Ix findings

Answer 2

• peripheral blood film: rouleaux formation
• electrophoresis: ++ IgA/IgG // Bence Jones proteins in urine
• BM aspiration: raised plasma cellsm

Question 3

myeloma imaging

Answer 3

XR –> rain-drop skull/pepperpot skull
whole body MRI

Question 4

blood film findings
- CLL
- CML
- hodgkins
- MM
- AML

Answer 4

• smudge/smear cells: CLL
• pseudo pelger-huet: CML
• reed-sternberg: hidgkin’s
• rouleaux: MM
• auer rods: AML

Question 5

disproportionate microcytic anaemia & raised HbA2 (plus raised HbF + absent HbA)

Answer 5

beta-thalassaemia trait

Question 6

howell-jolly bodies
blasts
heinz bodies
schistocytes
spherocytes

Answer 6

• hyposplenism (think coeliac, target cells, acanthocytes)
• AML
• G6PD deficiency
• TTP
• auto-immune haemolytic anaemia

Question 7

polycythaemia vera mx

Answer 7

aspirin (– risk thrombotic event)
venesection (1st line)

Question 8

haemochoromatosis monitoring

Answer 8

ferritin and transferrin saturation
(++ ferritin & transferrin // – low TIBC)

Question 9

reaction to transfusions plus management

Answer 9

• non-haem feb: slow/stop transfusion –> paracetamol
• minor allergic: temp. stop –> antihistamine
• anaphylaxis: stop –> IM adrenaline
• acute haemolytic (ABO): stop –> ocnfirm dx(ID px + coomb) –> supportive
• TACO (hypertensive): slow/stop –> IV diuretics + O2
• TRALI (hypotensive): stop –> supportive

Question 10

mechanism of
dabigatran
heparin
DOACs

Answer 10

direct thrombin inhibitor
antithrombin III
direct factor Xa inhibitor

Question 11

Sister Mary Joseph node

Answer 11

palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

Question 12

Bone pain, tenderness and proximal myopathy (→ waddling gait)

Answer 12

osteomalacia

Question 13

an inhibitor of the tyrosine kinase used as first-line treatment for chronic myeloid leukaemia

Answer 13

imatinib

Question 14

most common inherited clotting disorder

Answer 14

von willebrand disease (autosomal D)
haemophilia A (Factor VIII)

Question 15

sickle cell crises associated with sudden fall Hb & increased reticulocyte count

Answer 15

• aplastic (– reticulocyte//parovirus)
• sequestration

Question 16

Cryoprecipitate contains

Answer 16

factor VIII, fibrinogen, von Willebrand factor and factor XIII

Question 17

normocytic anaemia, jaundice, raised reticulocytes and raised LDH 1st line

Answer 17

acute haemolytic anaemia
warm –> steroids

Question 18

Hodgkin’s lymphoma type that carries the worst prognosis

Answer 18

lymphocyte depleted

Question 19

Sickle cell patients should be started on long term … to reduce the incidence of complications and acute crises

Answer 19

hydroxycarbamide

Question 20

prosthetic valves may result in

Answer 20

haemolytic anaemia

Question 21

causes of macrocytic anaemia

Answer 21

phenytoin
methotrexate
pregnancy
alcohol excess

Question 22

this medication decreases vitB12 absorption

Answer 22

metformin

Question 23

Persistent PUO and lymphadenopathy with high WCC? Look for …

Answer 23

lymphoma

Question 24

drugs precipitating G6PD deficiency

Answer 24

anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
(G6PD enzyme assays should be repeated around 3 months after acute haemolytic episodes to avoid false negatives)

Question 25

Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension

Answer 25

polycythaemia vera

Question 26

anaemia of chronic disease test features

Answer 26

microcytic
high iron
low TIBC

Question 27

… have the highest risk of bacterial contamination compared to other types of blood product

Answer 27

platelet transfusions

Question 28

… can transform to high-grade lymphoma (Richter’s transformation) making patients suddenly unwell

Answer 28

CLL

Question 29

cancer assocaitedw ith Philadelphia chromosome - t(9:22)

Answer 29

CML (granulocytes at different maturation ages)