Haematology

Question 1

What is myeloma?

Answer 1

Monoclonal expansion of an antibody M-protein or Bence-Jones protein

Question 2

What is myeloma?

Answer 2

Monoclonal expansion of an antibody M-protein or Bence-Jones protein

Question 3

What is the normal % of plasma cells in the bone marrow?

Question 4

What can be detected in the urine if the clonal proliferation occurs in the light chain component of the immunoglobulin?

Answer 4

Bence-Jones protein

Question 5

What is the paraprotein found in the serum or urine when a clonal immunoglobulin is present?

Answer 5

M-protein

Question 6

MGUS: what are the values of serum M-protein (g/L) and marrow clonal plasma cells (%)?

Answer 6

Serum M-protein

Question 7

What is the only difference between smouldering myeloma & multiple myeloma

Answer 7

Presence of CRAB features

Question 8

What are the CRAB features of myeloma?

Answer 8

C - hypercalcaemia
R - renal insufficiency
A - anaemia
B - bone lesions (lytic)

Question 9

What is the normal % of plasma cells in the bone marrow?

Question 10

What can be detected in the urine if the clonal proliferation occurs in the light chain component of the immunoglobulin?

Answer 10

Bence-Jones protein

Question 11

What is the paraprotein found in the serum or urine when a clonal immunoglobulin is present?

Answer 11

M-protein

Question 12

MGUS: what are the values of serum M-protein (g/L) and marrow clonal plasma cells (%)?

Answer 12

Serum M-protein

Question 13

What is the only difference between smouldering myeloma & multiple myeloma

Answer 13

Presence of CRAB features

Question 14

What are the CRAB features of myeloma?

Answer 14

C - hypercalcaemia
R - renal insufficiency
A - anaemia
B - bone lesions (lytic)

Question 15

Besides the CRAB features, what are some of the clinical consequences of myeloma?

Answer 15

Hyperviscosity, amyloidosis, recurrent infections

Question 16

What are the clinical manifestations of hypercalcaemia?

Answer 16

Abdominal pain, renal stones, delirium, osteopenia

Question 17

What test is diagnostic for multiple myeloma & what bodily secretions can it be performed on?

Answer 17

Protein electrophoresis - on serum or urine

Question 18

What markers are used for prognostic estimations in multiple myeloma?

Answer 18

LDH, B-2 microglobulin, serum albumin

Question 19

What are the treatments for multiple myeloma?

Answer 19

Chemotherapy (thalidomide based + alkylator + steroids), autologous transplants

+ symptom control: renal support, bone supplements, blood transfusions

Question 20

What medications are used for symptoms relief in multiple myeloma?

Answer 20

• Transfusions for anaemia
• Vitamin D supplements ± bisphosphonates for fractures
• Fluids for renal insufficiency

Question 21

What are the 3 broad lineages of lymphoma classification according to the WHO?

Answer 21

• Hodgkin lymphoma
• B-cell non-Hodgkin lymphoma
• T-cell non-Hodgkin lymphoma

Question 22

In terms of aggressiveness, name 1 low, 1 intermediate and 1 high type of B cell non-Hodgkin lymphoma.

Answer 22

Low: follicular lymphoma
Intermediate: diffuse large B-cell non-Hodgkin lymphoma
High: Burkitt lymphoma

Question 23

What are 4 clinical presentations of lymphoma?

Answer 23

• SOB & cough
• Abdominal discomfort
• Lymphadenopathy
• PUO & night sweats

Question 24

What cells found in the lymph nodes are pathognomic of Hodgkin lymphoma?

Answer 24

Reed-Sternberg cells

Question 25

Which immunohistochemical stains confirm a diagnosis of Hodgkin lymphoma?

Answer 25

CD15 and CD30

Question 26

How is Hodgkin lymphoma staged?

Answer 26

Ann-Arbor staging: according to extent of disease - ie. one or multiple nodes involved, one or both sides of the diaphragm

Question 27

What sort of lymphoma is diffuse large B-cell lymphoma?

Answer 27

An intermediately aggressive non-Hodgkin lymphoma

Question 28

What serum markers indicate aggressive disease in diffuse large B-cell lymphoma?

Answer 28

Serum uric acid and LDH

Question 29

Chemotherapy targets which receptor on B cells in diffuse large B-cell lymphoma?

Answer 29

CD20

Question 30

Which clinical syndrome might be seen in tumour lysis syndrome?

Answer 30

Hyperuricaemia, hypercalcaemia, hyperphosphataemia, hyperkalaemia & acute renal failure

Question 31

What prophylactic treatment can be provided for tumour lysis treatment?

Answer 31

Uric acid lowering agents, hydration

Question 32

What are some risk factors for the development of leukaemia?

Answer 32

- Previous cytotoxic therapy - Exposure to ionizing radiation - Chemical exposure - Infections, eg/ EBV - Genetics - Rare familial syndromes

Question 33

What are some clinical features of acute leukaemia (name 4)?

Answer 33

- Petechiae - Lethargy - Infection - SOB - B symptoms - fevers, sweats, weight loss

Question 34

What bone marrow feature is diagnostic of an acute leukaemia?

Answer 34

Blast cells accounting for >20% of nucleated cells in the bone marrow

Question 35

Which feature found in bone marrow aspirates is pathognomic of acute myeloid leukaemia?

Answer 35

Auer rods

Question 36

What does immunophenotyping (flow cytometry) show?

Answer 36

Specific surface proteins that the malignant cells possess, eg/ CD15 and CD30 in Hodgkin lymphoma

Question 37

What is the use of cytogenetics in leukaemia?

Answer 37

Cytogenetics can be used diagnostically & prognostically in leukaemia. They provide information about the particular genetic abnormalities possessed by the malignant cells.