haematology

Question 1

Would you test for a thrombophilia in this patient?

[Med J Aust 2011; 195 (3): 139-142]

Answer 1

1. to prevent VTE in patients considering pregnancy who have had a clot or a strong FHx of a clot
2. to prevent VTE in OCP taking women with history of heritable thrombophilia
3. if skin necrosis with warfarin
4. unprovoked clot in unusual place age < 50

maybe: testing female relatives of FVL carriers

disadvantages:

• may not change management
• unnecessary distress about perceived risk of recurrence
• discrimination by insurers based on results
• negative test may be false reassurance

Question 2

What are the causes of massive splenomegaly?

Answer 2

[when it crosses the umbilicus]
CML
myelofibrosis
primary lymphoma of spleen
malaria, kala azar

Question 3

What are the causes of moderate splenomegaly?

Answer 3

leukaemia - usually chronic, but can be acute
lymphoma
portal hypertension
thalassaemia
storage diseases - eg. Gauchers
EBV
amyloidosis

Question 4

What are the causes of generalised lymphadenopathy?

Answer 4

lymphoma - rubbery and firm
leukaemia - esp. CLL
metastatic malignancy - very firm nodes
infection - EBV, CMV, HIV, TB - possibly tender
connective tissue disease - RA, SLE
infiltrative disease - sarcoidosis
drugs - phenytoin (aka pseudolymphoma)