Haematology

Question 1

amount of plasma cells in myeloma

Answer 1

> 10% plasma cells in bone marrow

Question 2

prevalence of MGUS in >70yr

Answer 2

10%

Question 3

difference between smouldering and MM

Answer 3

lack of symptoms in smouldering (does not satisfy clinical sx)

Question 4

mechanism of hypercalcaemia in MM

Answer 4

plasma cells secrete RANK-ligand which stimulates osteoclasts

Question 5

purpose of autologous SCT transplants

Answer 5

to allow for giving high dose chemotherapy

Question 6

purpose of allogeneic SCT

Answer 6

1) allows for chemo with repalcement of marrow with healthy cells
2) Immune response against malignancy

Question 7

Donor recipient matching in HSCT

Answer 7

HLA
Class I - HLA-A, -B, -C
Class II - HLA-DRB1, DQB1, DPB1
standard BMT considers 6 loci (so 12 alleles between 2 parents)

Question 8

Alternatives to mismatch transplant

Answer 8

haploidentical relative (half-match) (higher risk of GVHD)
Umbilical cord blood - more permissive of HLA mismatches (used more frequently in paediatrics)

Question 9

PBSC - peripheral blood stem cells

Collection; GvHD risk and graft failure risk

Answer 9

G-CSF mobilisation and apheresis
Exclusive source for autologous (and most allogeneic)
Higher chronic GvHD risk than marrow
Lower graft failure rate

Question 10

When are bone marrow donor sources preferred?

Answer 10

Non-malignant disease (e.g. aplastic anaemia) as no benefit from GvHD

Question 11

3 criteria for HSCT

Answer 11

• Does the disease require a transplant
• Suitable available donor
• Patient sufficiently fit

Question 12

Most common indications for autologous transplant

Answer 12

MM
NHL
Hodgkin’s

Question 13

Most common indications for allogeneic transplant

Answer 13

AML
ALL
NHL
MDS
CML (less common with immunotherapy)

Question 14

Donor priorities

Answer 14

Matched sibling, matched unrelated, haplo, cord

Question 15

what recovers first after a HSCT

Answer 15

NK cells, then CD8, then CD4, then B cells

Question 16

acuteGVHD timing and involvement

Answer 16

Within 100 days of BMT

Predominantly skin, gut, liver

Question 17

chronicGVHD manifestation

Answer 17

predominantly fibrotic process

Question 18

prevention of chronic GVHD

Answer 18

cyclophosphamide

Question 19

open chromatin

Answer 19

chromosomes open and actively transcribing DNA

sign of aggressive malignancy

Question 20

What biopsy is preferred for diagnosis of lymphoma

Answer 20

excisional biopsy

Question 21

Lymphoma stageing

Answer 21

I - lymph nodes in 1 group
II - lymph nodes multiple groups in 1 side of the body
III - lymph node groups on both sides of the body
IV - organ involvement (excluding spleen; or stage E disease which is the involvement of an adjacent organ to the lymph nodes)

A or B based on whether they have B symptoms

Question 22

What is the significance of B symptoms

Answer 22

That they have larger disease bulk

Question 23

When is a diagnostic LP indicated in lymphoma

Answer 23

ALL, aggressive lymphomas w evidence of stage IV disease
High risk sites
High LHD

Question 24

Chemo regimen for early stage Hogkin’s

Answer 24

ABVD
local radiotherapy
more cycles if unfavourable disease

Question 25

Chemo regimen for advanced stage Hogkin's

Answer 25

ABVD

Question 26

Lines of treatment for DLBCL

Answer 26

R-CHOP x 6 H-hyperCVAD x 8 Mini-R-CHOP in older adults

Question 27

What factors prognosticate lymphoma

Answer 27

``` age LHD ECOG Stage >1 2 or more extranodal sites ``` IPI - international prognostic index

Question 28

Burkitt's chemotherapy regime

Answer 28

R-CODOX-M/R-IVAC

Question 29

Primary CNS lymphoma cell lineage origin

Answer 29

B cells due to lymphoid tissue in brain

Question 30

What immunodeficiency is BTK deficiency associated with

Answer 30

Brunton's gammaglobuinaemia

Question 31

What haematological conditions is ibrutinib used to treat

Answer 31

CLL, mantle cell leukaemia

Question 32

PE mortality - sudden death and 1 week mortality

Answer 32

25% and 30%

Question 33

optimal treatment duration for VTE

Answer 33

In general, there is a low recurrence rate after 3 months there is a low absolute risk for provoked distal DVTs so maybe they only need 6 weeks of anticoagulation After 3 months, there is an assessment to determine indefinite continuation of anticoagulation

Question 34

what provocation factor of VTE is assoc w the lowest recurrence rate

Answer 34

surgery (<1%)

Question 35

what age group is associated with a higher early recurrence

Answer 35

younger patients

Question 36

who to consider indefinite low dose NOAC after 3 mo anticoagulation

Answer 36

everyone aside from transient provoking and distal DVT

Question 37

anticoagulation management in non low risk surgery

Answer 37

Warfarin - determine if bridging is required - bridging is associated with increased bleeding but no benefit to thromboembolism - very high risk to consider bridging (AF w CHADVASC >6, SSE within 3 months, mitral stenosis) NOAC - does not need bridging because similar half life to LMWH - low risk of thrombosis (0.4%) - stop 48hr pre-op (72 hr if CKD, dabigatran or high risk consequences of bleeding) - normally recommence NOAC 2-3 days SEE SLIDES

Question 38

How to monitor dabigatran post op

Answer 38

dilute thrombin clotting time