Haematology

Question 1

What are the causes of microcytic anaemia? (5)

Answer 1

Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic

Question 2

What are the causes of normocytic anaemia? (5)

Answer 2

Anaemia of chronic disease
Acute blood loss
Aplastic anaemia
Haemolytic anaemia 
Hypothyroidism

Question 3

What are the causes of macrocytic anaemia? (6)

Answer 3

Megaloblastic - folate and B12 deficiency

Non-megaloblastic - alcohol excess, hypothyroidism, rectiuloctyes, azathioprine

Question 4

What are some inherited causes of haemolytic anaemia? (5)

Answer 4

Thalassaemia
Sickle cell
Spherocytosis
Elliptocytosis 
GPD6 deficiency

Question 5

What are some acquired causes of haemolytic anaemia? (5)

Answer 5

Autoimmune 
Alloimmune
Infection
Toxins
Prosthetic valve

Question 6

What test would you do to test for autoimmune haemolysis?

Answer 6

Direct Antiglobulin Test

Question 7

What are some causes of iron deficiency anaemia? (4)

Answer 7

Blood loss e.g. GI tract, menorrhagia
Dietary
Absorption e.g. coeliac disease
Excessive requirements eg. pregnancy

Question 8

What will the following be in iron deficiency anaemia?

1. Ferritin
2. TIBC
3. Transferrin saturation

Answer 8

1. Low
2. High
3. Low (indication of stores, % iron attached to transferrin)

Question 9

When starting iron tablets:

1. When should you check FBC?
2. How long will the person be on them for?

Answer 9

1. 2-4 weeks after starting

2. 3 months after Hb corrected

Question 10

Which medications can cause folate deficiency? (3)

Answer 10

Methotrexate
Sulfasalazine
Trimethoprim

Question 11

What must you check before commencing treatment for folate deficiency?

Answer 11

B12 - treating folate before B12 deficiency can precipitate subacute degeneration of the cord

Question 12

Which medical conditions can cause B12 deficiency? (2)

Answer 12

Coeliac

Crohn’s disease

Question 13

What blood test is required to diagnose thalassaemia?

Answer 13

Hb electrophoresis

Question 14

What is the management for major beta-thalassaemia? (2)

Answer 14

regular blood transusions and iron chelation

Question 15

What are the 4 sickle cell crises?

Answer 15

Vaso-occlusive crisis
Aplastic anaemia (parvovirus B19)
Sequestration (sudden enlargement of spleen)
Acute chest syndrome

Question 16

What can precipitate a sickle cell crisis? (4)

Answer 16

Infection
Dehydration
Cold
Exertion

Question 17

What blood test is required to diagnose sickle cell? What would you expect to find?

Answer 17

Hb electrophoresis

HbS

Question 18

Which medication can be used in sickle cell anaemia?

What is the general management of sickle cell anaemia? (4)

Answer 18

Hydroxycarbamide - stimulates HbF

Avoid triggers, vitamin supplements, vaccinations, antibiotic prophylaxis

Question 19

What are the different types of blood products available? (5)
What are they used for?

Answer 19

Red blood cells - Hb <70
Platelets - <10 or <30 if significant bleed
FFP - clinically significant bleed
Cryoprecipitate - fibrinogen <1.5 if significant bleeding
Prothrombin concentrate - reverse warfarin if severe bleeding

Question 20

Which clotting factors are in the:

1. Intrinsic pathway?
2. Extrinsic pathway?

Answer 20

1. VII, IX, XI, XII (and others)

2. II, V, VII, X

Question 21

Which blood test measures:

1. Intrinsic clotting pathway?
2. Extrinsic clotting pathway?

Which pathway measures:

1. Unfractionated heparin?
2. Warfarin?

What special test can you use to test effects of LMWHs?

Answer 21

1. APTT - measures effects of heparin
2. PT - measures effects of warfarin

Anti-Xa assay

Question 22

Which medication should be avoided in Von Willebrand’s disease?

Answer 22

NSAIDs

Question 23

What are the management options for Von Willebrand’s disease? (3)

Answer 23

Tranexamic acid, desmopression, vWF concentrate

Question 24

In what form of haemophilia can desmopressin be used?

Answer 24

Haemophilia A

Question 25

What are some of the criteria in the Wells score for PE? (7)

Answer 25

``` Signs or symptoms of DVT Heart rate >100 Immobilisation for >3 days or surgery in past 4 weeks Previous DVT or PE Haemoptysis Cancer Alternative diagnosis less likely ```

Question 26

What are some of the criteria in the Wells score for DVT? (9)

Answer 26

Active cancer Paralysis or immobilisation of legs Recently bedridden for >3 days or surgery in past 12 weeks Localised tenderness along deep venous system Entire leg is swollen Calf swelling by >3cm compared to asymptomatic leg Pitting oedema in symptomatic leg Collateral superficial veins Previously documented DVT

Question 27

What staging system is used in lymphoma?

Answer 27

Ann Arbor

Question 28

In which type of lymphoma will the lump become tender with alcohol?

Answer 28

Hodgkin's lymphoma

Question 29

What are some risk factors for Hodgkin's lymphoma? (3)

Answer 29

EBV infection, HIV infection, immunosuppression

Question 30

Which type of lymphoma is associated with chronic malaria? | What special test is there to test for this lymphoma?

Answer 30

Burkitt's lymphoma FISH analysis

Question 31

Which age groups are most likely to be affected by the following leukaemias? 1. ALL 2. CLL 3. CML 4. AML

Answer 31

<5 or >45 >55 >65 >75

Question 32

Which leukaemia is associated with? 1. Philidelphia chromosome 2. Richter's transformtion 3. Raised WCC 4. Autoimmune haemolytic anaemia

Answer 32

1. CML 2. CLL 3. CML 4. CLL

Question 33

What features are part of myeloma? (4)

Answer 33

Calcium Renal failure Anaemia Bone pain

Question 34

According to NICE, what blood tests should you order is someone >60 presents with persistent bone pain, especially back pain? (4)

Answer 34

FBC Bone profile ESR Plasma viscosity

Question 35

What tests should you order if someone >60 presents with hypercalcaemia or leukopenia and signs of myeloma?

Answer 35

Serum electrophoresis and urinary Bence-Jones proteins

Question 36

What are some complications of haematalogical malignanacies? (4)

Answer 36

Low blood cells of any line e.g. neutropenia, anaemia, thrombocytopenia - Bleeding secondary to thrombocytopenia - Neutropenic sepsis Effusions e.g. pericardial, pleural SVCO MSCC