Haematology Ixs

Question 1

Diagnose b thalassemia trait

Answer 1

hb electropheresis shows: Raised hba2- >3.5%
(diagnostic)

Question 2

what is the coombs test

Answer 2

Direct antiglobulin test (DAT, aka Coombs’ test): a positive DAT suggests immune-mediated haemolysis

negative=non immune mediated haemolysis

(its an antiglobulin test, sticks to antigens)

Question 3

what constitues HbA

Answer 3

2 alpha chains, 2 beta chains- in a normal adult this constitutes 97% of total haemoglobin

Question 4

what constitutes HbA2

Answer 4

2 alpha 2 delta chains

Question 5

what constitutes HbF

Answer 5

2 alpha chains 2 gamma chains

Question 6

GP6D deficiency diagnosis

Answer 6

G6PD enzyma assay 3 months after episode of haemolysis

Question 7

What does prothombin time test
and normal time?

Answer 7

measures the time taken for fibrin to form via the extrinsic pathway.
normal 9-12 seconds

Question 8

Activated thromboplastin time (APTT)
normal time?

Answer 8

measures the time taken for fibrin to form via the intrinsic pathway.
The normal range is 23-38 seconds.

Question 9

How to monitor heparin

Answer 9

APTT for unfractionated heparin

For LMWH anti-Xa assay

Question 10

Primary haemostasis screening

Answer 10

Platelet count

Question 11

what Liver marker indicates liver disease in anaemia

Answer 11

Low albumin

Question 12

PE investigations

Answer 12

1st line: 2-level PE wells score >4 = likely
if likely CTPA.
if CTPA neg and DVT suspected dp prox leg ultrasound

Question 13

Immune Thrombocytopenia (ITP) Ixs

Answer 13

blood film and FBC- isolated thrombocytopenia

Question 14

what wells score indicates DVT likely / unlikely

Answer 14

2 points or more DVT likely
<2 points unlikely

Question 15

Suspected lymphoma/ first line ix for lymphima

Answer 15

Fine needle aspirate or core biopsy

Question 16

diagnostic test for lymphoma

Answer 16

lymph node biopsy

Question 17

Cd20+ associated with what haematological cancer

Answer 17

B follicular cells in non hodgkins lymphoma

Question 18

CD15 &Cd30+ cells in what tumour

Answer 18

Reed stenberg cells in hodgkins lymphoma

Question 19

Which is worse b cell NHL or T cell nhl

Answer 19

T cell

Question 20

monitoring of TTP

Answer 20

monitor platelet count/LDH

Question 21

Reed stenberg cells a sign of?

Answer 21

Hodgkins lymphoma

Question 22

What is the ann arbor staging for and rough guide

(Laguno classification is the updated version)

Answer 22

staging for hodgkins

I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes

A= no systemic symptoms other than pruritis
b- systemic sypmtoms eg fever, night sweats. weight loss

Question 23

1st line imaging for multiple myeloma

Answer 23

whole body MRI

(if x-ray- shows rain drop skull)

Question 24

ixs multiple myeloma

Answer 24

• whole body mri
• protein electropheresis: IgA/IgG in serum, benc jones in urine

Diagnostic- bone marrow aspirate (plasma cells sig.fig. raised)

Question 25

hereditary spherocytosis test

Answer 25

EMA binding assay

Question 26

sickle cell definitive diagnosis

Answer 26

haemoglobin electropheresis- haemoglobin s found HPLC (not serum protein electropheresis!)

Question 27

Chronic lymphocytic leukaemia Ixs

Answer 27

Bloods/film-smudge cells bone marrow aspirate Cytogenetics- deletion of 13q

Question 28

myelofibrosis ix

Answer 28

fbs and blood film: leucoerythroblastic film tear drop shaped RBC bone marrow biopsy/aspirate: dry aspirate, fibrosis on trephine biopsy can have JAK2 mutations

Question 29

PT or APTT raised in von willerbrands disease

Answer 29

APTT!!!! as causes factor VIII deficiency! (bleeding time also raised due to platelet dysfunction)

Question 30

bleeding time is prolonged as a result of problems in primary or secondary haemostasis?

Answer 30

primary!

Question 31

myelodysplastic syndrom Ixs

Answer 31

fbc (abnormal) and blood film- may have blasts bone marrow biopsy diagnostic

Question 32

essential thrombocytois (aka essential thrombocythiaemia)

Answer 32

FBC- platelet count>450. wcc may be raised no basophillia Trephine biopsy- hypercellular marrow and pathological megakaryocytic clumping (no clear precipitant JAK2mutation in 60% of patients)

Question 33

Complete remission and partial remission diagnosis of acute myeloid leukaemia

Answer 33

Complete: <5% blasts - no need for blood transfusions - neutrophil >1.0 - platelets >100 -normal cellular components bone marrow -absence of extramedullary disease - partial is same except <10% blasts and greater than 50% decrease jn blasts from diagnosis

Question 34

von willerbrand disease ixs

Answer 34

clotting tests reveal abnormal APTT and prolonged bleeding time diagnostic: VWF level and activity assay confirms diagnosis

Question 35

intrinsic autoantibodies vs gastric parietal autoantybody testing for pernicious anaemia

Answer 35

intrinsic- specific not sensitive gastric- sensitive not specific

Question 36

tumour lysis syndrome ix

Answer 36

ECG, U%E, calcium and uric acid ecg important as hyperkalaemia can precipitate arrythmias

Question 37

serum iron studes results for anaemia of chronic disease

Answer 37

low serum iron, normal/high ferritin, low transferrin saturation (ferritin is normal/ raised due it it being an acute phase reactant so is raised in infection inflammation etc. as it is anaemic cause by chronic disease patient will have ongoing inflammatory conditions therefore raising acute phase reactants)