Haematology + Oncology

Question 1

Investigations for splenomegaly

Answer 1

FBE

Peripheral blood film

US

CT

Technetium 99 scan to assess function

Question 2

Treatment of polycythaemia

Answer 2

• Iron supplementation
  
  • Iron deficiet microcytic cells are more rigid increaing the risk of intracranial and other thrombosis
• In some instances phlebotomy

Question 3

Causes of splenomegaly

Answer 3

Anatomical

• Splenic cysts
• Polysplenia
• Harmatomas
• Haematoma
• Rupture

Haematological- hyperplasia

• Acute + chronic haemolysis
  
  • Sickle cell, hereditary spherocytosis, G6PD
• Chronic iron deficiency
• Extramedullary haematopoeises

Storage disease

• Lipidosis
• Mucopolysaccharidoses

Immune / inflamm

• Infection
• Autoimmune conditions

Malignancy

• Primary: leukaemia, lymphoma, angiosarcoma, Hodgkin
• Metastasis

Other

• Heart failure
• Portal hypertension

Question 4

What are the encapsulated bacteria you worry about in hyposplenism / asplenia

Answer 4

• Neisseria meningitides
• Haemophilus influenza
• Strep pneumoniae

Question 5

Clinical manifestations of fanconi anaemia

Answer 5

Haem

• Marrow failure

Skin

• Cafe-au-lait
• Vitiligo

Short stature

Skeletal

• Absence of radii
• Aplastic / hypoplastic / supernumerary / bifid thimbs
• Anomalies of the feet
• Congenital hip dislocation
• Absent radial pulse

Malignancies

Renal tract abnormalities

Question 6

Haemophilia A (Factor VIII deficiency)

x linked recessive

80-85% of haemophilia

Complications

Answer 6

Haemarthrosis

• Repeated haemarthroses can cause destructive arthritis + joint instability + anylosis

Neurological problems

• Intracranial haemorrhage
• Haemorrhage into the vertebral canal
• Peripheral nerve compression

Haemorrhage

• Retropharyngeal
• Retroperitoneal