Hematology

Question 1

Unexplained low back pain
Diffuse osteoporosis
High calcium
high total protein
Low serum albumin
Renal impairment
Anaemia

Answer 1

Multiple myeloma

CRAB:
calcium
Renal
anaemia
bone disease

Question 2

Prognosis of multiple myeloma

Answer 2

Low serum albumin

High serum beta 2 micro globulin

Question 3

Multiple myeloma first line investigation

Answer 3

Serum and urinary electrophoresis

M-protein or paraprotein

2nd line: X-ray:

punched out lytic bony lesions

MRI

Question 4

Test for hemochromatosis

Answer 4

Main: Serum Transferrin saturation

Serum ferritin

Iron saturation

If abnormal then HFE genotype

Question 5

Cervical lymphadenopathy plus

high lymphocytes plus

atypical lymphocytes

Answer 5

Next step immunophenotyping of peripheral blood cells

To confirm the presence of neoplastic cells

Question 6

Thrombotic thrombocytopenic purpura

Answer 6

Thrombocytopenia and organ damage

Hemolytic anaemia
Acute renal failure
Brain damage

Question 7

Fanconi anemia

Answer 7

Bone marrow failure - pancytopenia

Cancer susceptibility

Autosomal recessive

Question 8

Causes of thrombocytosis

Answer 8

Hyposplenism - because thrombocyte are destroyed by the spleen

Iron deficiency anaemia
Correction of vitamin B12 or folic acid deficiency
Polycythaemia Vera

Question 9

Pregnancy and vitamin deficiency

Answer 9

No B12 deficiency

Question 10

Vitamin deficiency in vegetarian people

Answer 10

B12

Question 11

Haemophilia inheritance

Answer 11

X linked recessive

50% of sons will get it,
50% of daughters will be carriers

Question 12

Most common symptom of multiple myeloma

Answer 12

Anemia

Question 13

Low hemoglobin
Low thrombocytopenia
Acute renal failure
Hallucinations

Answer 13

Thrombotic thrombocytopenia

Question 14

Splenctectomy -> change in thrombocytes?

Answer 14

Thrombocytosis

Question 15

INR > 1.6 - next step

Answer 15

Prothrombin complex

If not available - frozen plasma

Question 16

Patient on warfarin and platelets are low -> next step

Answer 16

Cease warfarin

Question 17

Primaquine +
Glucose-6 phosphate deficiency->

Answer 17

Acute hemolysis

Bite cells

Question 18

Signs of glucose 6 phosphate deficiency

Answer 18

Bite cells and Heinz bodies

Question 19

If a women who is a haemophilia carrier is pregnant

Answer 19

Measure factor 8 at first antenatal visit and 32 weeks

Majority have normal level and don’t require replacement

Vaginal delivery preferred

Vacuum extraction contraindicated

Question 20

Autoimmune thrombocytopenia in adults or kids is commonly after

Answer 20

Viral infection

Question 21

Severe allergic reaction after blood transfusion

Answer 21

Immunoglobulin A deficiency

Question 22

High hemoglobin A2

Answer 22

B-thalassemia

Question 23

Inv for b-thalassemia

Answer 23

Hb electrophoresis

Question 24

B12 is absorbed by binding to

Answer 24

Intrinsic factor

Question 25

Unlikely to result in AML

Answer 25

Colorectal cancer

Question 26

Myelodisplasia - all blood cells low and RBCs…

Answer 26

Macrocytosis Inv: bmb

Question 27

Why hypogonadism in hemochromatosis

Answer 27

Iron deposition in hypothalamus which decreases production of FSH and LH

Question 28

Anaemia in African people

Answer 28

Thalassemia

Question 29

Goal of Thalassemia treatment

Answer 29

To remove excess iron

Question 30

Pernicious anaemia

Answer 30

A type of B12 anaemia, which is autoimmune Immune system attacks stomach cells that produce intrinsic factor or the intrinsic factor itself, therefore B12 can’t be absorbed

Question 31

Sickle cell anaemia mechanism

Answer 31

Mutation in beta-globin gene RBCs are deformed into a sickle shape Cells rigid and sticky They block small vessels Have shorter lifespan Hemolysis and anaemia