Past paper corrections hematology

Question 1

Child with anaemia, blood film shows spherocytes and DAT+(?)

Answer 1

autoimmune hemolytic anemia

Question 2

Child with anaemia, blood film shows spherocytes and DAT+(?) What is the cause?

Answer 2

autoimmune hemolytic anemia

Question 3

Woman has had 2 children, her blood type is A-. Which naturally occurring IgM antibody would be present? (Repeat)

Question 4

Patient presenting with monocular blindness with extremely high neutrophils (140s) , basophils - what is the diagnosis?

Answer 4

Chronic myeloid leukemia!!

key signs:
-> spleenomegaly!!!
-> vision loss!!!
-> gouty arthritis!!!

Question 5

What coagulation factor falls most rapidly after starting warfarin?

Answer 5

factor 7

Question 6

Infants with sickle cell disease (HbSS) may have splenic sequestration. Why does this not occur before 3 months of age?

Answer 6

HbF

Question 7

Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?

Answer 7

apoptosis

Question 8

75 year old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked panyctopaenia.

Blood film shows numerous large cells of primitive appearance. What is the likely explanation?

Answer 8

Progression to AML

M in AML = myelodyplasia

Question 9

What is the diagnosis, results showed increased IgG lambda but normal kappa lambda ratio, <30g/L -

Answer 9

MGUS!!! (As criteria is)

1.. <10% plasma cells
2. Monoclonal protein spike <30 g/L -> this is IMMUNOGLOBULINS/IgG

3. no CRAB symptoms or organ damage
   * No evidence of other B-cell proliferative disorder

Question 10

Person with aortic stenosis. Has some blood transfusions for some reason, on the second unit of blood immediately develops SOB, 85% O2 Sats, JVP elevated by 3cm.

Answer 10

Transfusion related circulatory overload = symptoms of pulmonary edema/fluid overload. Signs of HF = Increased JVP. increased PCWP

Question 11

What is raised when a cell undergoes haemolysis?-

Answer 11

potassium

Question 12

Man with positive HTLV1 and other bloods and flower cells, what type of cancer? -

Answer 12

Adult T cell lymphoma

Question 13

What drug would be given to a patient with CLL with p53 deletion?

Answer 13

ibrutinib

Question 14

Patient with multiple myeloma, and lights chains >1000. Most likely kidney manifestation?

Answer 14

AL amyloidosis

Question 15

What is the most common site for a thrombotic event?,

Answer 15

deep leg veins

Question 16

Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?.

Answer 16

Fresh frozen plasma as anticoagulant reversal is needed. (cryoprecipitate is only used if fibrinogen is low.). Platelets if abnormal platelet count

Question 17

At what temperature can platelet transfusions be stored?

Answer 17

22 Degrees celsius. Rbcs at 4 degrees.

Question 18

Lady with macrocytic anemia. Became vegetarian 2 years ago. Most likely cause of patients symptoms?

Answer 18

alcohol

Question 19

40 year old with confusion, and difficulty speaking. Had a fever and a headache and bleeding from the gums for 10 days. On examination, kidney function had deteriorated, had become oliguric. Blood film shows thrombocytopenia and shistyocytes, what is the most likely diagnosis?

Answer 19

TTP = triad (thrombocytopenia, MAHA, kidney injury) + fever + neurological symptoms
Contrast to HUS = triad + bloody diarrhea

Question 20

Chronic myeloid leukemia

presentation?

mutation?

Answer 20

high WCC with neutrophila!! And basophilia!!

T(9,22). Philadelphia CreaML cheese.

Question 21

Chronic lymphocytic leukemia

which mutation makes worse?

Answer 21

TP53

Question 22

markers of myeloid cells seen in AML?

Answer 22

CD33, CD13, CD117 = myeloid cells.

mpo+ve

Question 23

Beta thalassemia in a pregnant woman. Most important test to investigate if the future health of fetus is at risk?

Answer 23

chorionic villious sampling

Question 24

21 year old with beta Thalessemia has been receiving blood transfusion for 6 years. No presents with congestive cardiac failure and gonadal failure. Most likely explanation?

Answer 24

iron overload

Question 25

23 year old. Bilateral cervical lymphadenopathy, night sweats and pain on drinking alcohol -

Answer 25

hodkins lymphoma

Question 26

Something about gamma globin chains?

Answer 26

learn hemophilias

Question 27

A patient who is known to have chronic lymphocytic leukaemia presents with sudden worsening of fatigue and is found to have had a fall in Hb. His FBC results are reported below. His blood film shows lymphocytosis, smear cells, spherocytes and polychromatic macrocytes. Which is the most likely cause of

Answer 27

AIHA - CLL

Question 28

In optimal circumstances, for a 70kg male, transfusion of 1unit RBC and 1 unit of platelet gives a predictable increment in the Hb and platelet count. Which statement is correct?

Answer 28

Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L.

Question 29

A 41 year old woman who is 20 weeks pregnant attends a routine antenatal appointment. She has a past medical hx of venous thromboembolic disease in a previous pregnancy. BMI 31. Mx?

Answer 29

low molecular weight heparin

Question 30

Children with Down syndrome have an increased incidence of which type of blood cancer?

Answer 30

Acute leukaemia. Especially AML

Question 31

A 55 year old man is being discharged from hospital on long term anticoagulation with Rivaroxaban a direct acting anticoagulant. Which is the correct approach for routine monitoring of his anticoagulation?

Answer 31

monitoring not required

Question 32

Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question - bilobed nuclei ]. What is the likely diagnosis? -

Answer 32

hodgkin's lymphoma! (dyspnoea and chest pain = mediastinal involvement)

Question 33

Person had an unprovoked DVT, treated with LMWH for 6 months. What long-term DVT prophylaxis should they take? Aspirin, warfarin, DOAC, none needed

Answer 33

LMWH used for DVT prophylaxis also

Question 34

A 30 year old woman with known ITP gives birth to a healthy full term baby. Which is the correct haematological management of the newborn baby?

Answer 34

Check daily FBC for a minimum of five days. if platelets less than 20, give IVIG to baby and gove intracranial ultrasound note: early onset thrombocytopenia eg 1st trimester of pregnancy -> high likely hood of ITP management = IV immunoglobulins, steroids eg azathioprine to increase platelet count

Question 35

what is the leading cause of maternal mortality in the UK

Answer 35

venous thromboembolism

Question 36

give one symptom that will make you add the suffix "B" to hodgkins disease

Answer 36

fever! night sweats!

Question 37

Man has fatigue and back pain. Blood results show - high creatinine, low IgG, low IgM, no paraprotein detected (via electrophoresis) , low serum kappa light chains, high lambda light chains, low kappa/lambda ratio. What is the likely diagnosis?.

Answer 37

Multiple myeloma!! regardless of meeting the other criteria, patient has CRAB symptoms and therefore automatically has MM!!!

Question 38

what is the usual prophylaxis for allograft rejection?

Answer 38

Basaliximab (anti-CD25) alemtuzumab Anti CD52 anti thymocyte globulin

Question 39

The wall of vessels expresses anti-thrombotic factors why is this?

Answer 39

Because it secrete Thrombomodulin - anticoagulant

Question 40

which blood count finding is characteristic of acute lymphoblastic anaemia (ALL)

Answer 40

neutropenia

Question 41

Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause?

Answer 41

post thrombotic syndrome

Question 42

A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?

Answer 42

myelofibrosis

Question 43

An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

Answer 43

– Glucose-6-phosphate dehydrogenase deficiency

Question 44

A man has multiple myeloma, and get amyloidosis. Which type of amyloidosis would it be?

Answer 44

amyloid light chain amyloidosis

Question 45

Woman hurt her back lifting something in the garden. Pain persisted for a week. Some blood abnormalities (low Hb, high Ca, high urea/creatinine? …) What is the best test?

Answer 45

serum protein electrophoresis

Question 46

Transfusion level for platelets after trauma?

Answer 46

10 bn/litre (10 x 10^9 /L) higher threshold of 20 in sepsis For rbcs = 70g/L if asymptomatic, 80g/L if symptomatic