14. Haematology quiz

Question 1

What is a normal WBC?

Answer 1

4.5 to 11.0 × 10^9/L

Question 2

What is a normal Hb?

Answer 2

Men: 130-180 g/L, women: 120-160 g/L. (Pregnant woman: 110 g/L lower limit)

Question 3

What is a normal MCV?

Answer 3

80-100 fl

Question 4

What is a normal platelet count?

Answer 4

150 - 450 × 10^9/L

Question 5

Interpreting FBCs - how could 99% lymphocytes and 1% neutrophils be interpreted as?

Answer 5

Could be due to a massive lymphocytosis or a massive neutropaenia

Question 6

How does anaemia of chronic disease develop?

Answer 6

1. Reduction in red cell life span;
2. cytokine release - IFN-gamma, IL1 and TNF;
3. reduced proliferation of erythroid precursors;
4. suppression of endogenous EPO production;
5. impaired iron utilisation.

Question 7

How do you treat ACD?

Answer 7

Treat the underlying disease; recombinant EPO may be used; transfusion may be considered in severe cases.

Question 8

What can ACD result from?

Answer 8

Anaemia of chronic disease can result from Hodgkin lymphoma

Question 9

What type of anaemia does ACD cause?

Answer 9

It can be normochromic and normocytic but eventually becomes hypochromic and microcytic

Question 10

What would bloods show in ACD?

Answer 10

Inflammatory markers are usually present; ferritin is high or normal; iron and transferrin are reduced

Question 11

At what age does Hodgkin Lymphoma normally present?

Answer 11

Peak in adolescence and > 50 years

Question 12

How does Hodgkin lymphoma present?

Answer 12

Commonly presents with painless supra-diaphragmatic lymphadenopathy. 1/3 will present with B symptoms: fever, night sweats, weight loss (> 10 % in 6 months)

Question 13

What is the aetiology of Hodgkin lymphoma?

Answer 13

Some familial component, associated with HLA DPB1. EBV found in >79% of over 50 years.

Question 14

How do you investigate for Hodgkin lymphoma?

Answer 14

Expert histopathological review of biopsy, ESR useful for prognosis and monitoring, CT/MRI/PET for staging. (Treatment is dependent on the stage of the disease)

Question 15

What is the treatment for

Answer 15

EVERYONE gets ABVD (chemotherapy): adriamycin, bleomycin, vincristine, DTIC (dacarbazine). 2-6 cycles depending on stage. With or without radiotherapy. PET CT will be done during the chemotherapy (after 2 cycles) to assess response to treatment and at the end of treatment to guide the need for radiotherapy. Some patients will present years later with a relapse. They may be treated with high-dose chemotherapy or an autologous stem cell transplant.