DAT haem

Question 1

what is hematopoiesis

Answer 1

formation of blood cellular componenets - occurs through yolk sac and then the liver - bone marrow taken over by birth

Question 2

multipotential haemoatopoietic stem cell differentiates into

Answer 2

common myeloid and common lymphoid

Question 3

common myeloid gives rise too

Answer 3

megakaryocyts , erythrocytes , mast cells and myelobasts

myeloid side - RBC and wbc in innate immune system

Question 4

myeloblasts diff into

Answer 4

granulocytes - baso , neutrophil, eosinophils and monocytes ( macrophages)

Question 5

common lymphoid progenitors give rise to

Answer 5

natural killer cells( innate) T and B lymphoctes ( adpative)

Question 6

difference between innate and adaptive immunity

Answer 6

Innate immunity is the body’s first line of defence against pathogens. It is general and non-specific, which means it does not differentiate between types of pathogens. Adaptive immunity is a type of immunity that is built up as we are exposed to diseases or get vaccinated

Question 7

blast vs cyte

Answer 7

blasts are immautre and tend to be much larger than when they are mature - cytes

Question 8

sx in blood cancer

Answer 8

B symptoms (or “constitutional symptoms”) - immune stimulation,
occurs more commonly in the lymphoid types
* Fever
* Weight loss >10% in 6 months
* Night sweats (drenching)
* Itching
* Bone marrow infiltration / crowding
* Bruising and bleeding (thrombocytopenia)
* Pallor, shortness of breath, fatigue (anaemia)
* Infections (leukopenia)
* Infiltration / tumour effect
* Lymphadenopathy
* Hepatosplenomegaly
* **blood - precursors, red cells, white cells, platelets, immunoglobulins

Question 10

CML - t(9:22) phildeelpha BCR-ABL fusion gene - produces tyrosine kianse driving abnormal prolif and affects myeloid cells
3 phases what are they

Answer 10

chronic - raised WCC
agrresive - systemic sx
blast phase - over 20% of blast cells in blood

ix show

FBC hb normal or low, raised WBC , platelets normla low or high
blood film neutropenia
bone marrow aspiration shows increased cellulairty

Question 10

AML - 1
children - acute proliferation of a single type of lymphocyte - usually B - excessive accumualtion of these cell in bone marrow causes infiltration and leads to

Answer 10

pancytopenia

Question 10

CLL - 3
slow proliferation of a single type of well differentiated lymphocyte - usually B
adults over 60

presents how

Answer 10

frequent infections, anaemia, bleeding adn WL
painless cervical, axillary or groin lymphadenopathy and hepatosplenomegaly

Question 10

IX in CLL show what

Answer 10

raised WCC , Hb normal or low , plateletes will be normal or low
immunoglobulins could be low
blood film - shows high percentage of lymphocytes, smear or smudge cells as WBC are fragile so rupture
bone marrow - heavily infiltrated with lymphocytes

Question 11

rare sign in boys with AML

Answer 11

testicular enlargement

Question 12

IX all show what

Answer 12

low Hb
raised WCC
low platelets

large blast cells on blood film
reducede erythropoeisis and reduced margakayroctes

CXR - t lymphoblastic leukaemia there may be mediastinal widening

Question 13

AML - present any age usualyl later
can result from transformation of a meyloproliferative disorder
clonal expansion of immature blast cells

rare to have lymphadenopathy

Answer 13

ix

low HB
raised WBC but low neutorphils
lo platelets
auer rods

Question 14

myeloma why do you get hper ca , renal impaire, anemai and bone lesion

Answer 14

primarily due to increased bone resorption
light chain depositon in renal tubules
bone marrow crowding
bone marrow infiltration creates lytic bone lesions

Question 15

mx of myeloma

Answer 15

chemotherapy + VTE prophylaxis

stem cell treatment

Question 16

A 26 year old female comes into clinic. For the last few weeks she has
been experiencing fevers, night sweats and feels she is losing weight.
When you examine her she has enlarged, rubbery cervical lymph nodes.
What investigations should you do?
What are your differential diagnoses?

Answer 16

suspecting lymphoma

Question 17

hodgkin features

Answer 17

20s or 70s
monucelosis infection

enalrgeed rubbery LN
enalrgeed spleen and liver
b sx
puritis fatigeu, anoeeia alcohol induced

Question 18

bloods in hodgkins show what

Answer 18

normocystic anaemia
lymphocytopenia
esoinophilia
raised ESR
GGT adn ALP and LDH raise

need biopsy for deifntiive
CT involvemnt
ann arbour

Question 19

non hodgkins is what
55-75 associated with EBV

Answer 19

Malignant tumours of the lymphoid tissue, that do not contain Reed-Sternberg cells.
70% B cell origin, 30% T cell origin
NHL refers to a wide range of conditions including MALT and Burkitt lymphoma.

Question 20

sx non hodgkins

Answer 20

painless superficial lymphadenopathy
b sx
pancytopenai infections and brusiing
comrpession sx

Question 21

ix do all for HL plus
bone marro aspiration adn trephine
immunophenotyping differntiate btween B and t tumours
measure uric acid - high lead to renal failure
immunoglobulin test
HIV test

Question 22

A 77-year-old man is being followed up in the haematology clinic after being
diagnosed with non-Hodgkin’s lymphoma. He initially presented to his general
practitioner with a painless, rapidly enlarging cervical mass. An excisional node biopsy
revealed a ‘starry sky’ pattern. He has commenced chemotherapy with
cyclophosphamide, doxorubicin, vincristine, and prednisolone. The specialist wants to
co-prescribe a medication that has been demonstrated to improve outcomes in
patients with this diagnosis.
What should be prescribed?

Bezlotoxumab
B. Denosumab
C. Infliximab
D. Interferon-alpha
E. Rituximab

Answer 22

E - Rituximab should be prescribed alongside CHOP chemotherapy
regimen

Question 23

2. A 10-year-old boy is brought to the general practitioner by his mother. She is
   concerned that he is not quite himself at the moment. She thinks he is looking paler
   than usual and over the last few weeks, he has been much more tired than usual
   despite no change in his daily routine. She says that he has also had several coughs
   and colds in the last month which is unusual for him. His vital signs are all normal and
   on examination, you note some pallor but no other abnormalities. What should be the
   next step to investigate this patient?
   A. Routine FBCs within 2 weeks
   B. FBC to be performed within 48 hours
   C. Bone marrow biopsy to be performed within 48 hours
   D. Lymph node biopsy within 2 weeks
   E. Bone marrow biopsy within 2 weeks

Answer 23

B - This child should be offered a FBC within 48 hours to assess for
leukaemia

Question 24

A 75-year-old lady presents with worsening fatigue, weight loss, and night
sweats over the past two months. She has also noticed some lumps in her right
groin, which seem to be enlarging and spreading although they do not hurt.
A lymph node biopsy shows large multinucleate cells with prominent eosinophilic
nucleoli.
What is the most likely diagnosis?
A. Burkitt lymphoma
B. Sarcoidosis
C. Chronic lymphocytic lymphoma
D. Hodgkin’s lymphoma
E. Tuberculosis

Answer 24

D - Hodgkin lymphoma, the findings of large multinucleate cells with
prominent eosinophilic nucleoli are Reed-Sternberg cells

Question 25

A 68-year-old male presents to his GP having noticed enlarge lymph nodes in
neck, axillae and groin. Blood tests show:
A blood film shows that 60% of the white cells are small mature lymphocytes.
What is the most likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Hodgkin’s lymphoma
C. Chronic lymphocytic leukaemia
D. Non-Hodgkin’s lymphoma
E. Chronic myeloid leukaemia

Answer 25

C - these findings are consistent with chronic lymphocytic leukaemia

Question 26

A 65-year-old woman presents to her GP complaining of a constant sense of
fullness. She is currently eating a third of her normal portion before having to stop
due to the feeling.
On examination, the patient looks alert and comfortable. The heart sounds are
normal and vesicular sounds are heard over the lung fields. There is increased
dullness in the left hypochondrium extending to the umbilicus. Her blood tests
show the following:
Hb
98 g/L
(115 - 160)
Platelets
456 * 10 9/L
(150 - 400)
WBC
30.3 * 10 9/L
(4.0 - 11.0)
Neuts
26.1 * 10 9/L
(2.0 - 7.0)
Lymphs
3.0 * 10 9/L
(1.0 - 3.5)
Mono
0.8 * 10 9/L
(0.2 - 0.8)
Eosin
0.4 * 10 9/L
(0.0 - 0.4)
What is the most likely diagnosis?
A. Acute lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Leukemoid reaction

Answer 26

D - these blood results - anaemia, thrombocytosis, raised WCC and
raised neutrophils point towards chronic myeloid leukaemia

Question 27

how can COPD lead to polycythaemia

Answer 27

It is important to remember that most abnormal blood results are reactive. It is first essential to differentiate between a true and relative polycythaemia. A true polycythaemia can be primary (e.g. myeloproliferative disorder) or secondary (reactive). Dehydration and diuretics can cause a relative polycythaemia (pseudopolycythaemia) where there is relatively low plasma volume to red cell mass ratio. Red cell mass and plasma volume studies are helpful to demonstrate a relative polycythaemia.

The patient in this example has risk factors for secondary polycythaemia including COPD and smoking. Impaired oxygen exchange in the lungs can result in a low PaO2 which results in stimulation of EPO release from the kidneys. EPO stimulates erythropoiesis and increases red cell mass, thereby resulting in polycythaemia. The low SpO2 is highly suggestive of a hypoxic driven polycythaemia. Therefore the most likely answer is COPD.

Question 28

A sudden anemia and a low reticulocute count indicates in sickle cell ….

Answer 28

parovirus

Acute sequestration and haemolysis causes a high reticulocyte count.