GM: Haematology

Question 1

What causes a normocytic anaemia?

Answer 1

Anaemia without altered RBC structure

Anaemia of chronic disease

Acute blood loss

Aplastic anaemia

Haemolytic anaemia

Question 2

What are the causes of microcytic anaemia

Answer 2

Thalassaemia: AR defects of haem chains

Anaemic of chronic disease

Iron deficency:can also be normocytic

Lead poisoning: blocks heme synthesising enzymes

Sideroblastic: Iron wont fit into RBCs

Question 3

How do you investigate iron deficiency anaemia?

Answer 3

FBCs showing low Hb, can confirm if low ferritin

Question 4

What is the initial management of iron deficiency anaemia?

Answer 4

1. oral iron

+ IV iron or blood transfusion

Question 5

For anaemia, when do you refer to…

Haematology

Answer 5

Supplementation fails to increase by 20g/L over 2-4 weeks and no GI or Gynae criteria

Question 6

Paraesthesia, changes to mood and vision+/- mild jaundice suggests which anaemia?

Answer 6

B12 deficiency

Question 7

What investigations suggest B12 deficiency

Answer 7

Macrocytic anaemia

Hypersegmented polymorphs

Low cobalamin is B12, low folate is folate

Question 8

How do you treat B12 deficiency?

Answer 8

No neuro: IM hydroxycobalamin 3x day 2 weeks; 1 per 3 months afterwards

Neuro: IM 1mg every other day until improves

TREAT B12 BEFORE FOLATE

give folic acid 5mg day 4 months

Question 9

When do you refer a vit B12 deficiency to…

Haem

Gastro

Answer 9

Haem: Uncertain, malignancy, resistant to treatment

Gastro: IBD, malabsorption, GI malignancy

Question 10

How doe sickle cell present on…

FBC

Blood film

Answer 10

Microcytic anaemia

Sickle cells, howell-Jolly bodies

Question 11

Outline the inheritance of sickle cell anaemia

Answer 11

AR inheritance of HbS instead of A.

One gene casues trait

Two causes disease

Question 12

Compare vaso-occlusive, splenic sequestration, aplastic crisis and acute chest syndrome in terms of…

Pain

Associated symptoms

Lab findings

Answer 12

VOC // SS // AC // ACS

Localised pain // abdo pain // painless // painless

Fever, priapism // HSM, hypotension // infective Hx // Resp symptoms

Raised Hc // Severe anaemia // severe anaemia // Infiltrates on X-ray

Question 13

How do you treat sickle cell crises?

Answer 13

Admit

Treat infection

IV fluids

Keep warm

Analgesia

Aspirate if priapism

Question 14

What prophylaxis is given to sickle cell patients

Answer 14

Penicillin 3m-5yrs

PPV23 every 5 years

MenB + ACWY then another MenB 4 weeks later

Question 15

What patient features might point towards thalassaemia?

Answer 15

Pronounced forehead and jaw

Jaundice, gallstone, splenomegaly

Question 16

How do you diagnose thalassaemia?

Answer 16

Haem electrophoresis

DNA testing

Question 17

How do you treat thalassaemia that is

alpha

Beta…

minor

intermedia

major

Answer 17

Alpha: monitor. Transfusions and bone marrow transplant potentially.

Bm: Conservative

BI: monitor + transfuse

BM: regular transfusion, chelation and splenectomy. Bone transplant can be curative

Question 18

Anaemia + gallstones + large spleen

Blood film…

Diagnose and treat

Answer 18

Hereditary spherocytosis

Folate supplementation + splenectomy

Question 19

Patient with PMHx of infections + jaundice after eating beans

Answer 19

G6PD deficiency

Heinz enzyme assay to confirm

Avoid triggers

Question 20

What are the features of leukaemia?

Answer 20

Abnormal bruising

Splenomegaly, lymphadenopathy

Palness, fever, fatigue

Question 21

Where suspected, what are the 1st line and GS test in leukaemia?

Answer 21

1st: <48hr FBC

GS: Bone marrow biopsy

+ blood film biopsy

Question 22

How are the leukaemias distributed by age?

Answer 22

ALL CLLmates have CMMon AMbitions

ALL: <5s, >45s

CLL: Over 55

CML: Over 65

AML: Over 75

Question 23

How can ALL, CLL, AML and CML be differentiate based on

Clinical history

Blood results

Answer 23

ALL: Children, Down’s syndrome, Blast cells (left)

CLL: Most common in adults, Smudge cells (right

AML: Myeloproliferative, Auer rods (middle)

CML: Raised WCC/low Hb, plts, pancyto

Question 24

How do you treat leukaemia?

Answer 24

Chemo and steroids

Question 25

What are the general features of a lymphoma?

Answer 25

Painless, assymetrical lymphadenopathy

+ systemic B symptoms

Question 26

How do NHL and HL differ on…

Age

Symptoms

Cells

Associations

Answer 26

NHL // HL

>75s // 20s, 70s

Early B symptoms, extra-nodal disease // painful nodes on alcohol

Depends on subtype // Reed sternberg cells

Question 27

How is Lymphoma confirmed?

Answer 27

Lymph node biopsy

+CT/MRI/PET

Question 28

What is myeloma and its subgroups

Answer 28

Plasma cell malignancy resulting in excess antibody production

MGUS: Raised antibodies without specific infection

Multiple myeloma: affected multiple sites

Smouldering: MGUS progression with higher Ig levels; waldenstrom’s if specifically IgM raised

Question 29

>60s presents with bone pain.

Bloods show rasied calcium, total protein and renal impairment

What is the diagnosis

Answer 29

myeloma

Question 30

What investigations are performed in suspected myeloma?

Answer 30

Monoclonal IgM or IgA in serum and urine (BJ proteins)

Increased plasma cells on bone marrow biopsy

Whole body MRI for bone lesions

+ ‘tear-drop skull’ on X-ray

Question 31

B symptoms + splenomegaly + the following bloods indicate what?

Raised Hb

Raised platelets

Low Hb, abnormal platelets + WCC, teardrop RBCs

Answer 31

Myeloproliferative disorders

Polycythaemia vera

Essential thrombocytopaenia

Myelofibrosis

Question 32

How do you treat…

Polycythaemia vera

Essential thrombocytopaenia

MF

Answer 32

PC: Venesection, chemo

ET: chemo

MF: Chemo + stem cell transplant

Question 33

How do you stage Hodgkin’s lymphoma?

Answer 33

Ann-Arbor staging

I: Single lymph node

II: 2 or more nodes/regions on same diaphragm side

III: Nodes on both sides of diaphragm

IV: Spread beyond lymph nodes

+ A: Pruritis only

B: >10% weight loss, fever >38 degrees, night sweats

Question 34

What are the diagnostic criteria for myeloma

Answer 34

Factor: Major // minor

Imaging: Plasmacytoma // osteolytic lesions

Plasma cells: 30% // 10-30%

M protein: Elevated // minor elevations

+ low antibody levels for minor

NEED 1 MAJOR + 1 MINOR / 3 MINOR

Question 35

What are the subtypes of non-hodgkin’s lymphoma and their associations?

Answer 35

Burkitt’s: EBV, tumour lysis, ‘starry sky’ histology

MALT: H. pylori, perigastric tissue

Diffuse B cell: rapidly growing painless mass in >65yrs

Question 36

Muscle cramps in a NHL patient just starting chemo suggests what and how is it prevented?

Answer 36

Tumour lysis syndrome in burkitt’s lymphoma

Give rasburicase to prevent uric acid –> allantoin

Allopurinol is alternative

Question 37

Infant experiencing painful swelling in hands and feet in absence of other pathology suggests what?

Answer 37

Thrombotic crises

Question 38

How can you distinguish ITP, TTP and DIC in terms of…

Symptoms

Labs

Cells

Answer 38

ITP // TTP // DIC

Bleeding // ‘The Terrible Pentad’* // Bleeding, sepsis

high bleed time // high bleed, low platelets // high bleed, low platelets + D-dimer

none // schistocytes // schistocytes

Question 39

Polycythaemia rubra vera is most likely to convert into which cancer?

Answer 39

AML or myelofibrosis

Question 40

What test confirms the diagnosis if spherocytes are found on blood film?

Answer 40

DIRECT coomb’s test

confirms diagnosis of haemolytic anaemia