Haem

Question 1

Polycythaemia management

Answer 1

Venesection/phlebotomy (1st line)
Aspirin
Chemotherapy

Question 2

Management for autoimmune haemolytic anaemias?

Answer 2

Steroids +/- rituximab

Question 3

Management for hereditary spherocytosis/elliptocytosis

Answer 3

Folic acid supplement
Splenectomy before 5 is curative

Acute:
Transfusion

Question 4

What is seen on the blood film for autoimmune haemolytic anaemia?

Answer 4

Spherocytes
Reticulocytes
Normocytic

Question 5

Investigations, including blood film for G6PD deficiency

Answer 5

G6PD enzyme assay dignostic

Heinz bodies
Bite and blister cells

Question 6

Investigations for hereditary spherocytosis/elliptocytosis

Answer 6

Spherocytes on blood film
Mean corpuscular haemoglobin concentration high
EMA binding

Question 7

What are the laboratory investigations for DIC?

Answer 7

Decreased platelet
Prolonged PT (APTT sometimes)
Decreased fibrinogen
Increased fibrin degradation products
Decreased factors 5, 8, 10, 13

Question 8

What is seen on a blood film for a DIC patient and why

Answer 8

Schistocytes due to microangiopathic haemolytic anaemia

Question 9

Auer rod cells are associated with what?

Answer 9

Acute myeloid leukaemia

Question 10

What is associated with smear/smudge cells

Answer 10

Chronic lymphoid leukaemia

Question 11

Which leukaemia can progress to lymphoma

Answer 11

CLL

Question 12

Which cancer causes symmetrical painless lymphadenopathy?

Answer 12

CLL

Question 13

What is associated with tear drop poikilocytes?

Answer 13

Myelofibrosis

Question 14

Which sickle cell crisis causes a decrease in reticulocytes

Answer 14

Aplastic crisis

Question 15

Which sickle cell crisis causes increased reticulocytes

Answer 15

Splenic sequestrian

Question 16

Difference between CML and AML in terms of WBCs?

Answer 16

WBC count in CML is massively raised (if >100 it’s cml)

AML has a somewhat raised WBC
CML has granulocytosis with all stages of maturation seen whilst AML has low % granulocytes and high -blasts

Question 17

Management for CML

Answer 17

Imatinib (tyrosine kinase inhibitor)

Question 18

What is seen on blood film in alpha thalassemia?

Answer 18

Heinz bodies

Target cells in HbH disease too

Question 19

What are the 3 types of alpha thalassemia and how do they present

Answer 19

1/2 alpha globulin affected:
- hypochromic microcytic RBCs
- normal Hb and usually asymptomatic

3 alpha globulins (HbH DISEASE):
- hypochromic microcytic anaemia with splenomegaly
- jaundice, fatigue, SOB, facial bone deformities

4 alpha globulins:
- death in utero

Question 20

Anaemia of chronic disease compared to IDA:
Serum iron, TIBC, ferritin

Answer 20

Serum iron: low
Ferritin: high/normal
TIBC: low/normal

IDA
Serum iron: low
Ferritin: low
TIBC: high

Question 21

Which blood cancer is massive splenomegaly associated with?

Answer 21

CML

Question 22

What blood cancer causes swollen gums and mild splenomegaly

Answer 22

AML

Question 23

Management for vaso-occlusive crisis (including acute chest syndrome) of sickle cell

Answer 23

Analgesia (paracetamol, ibuprofen)
O2 if hypoxic
IV fluids
Transfusion if life-threatening or symptomatic anaemia

In acute chest syndrome:
- O2 is first with incentive spirometry
- paracetamol
- Broad spec AB (pneumonia never ruled out)
- Transfusion

Question 24

DIC management

Answer 24

Treat underlying
FFP if high bleeding risk/active bleeding

Chronic:
- heparin for thrombosis signs
- anti fibrinolytic agents (tranexamic acid) for hyperfibrinolysis