Haem

Question 1

Blood features of Hereditary Spherocytosis

Answer 1

Type of haemolytic anaemia
Can present at any age

Increased unconjug bilirubin
Increased urinary urobilinogen
Increased LDH
Increased reticulocytes
Increased MCHC
Decreased haptoglobin

Question 2

VTE RFs

Answer 2

Surgery
Trauma
Immobility
Malignancy
OCP/HRT
Pregnancy
IBD
Nephrotic syndrome
Obesity
Inherited thrombophilia: FVL, pCS deficiency, Antithrombin deficiency

Question 3

6mo old girl with FTT, anaemia, frontal bossing

Dx and Rx

Answer 3

Cooley’s Anaemia AKA. Beta thalassaemia MAJOR (px in first year of life)

Lifelong transfusion + desferrioxamine

NB. Betathal minor is asymptomatic carrier state
Betathal intermedia has anaemia and moderate splenomegaly

Question 4

Disoder causing bleeds into joints and muscles eg. massive haemarthrosis

Answer 4

Haemophilia

Question 5

In warfarin toxicity, when to give vitamin K?

Answer 5

If minor bleeding present
OR
If INR >8

Question 6

target cells, other names and causes?

Answer 6

codocytes
leptocytes
Mexican hat cells

Thalassaemia
Iron deficiency
Splenectomy
Liver disease

Question 7

Auer rods, Dx?

Answer 7

AML

Question 8

Reed-Sternberg cells, Dx?

Answer 8

Hodgkins lymphoma

Question 9

APL Rx + if pregnant?

Answer 9

Warfarin

If pregnant: Aspirin + LMWH

Question 10

40-60yo
abdo pain
massive splenomegaly
WCC HIGH +/- low Hb/platelets

Dx and Rx

Answer 10

CML
(Ph chromosome t(9:22) in 80%)

Rx:
Chemo (imatinib)
SCT

Question 11

65+yo
w/l
painless LNopathy
lymphocytosis
HSM

Dx and Rx

Answer 11

CLL - often asymptomatic

Rx: no curative option
Chlorambucil
Fludarabine
Monitor if no symptoms

Question 12

Smear cells

Answer 12

CLL

Lymphocytes with ruptured cell membranes

Question 13

Teardrop cells

Answer 13

Myelofibrosis

immature erythroid and myeloid cells also seen

Question 14

Myelofibrosis important complication

Answer 14

10% risk transformation to AML

Question 15

Mycoplasma complications

Answer 15

Cold agglutinin (IgM) haemolytic anaemia
Erythema nodosum
Erythema multiform
Mycocarditis
Meningo-encephalitis

Question 16

Ileal resection + hypersegmented polymorphs

Answer 16

B12 deficiency

folate also causes hypersegmented polymorphs but is instead digested in duodenum and proximal jejunum

Question 17

What is a paraproteinaemia and examples

Answer 17

Presence of immunoglobulins produced by single clone of plasma cells

eg. MM, primary amyloidosis, Waldenstroms macroglobulinaemia, heavy chain disease

Question 18

Definitive Ix for Dx of Amyloidosis

Answer 18

Biopsy of affected tissue
Red congo stain
Red-green birefringence under polarised light microscopy

Question 19

SLE or Hep B - which can cause BM failure?

Answer 19

Hep B

Question 20

Treatment options for Hodgkins

Answer 20

Chemo + radio (no rituximab)

Question 21

Staging system for Lymphoma

Answer 21

Arbor staging:
Stage I: single lymphatic organ/extranodal site
Stage II: two or more regions same side of diaphragm
Stage III: LN involvement both sides of diaphragm
Stage IV: disseminated, with extra nodal site involvement eg. BM, liver

Question 22

Indication and Rx for treating thrombocythaemia

Answer 22

Platelets >1000

Rx:
Low dose Aspirin
Hydroxycarbamide if >60yo or previous thrombosis

Question 23

Definition of hyperviscosity syndrome

Answer 23

When viscosity of blood gets thick enough to impair microcirculation

eg. lethargy, confusion, GI or GU bleed, visual disturbance

Question 24

When to consider PCA in SC crisis

Answer 24

If had two doses strong opioid in 2 hours

NB. Pethidine c/I in SCD

Question 25

High-grade Non Hodgin’s Rx

Answer 25

CHOP:
Cyclophosphamide
Hydroxydaunorubacin
Vincristine
Prednisolone

+/- Rituximab

Question 26

Lead poisoning definitive features

Answer 26

Sideroblasts

High ferritin

Question 27

Curative treatment for CML

Answer 27

Allogeneic BM transplant
ie. first line in younger patients
(NB. Not imatinib)

Question 28

Patient APML
?cytogenetics finding
?Rx

Answer 28

t(15:17)

All trans-retinoic acid

Question 29

CLL - if to treat with one agent, which one?

Answer 29

Chlorambucil - reduces lymphocytes, LN size, improve function

Question 30

Transfusion related complication of Beta Thal Major, and Rx

Answer 30

Splenomegaly, causes increased uptake of RCs ie. become refractory to transfusion

Rx: splenomegaly

Question 31

Endo complications of beta thal, and Rx

Answer 31

1. Pituitary dysfunction -> delayed puberty and development
   Rx: somatotrophin
2. Osteoporosis
   Rx: bisphosphonates

Question 32

Heinz body

Answer 32

G6PD deficiency

Question 33

G6PD diagnostic test

Answer 33

Beutler fluorescent spot

Question 34

Blood tests suggesting parasitic infection

Answer 34

Eosinophilia

Question 35

Lymphopaenia causes

Answer 35

AIDS
Steroids
Chemo
Radio
Malignancy
Renal failure
Liver failure
Sarcoidosis

Question 36

Investigation for plasma viscosity

Answer 36

ESR

Question 37

Thalassaemia patient with vomiting, abdo pain, polydipsia, hyperglycaemia

Answer 37

Iron overload

deposition into pancreas, heart, liver, pituitary

Question 38

Causes and Rx of aplastic anaemia

Answer 38

Radio 
Chemo
AI
Drugs:
-chloramphenicol
-carbamazapine
-phenytoin
-quinine

Rx: antithymocyte globulin

Question 39

PCV Rx

Answer 39

Asymptomatic:
-Venesection

Immunosuppression/Cytotoxic IF:
Symptomatic +/- organomegaly

Splenectomy if symptoms severe, as last resort

Question 40

Asymptomatic with ET

Answer 40

Surveillance
Aspirin ONLY if evidence of vascular occlusion

(plasmapheresis used for urgent reduction of platelets)

Question 41

AI thrombocytopenia Rx to reduce risk of splenectomy

Answer 41

Rituximab
Only given if condition severe enough

(NB. No role for steroids of Igs)

Question 42

Aggressive NHL Rx

Answer 42

Options include: 
biologics
radio
chemo
BMT

If aggressive and young patient, eg. with b symptoms, best option for remission is BMT

Question 43

Common blood disease in Mediterranean?

Answer 43

Thalassaemia