HAEM

Question 1

APS blood test results:

Answer 1

Thrombocytopenia
APTT prolonged
Normal PT

Anticardiolipin antibodies
Lupus anticoagulant
Anti-beta2 glycoprotein I

Question 2

Most common inherited bleeding disorder:

Answer 2

VWB disease

Question 3

Drugs triggering haemolysis in G6PD deficiency:

Answer 3

Primaquine
Ciprofloxacin
Sulf- group drugs

Question 4

Parvovirus can trigger aplastic crisis in both:

Answer 4

Sickle-cell disease

Hereditary spherocytosis

Question 5

Metabolic abnormalities observed in tumour lysis syndrome, and what drug is given as prophylaxis during chemo?

Answer 5

Hyperphosphataemia

Hyperkalaemia

Hypocalcaemia

Allopurinol - lower risk groups

Rasburicase - higher risk groups

Question 6

When are platelet transfusion thresholds higher than normal?

Answer 6

<100 x10^9:

Severe bleeding

Intracranial bleeding / critical sites include the CNS

Question 7

RBC transfusion threshold for patients a) without and b) with ACS.

Answer 7

Without = 70

With = 80

Question 8

Blood results in DIC:

Answer 8

PT prolonged
APTT prolonged
Bleeding time prolonged

Platelets low

Fibrin degradation products high
Fibrinogen low

Question 9

Metabolic electrolyte abnormalities are present in tumour lysis syndrome. 1 of which 3 other features is required for a diagnosis of tumour lysis syndrome?

Answer 9

Raised serum creatinine

Cardiac arrhythmia

Seizure

Question 10

What do hypersegmented neutrophils indicate on a blood film?

Answer 10

Megaloblastic anaemia e.g. B12/Folate deficiency most likely

Question 11

Typical characteristics of TTP:

Answer 11

Fever
Altered mental status
Thrombocytopenia
Haemolytic anaemia
Reduced renal function

Hypertension

Over-representation in Black African and Afro-Caribbean populations

Question 12

What should patients be screened for before starting rituximab?

Answer 12

HBV

Rituximab is anti-CD20

Question 13

What should patients be screened for prior to starting infliximab?

Answer 13

TB

Infliximab is anti-TNFa

Question 14

What is screened for prior to commencing natalizumab?

Answer 14

Progressive multifocal leukoencephalopathy

The risk of PML caused by reactivation of the JC virus is greater in these groups.

Nat. is used for treatment of MS and Crohn’s

Question 15

Which condition is associated with tear drop shaped rbcs on blood film?

Answer 15

Myelofibrosis

Bone marrow is fibrosed so the rbc are ‘squeeze out’ to form the tear drop shape