Haem

Question 1

Autoimmune haemolytic anaemia

Answer 1

Steroid- prednisolone 1mg/kg of prednisolone daily

Folic acid

Question 2

B than major

Answer 2

Regular transfusion programme to maintain Hb 95-105

Question 3

Iron overload

Answer 3

250mg of iron per unit of red cells
Chronic anaemia drives increased iron absorption
NOT VENESECTION (already anaemic)
Iron chelation e.g. desferrioxamine

Question 4

Sickle crisis

Answer 4

Opiate analgesia
Hydration, rest, oxygen
Antibiotics (if infection)
Red cell exchange transfusion is severe

Question 5

Long term management of sickling disorder

Answer 5

Hyposplenism- prophylactic penicillin, vaccination
Folic acid supplements
Hydroxycarbamide (increased HbF production)

Question 6

Haemophilia

Answer 6

Infusions of missing factor

The infusions last for 2 days (major complication of the infusion is the formation of autoantibodies)

Question 7

Hypersensitivity reaction

Answer 7

Lie patient flat
Administer adrenaline
Administer chlorampheniramine
Administer salbutamol
Adminsiter corticosteroids

Question 8

Incompatible blood type

Answer 8

Exclude major transfusion reaction
Ensure the patients details matched the blood being transfused
Slow the transfusion
Give paracetamol
Instruct nurses to watch the patient closely

Question 9

Fluid overload

Answer 9

Furosemide to encourage a diuresis and reduce hydrostatic pressure

Question 10

Venous thrombosis

Answer 10

Heparin/Warfarin/NOACs (anticoagulation)

Question 11

Arterial thrombosis

Answer 11

Aspirin and other antiplatelets

Modify RF for atherosclerosis

Question 12

Hereditary thrombolphilias

Answer 12

Avoid risk
Short term prophylaxis
Short term anticoagulant- to prevent thrombotic effect
Long term anticoagulation

Question 13

Antiphospholipid antibody syndrome

Answer 13

Aspirin and Warfarin

Question 14

HUS

Answer 14

Dialysis for AKI

Plasma exchange for severe persistent cases

Question 15

ITP

Answer 15

Prednisolone mainstay

Question 16

Acute leukaemia

Answer 16

Multi-agent chemotherapy

Question 17

Pancytopenia

Answer 17

Treat neutropenic fever promptly without waiting for microbiology results
Primary- Chemotherapy, bone marrow transplant or immunosuppression depending on cause
Secondary- Stop drugs, treat virus, replace b12/folate or red cell transfusion
Consider splenectomy

Question 18

Myeloma

Answer 18

Combination chemotherapy (high dose corticosteroids + alkylating agents)
High dose chemo/autologous stem cell transplant
If cast nephropathy then hydration and stop neophrotoxic drugs
Relapse in inevitable

Question 19

AL amyloidosis

Answer 19

Chemo

Question 20

Waldenstroms macroglobinaemia (IgM paraprotein)

Answer 20

Chemotherapy

Plasmapheresis

Question 21

Chronic myeloid leukaemia

Answer 21

Imatinab

Question 22

Polycythaemia rubra vera

Answer 22

Take out all of patient blood–> Get the HCT level down to 0.45–> Put it all back in
Give aspirin
Give cytotoxic oral chemo e.g. hydroxycarbomide

Question 23

Essential thrombocytopenia

Answer 23

Aspirin

Cytoreduction therapy to control proliferation –> hydroxycarbamide, anagrelide, INF alpha

Question 24

Myelofibrosis

Answer 24

Supportive care- blood transfusion, antibiotics, platelets
Allogenic stem cells transplantation in selected patients (curative but high mortality)
Splenectomy
JAK2 inhibits