Haem - Bain quiz cases

Question 1

Rheumatoid arthritis = associated haem abnormalities?

Answer 1

• Anaemia of Chronic Disease
• IDA - due to aspirin and NSAID use
• neutropenia + thrombocytopenia from drug toxicity
• Felty syndrome
• increased ESR

Question 2

10yo girl with painful R knee after it was knocked in swimming pool
Afebrile
Raised ESR + CRP
X-ray showed changes on medial tibial plateau.

Most likely out of: septic arthritis/haemophilia/osteomyelitis/thrombocytopenia?

Answer 2

OSTEOMYELITIS - due to mild trauma and x-ray changes

Haemophilia unlikely in girl
Septic arthritis - would be febrile, with raised WCC and wouldn’t have these x-ray changes

Question 3

1 year old boy with swollen right elbow following mild trauma. Normal x-ray and bloods.
3 days later = increased pain and swelling + haemorrhage fluid on joint aspiration.
4 weeks later = dark blood found on surgery and biopsy showed synovitis.
Wound bled persistently.

What test would you do?

Answer 3

A coagulation screen !!

Normal PTT
and prolonged APTT

Question 4

Differentials for a child with a single swollen joint + bruising + effusion after trauma?

Answer 4

Haemophilia
Osteomyelitis
NAI

Question 5

21yo woman. Abdo pain, brushing, altered level of consciousness.
Low grade fever
V low platelets
Br ++, LDH +++
Cr +

RBC fragments

what is the Dx? : ITP/Hereditary spherocytosis/infectious hepatits/meningococcal meningitis/TTP

Answer 5

TTP

Why? MAHA + thrombocytopenia + fever + neuro and renal impairment

Question 6

Underlying defect in TTP?

Answer 6

Deficiency of vWF cleaving protease –> high levels of vWF –> many platelet thrombi

Question 7

In TTP - how do treat them?

Do you treat with platelets? Do you give steroids?

Answer 7

PLASMA EXCHANGE

do NOT give platelet transfusions or steroids

Question 8

5 features of TTP

Answer 8

MAHA
Low platelets
Fever
Neuro impairment
Renal impairment

Question 9

20yo man
fever, sore throat, malaise, SOB, abdo pain
10/7 ago he fell on left side and attended A&E with pain in left chest wall - had normal CXR

Now, he has fever + tachycardia + lymphadenopathy + inflamed pharynx + mild hepatosplenomegaly + tender abdomen.
Increased lymphocytes + anaemia.

What test would you do? How do you manage him?

Answer 9

Screen for infectious mononucleosis

Suspect splenic damage + intraperitoneal haemorrhage, therefore do urgent abdoUSS

Question 10

What are the risks of hyposplenism? Therefore how do we manage it?

Answer 10

Bacterial sepsis
- Vaccinate for pneumococcus + meningococcus + Hib
- Prescribe life long penicillin
Fatal malaria
- Advise on malaria zones

• Issue a splenectomy card + info sheet

Question 11

63yo man
Microcytic anemia
known GORD + rectal bleeding
Normal colonoscopy

1 yr later, had worsening aenmia, weight loss, cervical lymph node felt + later disappeared.

Ferritin was normal and CRP was v high

PMH: splenomegaly for 30 years, IHD, renal colic, gout, chronic cough, GORD

Ddx? give 3

Answer 11

Alpha thalassemia
Sideroblastic anemia
ACD

Question 12

Pathophysiology of anaemia of chronic disease

Answer 12

Reduced RBC lifespan
Reduced proliferation of erythroid precursors
Suppressions of EPO
Impaired iron utilisation
Cytokine release

Question 13

Tx of anaemia of chronic disease

Answer 13

Treat the cause

Consider giving EPO + transfusion

Question 14

Smear cells

Answer 14

CLL

Question 15

Give 3 Ddx for a 58 yo man with:

Hb+, RBC+, Hct+. Normal platelets

Answer 15

polycythemia secondary to hypoxia/malignancy

Psuedopolycythemia (reduced plasma volume

PRV

Question 16

67yo woman with:
Neutrophils +
Basophils +
Hb +
Platelets +

What investigations would you order? Ddx?

Answer 16

Blood film + bone marrow aspirate

Myeloproliferative disorder
no immature cells in circulation, high levels of everything

Question 17

64 year old woman w splenomegaly
High WCC
high lymphocytes
High myelocytes
high basophils

likely Dx?

Answer 17

CML

Question 18

Causes of gangrene

Answer 18

Vessel abnormality:
Atherosclerosis

Blood abnormality: myeloproliferative disease

Question 19

In children, what is the most common coagulation abnormality which leads to bruising + pallor?

Answer 19

Haemophilia A

Question 20

Which 2 causes of thrombocytopenia can cause bruising + pallor in a baby?

Answer 20

ITP

ALL

Question 21

Elongated RBCs

Answer 21

IDA

Question 22

Felty syndrome

Answer 22

Rheumatoid arthritis
Neutropenia
Splenomegaly