Haem exam pearls

Question 1

What would make you think acute over chronic leukaemia when looking at a high white cell count?

Answer 1

Short history
Less splenomegaly/lymphadenopathy
signs of marrow failure
gum infiltration (AML)
DIC (APML)

Question 2

What would make you think chronic leukaemia over acute when looking at a high WCC?

Answer 2

Long history
Splenomegaly +++
Lymphadenopathy +++
Often no marrow failure
Clue= smear cells CLL
Left shift or high platelets CML
Persistent monocytosis CMML

Question 3

High white count and high platelets or left shift suggests

Answer 3

CML

Question 4

Smear cell and high white count

Answer 4

CLL

Question 5

Monocytosis and high white cells

Answer 5

CMML

Question 6

Gene defect in APML

Answer 6

t(15;17)

PML-RARAalpha

Question 7

Treatment for APML

Answer 7

ATRA
idarubacin
arsenic

Question 8

How do the second and third generation TK inhibitors (dasatinib and nilotinib) compare with imatinib

Answer 8

quicker response in front line therapy
no longer term evidence
less tolerable than imatinib

Question 9

JAK 2 - in what proportion of PRV, ET, MF patients?

Answer 9

ET 50%
MF 50%
PRV over 99%

Question 10

TRUE OR FALSE- JAK2 is often lost on transformation from myeloproliferative disorder to acute leukaemia

Answer 10

true

Question 11

What is the JAK2 gene defect called

Answer 11

single acquired V617F mutation in JAK2

Question 12

What causes gingival hyperplasia

Answer 12

phenytoin
cyclosporin
ca channel blockers
AML