Haem - haemolytic anaemia + anaemia generally

Question 1

Causes of extravascular haemolytic anaemia?

Answer 1

Autoimmune causes + hereditary spherocytosis

Question 2

Features of intravascular haemolytic anaemia?

Answer 2

Dark red urine (haemoglobinuria)
Low haptoglobin (binds free Hb)

Question 3

Inherited causes of haemolytic anaemia

Answer 3

Membrane: spherocytosis, elliptocytosis
Enzyme: G6PD, pyruvate kinase deficiency
Hb: sickle cell, thalassemia

Question 4

Acquired causes of haemolytic anaemia

Answer 4

Immune or non-immune
Immune: Autoimmune(hot or cold) or alloimmune
Non-immune: malaria, MECHANICAL, PNH, MAHA

Question 5

Which test should be done to determine if haemolytic anaemia is immune or non-immune?

Answer 5

DAT test

Question 6

Warm autoimmune haemolytic anaemia.

List 5 causes?

Answer 6

Idiopathic - most common
Lymphoma
CLL
SLE
methyldopa

Question 7

3 point plan re management of warm autoimmune haemolytic anaemia?

Answer 7

Steroids
Splenectomy
Immunosuppression

Question 8

Which Ig class is implicated in warm AIHA? and in cold AIHA?

Answer 8

Warm = IgG
Cold = IgM

Question 9

4 causes of cold agglutinin disease?

Answer 9

Idiopathic
Lymphoma
Mycoplasma
EBV

Question 10

Which chemotherapy drug is used for cold agglutinin disease?

Answer 10

Chlorambucil

Question 11

Management of PNH - 3 marks

Answer 11

1) Iron/folate supplements
2) Monoclonal Abs against complement
3) Prophylactic vaccines/Abx

Question 12

MAHA - 4 causes?

Answer 12

HUS
TTP
DIC
Preeclampsia

Question 13

Cause of HUS? How does MAHA develop?

Answer 13

E. Coli –> toxin damages endothelial cells

Fibrin mesh forms –> mechanical damage of RBCs!

Question 14

Classical 5 features of TTP?

Answer 14

MAHA
Fever
renal failure
Low plts
Neuro abnormalities!!!! - not seen in HUS

Question 15

3 features of HUS?

Answer 15

Haemolysis
Renal failure/uraemia
Thrombocytopenia

Question 16

How are HUS and TTP linked

Answer 16

anyone with TTP has HUS (all 3 features of HUS + fever + neuro sx = TTP)

Question 17

TTP vs HUS - which one is more likely in children?

Answer 17

HUS

Question 18

How can one distinguish between DIC and TTP?

Answer 18

DIC has prolonged APTT and PT

Question 19

Paroxysmal nocturnal haemoglobinuria - key features?

Answer 19

Haemoglobinuria in the morning

• low haptoglobin
• high free serum Hb
• high LDH

Question 20

What should you look for to diagnose a patient with heparin induced thrombocytopenia?

Answer 20

Heparin use lol

• Low platelets lol
• haemolysis
• renal failure/uraemia

i.e. Heparin + HUS

Question 21

7 features of DIC

Answer 21

Haemolysis
Low platelets
Renal failure/uraemia
Neuro changes
Fever
Prolonged APTT
prolonged PT

Question 22

Abnormal RBCs seen in a crisis of a pt with G6PD deficiency

Answer 22

Heinz bodies

Question 23

3 egs of when you may see pencil cells in a blood film

Answer 23

IDA
thalassemia
Pyruvate kinase deficiency

Question 24

Target cells - causes?

Answer 24

3Hs: hyposplenism, hepatic failure, haemoglobinopathies

Question 25

Spherocytes - what can cause this? other than hereditary spherocytosis duh

Answer 25

Autoimmune haemolytic anemia

Question 26

Acanthocytes - what do they look like? What can cause it?

Answer 26

Spiky RBCs. Abetalipoproteinaemia, liver disease

Question 27

What is basophilic stippling?

Answer 27

purple spots in cytoplasm of RBCs, they are rRNA remnants

Question 28

Underlying condition in basophilic RBC stippling?

Answer 28

Haemoglobinopathies | Megaloblastic anemia

Question 29

Main cause of Heinz bodies

Answer 29

G6PD DEFICIENCY

Question 30

Main cause of rouleaux

Answer 30

Myeloma

Question 31

Pelger-Huet cells - what even is it? What is the cause?

Answer 31

Hyposegmented neutrophils Myelodysplastic syndromes

Question 32

Howell-Jolly bodies: what do they look like?

Answer 32

purple spot in the centre of an RBC

Question 33

2 major causes of howel jolly bodies

Answer 33

Hyposplenism | Megaloblastic anemia

Question 34

In IDA, which 2 measurements goes UP and why

Answer 34

Transferrin: transports iron, so when iron is low, the liver increases transferrin production to bind to as much available iron it can TIBC

Question 35

Name of the Neuro issue which develops following B12 deficiency?

Answer 35

Subacute Combined Degeneration of the cord (SACD) = Loss of proprioception + loss of touch + ataxia . Spinothalamic tracts are spared!

Question 36

Pernicious anemia - which antibody is most specific for it?

Answer 36

Anti-parietal cell antibodies

Question 37

Causes of macrocytic anaemia

Answer 37

Megaloblastic: B12 and folate def Non-megalo: RALPH =reticulocytes, alcohol, liver failure, pregnancy, hypothyroid Other haem probs: aplastic anaemia/MDS/MPS