Haem passmed (2)

Question 1

Polycythaemia: Classical presentation?

Answer 1

• Intense itching which usually occurs after exposure to hot water or hot and humid weather.
• Is a neoplasm of the bone marrow= results in excessive production of RBCs.
• will also show a raise in haemoglobin

Question 2

Haemolysis features?

Answer 2

• raised bilirubin
• normal LFTs
• release of free haemoglobin= low haptoglobin: function is to bind to free haemoglobin: therefore if blood results have low Hb.

Question 3

Common cause of tumour lysis syndrome?

Answer 3

Burkitt’s lymphoma

Question 4

Presence of symptoms that suggest: ISOLATED thrombocytopenia (reduced platelets) e.g. epistaxis, menorrhagia?

Answer 4

ITP: Immune Thrombocytopenic Purpura.

Question 5

Acute promyelocytic leukaemia: think of AML; diagnostic feature on blood film?

Answer 5

Auer rods

Question 6

diagnostic blood film feature: of myelofibrosis?

Answer 6

Tear-drop Poikilocytes: flat, long RBC that looks like a tear-drop in appearance.

Question 7

diagnostic blood film feature: of CLL?

Answer 7

Smear cells: are remnants of cells: that have no identifiable plasma membrane/nuclear structure.

Question 8

Aplastic crises linked to sickle cell anaemia: how will it present on bloods?

Answer 8

With low Haemoglobin

DDX: Sequestration crises: would present with abdo pain, haemodynamic compromise and hepatomegaly/splenomegaly + also increased number of reticulocytes

Question 9

Autoimmune haemolytic anaemia is characterised by?

Answer 9

A positive direct antiglobulin test (Coombs’ test)
Mx: Corticosteroids: to reduce amount of circulating antibodies: causing haemolysis.

Question 10

what can be used to REVERSE: apixaban/rivoroxaban?

Answer 10

Andexanet Alpha

Nb: reversal of dabigatran (another DOAC): Idarucizumab

Question 11

Transfusion-associated circulatory overload should be treated with?

Answer 11

IV loop diuretics (eg. furosemide)

Question 12

DIC typical blood picture:

Answer 12

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products

• can occur after massive burns injury to body

DIC: is a condition= when body’s blood clotting system becomes overreactive. Inappropriate activation of clotting cascade= causes depletion of clotting factors and platelets.
-Deranged coagulation in sepsis -> is also: DIC

Question 13

A macrocytic anaemia findings?

Answer 13

Presence of hyper-segmented neutrophil polymorphs on the blood film is likely to be a megaloblastic anaemia eg. vitamin b12, folate deficiency

Others: Normoblastic causes of macrocytic anaemia: alcohol, liver disease, hypothyroidism, myelodysplasia, reticulocytosis

Question 14

What type of cells are diagnostic of Hodgkin’s lymphoma?

Answer 14

Mirror image nuclei = Reed-Sternberg cells
Reed-Sternberg cells

Question 15

Acute haemolytic transfusion reaction (mx.)?

Answer 15

should be treated with generous fluid resuscitation and termination of the transfusion. (eg. patient is haemodynamically unstable: stop transfusion + give IV fluids)

presents: 10 mins after blood transfusion, symptoms: patient becomes ACUTELY unwell: with fevers, rigors, abdo pain.

Question 16

What drugs may cause? (methhaemoglobinaemia)

Answer 16

Nitrates, including recreational nitrates such as amyl nitrite (‘poppers’)

Question 17

what cancer can CML be transformed into?

Answer 17

Non-Hodgkin’s lymphoma (transformed to a higher grade lymphoma)