Haem PassQues Flashcards
1
Q
Gold standard investigation for sickle cell disease
A
Haemoglobin electrophoresis
2
Q
Men with haemoglobin below 110g/L
A
Do urgent GI endoscopy to rule out malignancy
3
Q
Patient deficient in B12 and folate - which do you treat first?
A
B12
- to avoid precipitating subacute combined degeneration of the cord
4
Q
Management of haemorrhage in patient with Von-Willebrand disease
A
Tranexamic acid + desmopressin
- Tranexamic acid for mild bleeding
- Desmopressin: raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
5
Q
Reversal agent for dabigatran
A
Idarucizumab
6
Q
Why are irradiated blood products used for immunocompromised patients?
A
Depletes T-lymphocyte numbers which reduces risk of transfusion-associated graft vs host disease (TA-GVHD)
7
Q
High GGT + macrocytic anaemia =
A
Alcohol excess
8
Q
Transfusion-associated circulatory overload
(pulmonary oedema + hypertension following a transfusion)
Treatment = ?
A
IV loop diuretics
9
Q
Suspicious of leukaemia - what investigations?
A
FBCs within 48 hours
10
Q
Megaloblastic anaemia =
A
Increased MCV, reduced Hb
(B12, folate, methotrexate)
11
Q
Causes of megaloblastic anaemia =
A
B12, folate, methotrexate
12
Q
Which virus can trigger an aplastic crisis (bone marrow stops producing red cells causing extreme anaemia) in patients with hereditary spherocytosis ?
(*happens in sickle cell disease)
A
Parvovirus
13
Q
Multiple myeloma symptoms (mnemonic)
A
CRAB:
hyperCalcaemia
Renal failure
Anaemia
Bone pain/fractures (both due to lytic lesions)
+susceptible to infection
+rouleaux formation on blood film
bone pain normally in vertebrae causing back pain. sometimes in ribs causing chest pain
14
Q
Beta-thalassaemia major treatment ?
A
Lifelong blood transfusions
15
Q
TRALI vs TACO
A
TRALI = Hypotension
TACO = Hypertension
TRALI = Transfusion-related acute lung injury
TACO = Transfusion-associated circulatory overload
16
Q
Hyposplenism blood film findings =
A
Howell-Jolly bodies and siderocytes
Howell-Jolly = No spleeny
17
Q
Lead poisoning blood film findings =
A
Basophilic stippling and cabot rings
18
Q
Howell-Jolly
A
No spleeny
19
Q
Features of acute haemolytic transfusion reaction (confirmed by DAT/Coombs test)
A
Fever, abdominal pain, hypotension
20
Q
Treatment of non-haemolytic febrile transfusion reaction ?
A
Oral paracetamol
(reduces pyrexia)
21
Q
Intense itching after exposure to hot water =
A
Polycythaemia vera
22
Q
Minor anaphylactic reaction during blood transfusion. What to do?
A
Temporarily stop transfusion and give an antihistamine
23
Q
Rouleaux formation on blood film =
A
Myeloma
24
Q
G6PD deficiency
A
X-linked recessive disorder affecting red cell enzymes
Results in a reduced ability of the red cells to respond to oxidative stress.
Therefore, red cells have a shorter life span and are more susceptible to haemolysis
particularly in response to drugs (e.g. nitrofurantoin), infection, acidosis and certain dietary agents (e.g. fava beans).
25
Cancer associated with myasthenia gravis ?
Thymoma
26
What to use for emergency reversal of anticoagulation in patients with severe bleeding or a head injury
Prothrombin complex concentrate
27
Immunocompromised patient has a tender maculopapular rash primarily confined to his neck, the palms of his hands and the soles of his feet
Graft versus host disease (GVHD)
28
Reversal agent for dabigatran (new oral anticoagulant)
Idarucizumab
29
Myeloma investigations
Protein serum electrophoresis
- raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
- urine = Bence Jones proteins
30
Haemarthroses without trauma =
Haemophilia A
31
Haemophilia A vs vWF bleeds ?
Haemophilia A = haemarthroses
vWF = mucosal bleeds (epistaxis, menorrhagia) + easy bruising
32
Treatment for DVT while pregnant
Subcutaneous LMWH
33
Treatment for DVT
Apixaban/rivaroxaban (DOACs)
34
Benign ethnic neutropaenia = what ethnicity ?
Black African and Afro-Caribbean
35
3-7 days after starting chemotherapy for Burkitt's lymphoma, patient starts to feel confused and experience muscle cramps
Tumour lysis syndrome
36
Reed-Sternberg cells
Hodgkin's lymphoma
37
When to do a Doppler for DVT ?
Either high Wells Score or raised D-dimers
38
Lymph node pain when drinking alcohol =
Hodgkin's lymphoma
39
Heinz cells =
G6PD
*Heinz Beans - G6PD gets worse when you eat fava beans*
40
Treatment for autoimmune haemolytic anaemia
Steroids (+/- rituximab)
41
At what age does polycythaemia vera peak?
60s
42
Raised haemoglobin + hypertension
Plethoric appearance (puffy, red face), itchy when showering, splenomegaly
Diagnosis = ?
Polycythaemia vera
43
'Starry sky' appearance on lymph node biopsy =
Burkitt's lymphoma
44
Raised ESR and osteoporosis =
Myeloma
45
Rivaroxaban MOA
Direct factor Xa inhibitor
46
What is a sequestration crisis?
(patients with Sickle cell disease)
Sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
associated with reticulocytosis
47
Treatment for flares of acute intermittent porphyria
IV haem arginate
48
What is the most common inherited clotting disorder?
Von-Willebrand's
49
Most common cause of neutropaenic sepsis =
Staphylococcus epidermidis
50
Acute lymphoblastic leukaemia age group =
2-5 years old
51
Auer rods on blood film ?
Acute promyelocytic leukaemia
52
'Tear-drop' poikilocytes on blood film
Myelofibrosis
53
Smear cells on blood film
Chronic lymphocytic leukaemia
54
Target cells on blood film
Iron-deficiency anaemia or hyposplenism
55
Treatment for post-thrombotic syndrome ?
Compression stockings
56
Thrombocytopaenia =
Low platelets
(Thrombocyte = thrombosis cell)
57
Isolated thrombocytopaenia (no other symptoms)
Immune thrombocytopaenic purpura (ITP)
58
Which drugs can cause haemolytic anaemia ?
Cephalosporins and quinine
59
How long to transfuse 1 unit of blood (non-urgent)
90-120 minutes
60
What is used to confirm a diagnosis of pernicious anaemia ?
Autoantibodies against intrinsic factor
61
Suspected cancer with raised neutrophils and platelets (myeloid-derived cells)
Chronic Myelogenous Leukaemia
62
Treatment for Chronic Myelogeous Leukaemia (CML)
Imatinib
(highly successful treatment)
63
Translocation present in CML
t(9;22) Bcr-Abl
64
Translocation in Burkitt's Non-Hodgkin's Lymphoma = ?
t(8;14) IgH-Myc
65
Immune thrombocytopaenic purpura in children - treatment = ?
85% are self-limiting
- tends to follow a viral infection
66
Does total iron binding capacity (TIBC) increase or decrease in iron deficiency anaemia ?
Increase (because less iron so more is taken up)
67
Beta-thalassaemia age of presentation
1st year of life
68
Haematological cause of frontal bossing? (unusually prominent forehead)
Beta-thalassaemia
69
D-dimer =
Clotting
70
Why does DIC cause reduced platelets and clotting factors, and cause increased APTT and PT?
Clots use up platelets and clotting factors, therefore APTT and PT are longer, and excessive bleeding can occur
71
Diagnostic investigation for Haemophilia A =
Factor VIII assay
72
Philadelphia chromosome indicates which haematological cancer ?
CML (Chronic Myeloid Leukaemia)
73
Carbimazole + sore throat shows...
Agranulocytosis + neutropaenia
74
Polycythaemia vera mutation =
JAK2 (V617F) mutation
75
Abnormal proteins in multiple myeloma
Serum protein electrophoresis = high levels of M proteins
Urine protein electrophoresis = Bence Jones proteins
76
Blood product used for reversal of warfarin
Prothrombin complex concentrate + Vitamin K
- PCC contains clotting factors 2,7,9,10 - which warfarin inhibit
- Vitamin K ensures reversal continues over subsequent hours
77
Why is ferritin sometimes raised in iron deficiency anaemia ?
It is an acute phase reactant
therefore raised in infection/inflammation
78
Why is weekly blood monitoring necessary for patients on clozapine (atypical antipsychotic) ?
Can cause agranulocytosis and neutropaenia
79
Smudge cells =
CLL (Chronic lymphocytic leukaemia)
80
Bence-Jones protein
Multiple myeloma
(found by urine protein electrophoresis)
81
Medication used for prophylaxis of hyperuricaemia related to chemotherapy ?
Allopurinol
(high number of cancer cells die at once, causing hyperuricaemia)
82
Lymphoma with absence of Reed-Sternberg cells =
Non-Hodgkin's lymphoma
83
Lymphoma with presence of Reed-Sternberg cells =
Hodgkin's lymphoma
84
Pernicious anaemia causes which deficiency ?
Vitamin B12
85
Normocytic anaemia with normal ferritin, + an inflammatory/malignant chronic condition =
Anaemia of chronic disease
a.k.a. anaemia of inflammation
86
Pancytopaenia + no abnormal cells =
Aplastic anaemia
(Pancytopaenia = deficiency in all three blood cells: red cells, white cells, platelets)
87
Example of a thrombin inhibitor =
Dabigatran
88
Beta-thalassaemia major patient presents with reddish-brown macules over her legs
Haemosiderosis (iron deposition due to frequent blood transfusions)
89
Teardrop cells + leucoerythroblastic reaction in blood film + massive splenomegaly =
Myelofibrosis
90
Spur cells + acanthocytes + clusters of megakaryocytes =
Myelodysplastic syndrome
91
Type 1 vWF vs Type 2 vWF
Type 1 = less severe, presents in adulthood
Type 2 = more severe, presents earlier in life
92
Thrombotic thrombocytopaenic purpura - what protein deficiency ?
ADAMTS13
93
Alcoholism
Splenomegaly and thrombocytopaenia
Oesophageal varices
94
Auer rods + blast cells on bone marrow biopsy =
Acute myeloid leukaemia
95
Treatment for neutropaenic sepsis
IV piperacillin with tazobactam (broad-spectrum antibiotic)
96
Waldenstrom macroglobulinaemia causes what syndrome ?
Hyperviscosity syndrome
97
Von-Willebrand factor stabilises which clotting factor ?
Factor 8
98
Medication for non-Hodgkin's lymphoma =
Rituximab
(in addition to CHOP chemotherapy)
99
Definitive treatment of tapeworm
Praziquantel + Niclosamide
100
Treatment for scabies
Permethrin
101
Schistocytes on blood film
Haemolytic anaemia
102
What immunoglobulin is involved in cold autoimmune haemolytic anaemia ?
IgM
103
G6PD-deficiency inheritance pattern =
X-linked recessive
104
Large number of malignant pro-myelocytes accumulating in bone marrow + easy bruising - which blood cancer ?
Acute myeloid leukaemia
105
Investigations for pernicious anaemia =
Methylmalonic acid + anti-intrinsic factor antibody
106
Multiple myeloma blood film findings
Rouleaux formation
107
MOA of hydroxyurea
Suppresses platelet production in bones
108
Tumour lysis syndrome (acute) treatment
Rasburicase
- metabolises uric acid to allantoin
(Allopurinol used to prevent TLS)
109
Investigation for myelofibrosis
Dry tap on bone marrow aspiration
110
Which antibiotic is contraindicated in methotrexate users ?
Trimethoprim
(also a folate antagonist)
111
Prolonged PT = which factor is deficient ?
Factor VII
112
Essential thrombocythaemia treatment ?
Hydroxycarbamide and aspirin
- Hydroxycarbamide = cytoreductive
- Aspirin = anti-platelet
113
Myelofibrosis investigation
Bone marrow biopsy
114
Autoimmune haemolytic anaemia first-line treatment
Corticosteroids
- suppress the immune system, which suppresses the production of autoantibodies
115
Foetal complications of alpha-thalassaemia ?
Bart's hydrops fetalis
116
Suspected antiphospholipid syndrome - investigation?
Thrombophilia testing
117
Haemophilia with a normal Factor VIII assay = ?
Haemophilia B
- Factor IX deficiency
(rare)
118
Inheritance pattern of haemophilia
X-linked recessive
- affects only males
119
Minor bleed in Haemophilia A/B - management ?
Desmopressin
120
Major bleed in Haemophilia A/B - management ?
Recombinant factor VIII/IX
121
Patient has a high-grade diffuse large B-cell Lymphoma.
What should be prescribed before starting R-CHOP chemotherapy ?
Rasburicase (recombinant xanthine oxidase)
122
vWF inheritance pattern
Autosomal dominant
123
Cold autoimmune haemolytic anaemia is most commonly caused by which Ig antibodies?
IgM
124
Neutropenia + fever - management ?
Neutropenic sepsis
Sepsis 6 bundle:
Blood culture, fluid balance monitoring, lactate measurement, broad-spectrum antibiotics, IV fluids and supplemental oxygen
125
Iron study results in anaemia of chronic disease
Low serum iron, high ferritin and low transferrin saturation
126
Macrocytic megaloblastic anaemia
Fatigue, pallor, paraesthesias, and neurological symptoms such as decreased vibratory sensation and proprioception
Pernicious anaemia
127
Most common thrombophilia = ?
Factor V Leiden
128
Reversal agent for rivaroxaban and apixaban
Andexanet alfa
129
Neutropenic sepsis antibiotic = ?
Tazocin (a.k.a. Piperacillin with tazobactam)
130
Vitamin B12 and folate deficiency - what must be treated first ?
Treat Vitamin B12 first with cyanocobalamin IM injections
*treat Vit B12 first to prevent subacute combined degeneration of spinal cord
131
Myelodysplastic syndrome can progress into...
Acute myeloid leukaemia
132
Cancer patient with a VTE - treatment ?
6 months of DOAC
(apixaban, rivaroxaban)
133
Rivaroxaban/apixaban reversal agent
Andexanet alfa
134
Malaria prophylaxis can cause ________ in patients with G6PD deficiency?
Haemolytic anaemia
135
Taeniasis/Tapeworm treatment
Praziquantel and Niclosamide
136
Dry tap on bone marrow aspirate =
Myelofibrosis
137
O+ blood - what blood can patient receive ?
O+ and O-
(Rhesus +ve so can receive both)
138
