Haematological

Question 1

Iron Deficiency Anaemia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 1

Definition - Microcytic anaemia caused by low insufficient iron in the body to support RBC production
Epidemiology - common, women pre menopause
Pathogenesis - Excessive blood loss, increasing demand, reduce intake
Presentation - fatigue, dyspnoea, palpitations, headache, hairless, irritability
Investigations - FBC, serum ferritin
Differentials - thalassaemia, chronic disease anaemia, sidenoblastic anaemia
Risk Factors - related to causes
Treatment - oral iron supplement, adjunct ascorbic acid, Hb<7 - blood transfusion

Question 2

Macrocytic Anaemia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 2

Definition - fit B12 or folate deficiency
Epidemiology - 60+, F1.6:M1, 80% megaloblastic anaemia
Pathogenesis - Megaloblastic: b12 deficiency, folate deficiency
Non- megaloblastic - alcohol abuse, liver disease, reticulocytosis, hypothyroidism
Presentation - fatigue, lethargy, dyspnoea, palpitations, headache
Investigations - FBC, peripheral blood smear
Differentials - myelodysplasia, aplastic anaemia, pure red cell aplasia
Risk Factors
Treatment - Severe: 1st line: parenteral cyanocobalamin or hydroxoxobalamin
Mild-Moderate: 1st line: oral or parenteral cyanocobalamin

Question 3

Non-Hodgkin Lymphoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 3

Definition - neoplastic transformations of normal B or T cells residing in lymphoid tissue
Epidemiology - increasing incidence per year 4% from 70’s
Pathogenesis - B cell - malignant phenotype, multistep accumulation of genetic conferring growth advantage
Presentation - night sweats, weightless, fatigue, lymphadenopathy, splenomegaly, pain on alcohol consumption, enlarged lymph nodes
Investigations - examination, FBC, LFT, U&E, lymph node biopsy + skin biopsy
Differentials - Hodgkin lymphoma, acute lymphocytic leukaemia, infectious mononucleosis, Hep c, TB, HIV
Risk Factors - over 50, male, immunocompromised, EBV, H.Pylori, coeliac
Treatment - R-chop 21 with or without radiotherapy - rituximab

Question 4

Hodgkin Lymphoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 4

Definition - neoplastic transformation of normal B or T cells, presence of Hodgkin reed Sternberg cells within cellular infiltrate of non-malignant inflammatory cells
Epidemiology - 20-40 and >75
Pathogenesis - unclear causes
Presentation - cervical/supraclavicular lymphadenopathy
Investigations - lymph node examination, FBC, metabolite panel, ESR, CXR, PET-CT scan, contract CT neck , excision lymph node biopsy
Differentials - non-hodgkin lymphoma, lymphadenopathy from other malignancies, infectious mononucleosis
Risk Factors - EBV history, Hodgkin lymphoma history
Treatment - ABVD - doxorubicin, bleomycin