Haematology 1 - Systemic disease

Question 1

Which factors do proteins C and S inhibit?

Answer 1

Factors V and VIII

Question 2

Laboratory findings in IDA

Answer 2

Microcytic, hypochromic, reduced ferritin and transferrin saturation, raised TIBC and transferrin

Question 3

Leucoerythroblastic anaemia blood film features

Answer 3

Nucleated RBCs, immature myeloid cells, poikilocytes and anisocytes (tear drop poikilocytes)

Question 4

Causes of a leucoerythroblastic film

Answer 4

BM malignancy, haematological malignancy (leukaemia/lymphoma/myeloma), myelofibrosis, severe infection e.g. miliary TB, fungal infection

Question 5

Antibodies in warm and cold AIHA and their respective places of haemolysis

Answer 5

Warm = IgG, extravascular haemolysis
Cold = IgM, intravascular haemolysis

Question 6

Worlwide commonest cause of non-immune mediated haemolytic anaemia?

Answer 6

Malaria

Question 7

Some causes of MAHA

Answer 7

HUS, TTP, DIC, Pre-eclampsia, Adenocarcinoma

Question 8

Treatment for TTP and HUS

Answer 8

PLASMA EXCHANGE, NOT STEROIDS

Question 9

How do adenocarcinomas cause MAHA?

Answer 9

They cause a low-grade DIC by releasing procoagulant factors and granules in to blood –> platelets clump together in circulation and promote conversion of fibrinogen in to fibrin –> red cell fragmentation

Question 10

What does a low reticulocyte count and anaemia suggest?

Answer 10

Suggests there is impairment of the bone marrow so it is unable to respond to the anaemia by making more RBCs

Question 11

What % of blasts is normal in BM?

Answer 11

<5%

Question 12

What are some causes of neutrophilia?

Answer 12

Corticosteroids (due to demargination)
Acute inflammation e.g. colitis or pancreatitis
Neoplasia
Myeloproliferative or leukaemic disorders
Pyogenic infection (MOST LIKELY)

Question 13

Which infections classically don’t produce neutrophilia?

Answer 13

Typhoid, brucella, viral infections

Question 14

Signs of a reactive neutrophilia

Answer 14

Toxic granulation, no immature cells, only neutrophils, heavy granulation, vacuoles in the neutrophils

Question 15

Signs of malignant neutrophilia

Answer 15

massively raised neutrophil count, neutrophilia/basophilia, immature cells (myelocytes), splenomegaly = CML
Neutropenia + myeloblasts = AML

Question 16

What infections is monocytosis seen in?

Answer 16

Typhoid, brucella, TB, viruses

Question 17

Non-infectious causes of monocytosis

Answer 17

Sarcoidosis, CMML, MDS

Question 18

Causes of a reactive eosinophilia

Answer 18

Parasitic infection, allergic disease (asthma, RA), underlying neoplasms e.g. NHL/HL, drug reaction e.g. erythema multiforme

Question 19

Leukaemia associated with eosinophilia

Answer 19

Chronic eosinophilic leukaemia

Question 20

B cell clonality: light chain restriction, what do polyclonal and monoclonal suggest?

Answer 20

Polyclonal (kappa and lamda): reactive lymphocytosis

Monoclonal (kappa only or lamda only) = malignant

Question 21

Mutations in tyrosine kinase genes cause…

Answer 21

Excess proliferation but have no effect on differentiation

Question 22

Which mutation type causes a blockage of cell differentiation?

Answer 22

Mutations in nuclear transcription factors, if present along with a mutation in proliferation –> acute leukaemia

Question 23

Which mutation in follicular lymphoma?

Answer 23

BCL2 = anti-apoptotic (t14;18)

Question 24

Diagnostic workup in leukaemia and lymphoma

Answer 24

TIssue biopsy:

• Morphology
• Immunophenotype
• Cytogenetics
• Molecular genetics

Question 25

What will a biopsy determine?

Answer 25

Lineage and stage of maturation and normal cell counterpart