Haematology

Question 1

Suspected Adult’s Non-Hodgkin’s lymphoma

Answer 1

Consider 2ww if….

Unexplained splenomegaly or lymphadenopathy

Question 2

Suspected Hodgkin’s lymphoma

Answer 2

Consider 2ww if…. Lymphadenopathy

Question 3

Myeloma

=; Sx 4; Ix 3; Prognosis; Rx 5

Answer 3

= Abnormal proliferating plasma cells —> paraprotein in serum and Bence-Jones protein in urine

Sx:

1. Anaemia
2. Bone pain (backache, long bones, ribs, etc)
3. Renal failure
4. Weight loss, high calcium

Ix:

• Bloods: FBC, ESR or plasma viscosity, U&E, calcium, albumin
• Electropheresis (serum and urine)
• Bone marrow aspirate, MRI

Prognosis: incurable, variable but generally poor prognosis

Rx:

• Bisphosphonates
• Chemotherapeutic agents
• Steroids
• Treat anaemia
• Stem cell transplantation

Question 4

Anaemia

Symp 5; Signs 3; Micro 3; Normo 4; Macro 5

Answer 4

Symp: SOB, tiredness, headaches, palpitations, chest pain

Signs (may not be any): pallor, tachycardia, murmurs

Microcytic:

• Fe deficiency
• Thalssaemia
• Lead poisoning

Normocytic:

• Anaemia of chronic disease
• Bleeding
• Pregnancy
• Mixed Fe/folate deficiency

Macro:

• B12 deficiency
• Folate deficiency
• Hypothyroidism
• Alcohol
• Liver cirrhosis

Question 5

Folate deficiency

Answer 5

—> macrocytic anaemia

Rx: Folic acid 5mg OD usually for 4 months

If B12 low as well, TREAT B12 FIRST! (Otherwise could speed up onset of SACD)

Question 6

ESR

Answer 6

Rises with age

Rough upper limit:

Male = age / 2
Female = age + 10 / 2

Question 7

Coagulation disorders

Answer 7

Inherited or Acquired

Inherited:
- Haemophilia A (factor VIII deficiency) —> IV factor VIII concentrate
- Haemophilia B (factor IX deficiency) —> IV factor IX concentrate
(Both x-linked and present early)
- Von Willebrand disease - autosomal dominant , various sites of mild/moderate bleeding

Acquired:

• Vitamin K deficiency (can present in newborn or later, e.g. secondary to coeliac)
• Liver disease (e.g. alcohol)
• DIC (e.g. due to malignancy, sepsis, trauma) —> may need platelet transfusion, FFP, cryoprecipitate