Haematology

Question 1

Ivx for pernicious anaemia

Answer 1

Intrinsic factor antibody

Gastric parietal cell antibody

Question 2

Pernicious anaemia management

Answer 2

cyanocobalamin oral replacement

If absorptive issue, hydroxycobalamin IM

Question 3

Features of haemolytic anaemia

Answer 3

Anaemia due to the reduction in circulating red blood cells
Splenomegaly as the spleen becomes filled with destroyed red blood cells
Jaundice as bilirubin is released during the destruction of red blood cells

Question 4

Haemolytic anaemia

Answer 4

Full blood count shows a normocytic anaemia

Blood film shows schistocytes (fragments of red blood cells)

Direct Coombs test is positive in autoimmune haemolytic anaemia

Question 5

G6PD Deficiency diagnosis

Answer 5

G6PD enzyme assay.

jaundice (usually in the neonatal period), gallstones, anaemia, splenomegaly and Heinz bodies on blood film

Question 6

Spherocytosis management

Answer 6

folate supplementation and splenectomy

Question 7

Autoimune haemolytic anaemia management

Answer 7

Blood transfusions
Prednisolone (steroids)
Rituximab (a monoclonal antibody against B cells)
Splenectomy

Question 8

Thalassaemia features

Answer 8

pronounced forehead
malar eminences
splenomegaly

Microcytic anaemia (low mean corpuscular volume)
Fatigue
Pallor
Jaundice
Gallstones
Splenomegaly
Poor growth and development
Pronounced forehead and malar eminences

Question 9

Thalassaemia ddx

Answer 9

Full blood count shows a microcytic anaemia.

Haemoglobin electrophoresis is used to diagnose globin abnormalities.

DNA testing can be used to look for the genetic abnormality

Question 10

Iron overload management

Answer 10

iron chelation

Question 11

Sickle cell anaemia dx

Answer 11

newborn screening heel prick test at 5 days of age.

Question 12

Sickle cell anaemia cx

Answer 12

Anaemia
Increased risk of infection
Stroke
Avascular necrosis in large joints such as the hip
Pulmonary hypertension
Painful and persistent penile erection (priapism)
Chronic kidney disease
Sickle cell crises
Acute chest syndrome

Question 13

Sickle cell disease management

Answer 13

Avoid dehydration and other triggers of crises

Ensure vaccines are up to date
Antibiotic prophylaxis to protect against infection with penicillin V (phenoxymethypenicillin)

Hydroxycarbamide can be used to stimulate production of fetal haemoglobin (HbF).

Blood transfusion for severe anaemia

Bone marrow transplant can be curative

Question 14

Acute chest syndrome diagnosis

Answer 14

Fever or respiratory symptoms with

New infiltrates seen on a chest xray

Question 15

Acute chest syndrome management

Answer 15

Antibiotics or antivirals for infections

Blood transfusions for anaemia

Incentive spirometry using a machine that encourages effective and deep breathing

Artificial ventilation with NIV or intubation may be required

Question 16

Aplastic crisis trigger

Answer 16

parvovirus B19.

Question 17

Splenic sequestration crisis definition

Answer 17

Splenic sequestration crisis is caused by red blood cells blocking blood flow within the spleen.

This causes an acutely enlarged and painful spleen.

The pooling of blood in the spleen can lead to a severe anaemia and circulatory collapse (hypovolaemic shock).

Question 18

Vaso-occlusive Crisis (AKA painful crisis) definition

Answer 18

sickle shaped blood cells clogging capillaries causing distal ischaemia.

Dehydration and Raised haematocrit

Can cause priapism

Question 19

Post VTE anticoagulation

Answer 19

3 months if there is a reversible cause (then review)

Beyond 3 months if the cause is unclear, there is recurrent VTE, or there is an irreversible underlying cause such as thrombophilia (often 6 months in practice)

3-6 months in active cancer (then review)

Question 20

Unprovoked DVT investigations

Answer 20

Antiphospholipid syndrome (check antiphospholipid antibodies)

Hereditary thrombophilias (only if they have a first-degree relative also affected by a DVT or PE)

Question 21

Budd-Chiari Syndrome triad

Answer 21

Abdominal pain
Hepatomegaly
Ascites

Question 22

Budd-Chiari Syndrome description

Answer 22

Budd-Chiari syndrome is where a blood clot (thrombosis) develops in the hepatic vein, blocking the outflow of blood. It is associated with hyper-coagulable states. It causes acute hepatitis.

Question 23

DVT mx

Answer 23

apixaban or rivaroxaban

The NICE guidelines (2020) recommend considering catheter-directed thrombolysis in patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days.