Haematology

Question 1

What is DIC

Answer 1

• disorder of primary and secondary haemostasis
• widespread activation of coagulation cascade and platelet activation

Question 2

Presentation of DIC

Answer 2

• bleeding
• ARDS

Question 3

Investigations for DIC

Answer 3

bloods

• low platelets
• low fibrinogen
• high d-dimer
• long PT
• long APTT

blood smear → schistocytes

Question 4

Treatment for DIC

Answer 4

• treat underlying cause
• low fibrinogen → cryoprecipitate
• low platelets → transfusion

Question 5

Causes of DIC

Answer 5

• sepsis
• crush injury
• malignancy

Question 6

What is alpha thalassemia

Answer 6

gene deletion of one or both alpha chains

4 gene deletion

• incompatible with life
• infants often stillborn

3 gene deletion

• moderate anaemia
• splenomegaly
• not transfusion dependent

2 gene deletion

• microcytosis
• carrier presentation

Question 7

Diagnosis of alpha thalassemia

Answer 7

FBC

• microcytic anaemia
• raised serum iron

Hb electrophoresis

Question 8

Treatment of alpha thalassemia

Answer 8

• transfusion during crises
• desferrioxamine → iron excretion
• folic acid

Question 9

What is beta thalassemia?

Answer 9

• decreased/absent beta chains
• excess alpha chains
• point mutations in gene

Question 10

Presentation of minor beta thalassemia

Answer 10

• mild anaemia
• hypochromic RBCs
• often asymptomatic

Question 11

Presentation of intermedia beta thalassemia

Answer 11

• infections
• gallstones
• recurrent leg ulcers
• bone deformities

Question 12

Presentation of major beta thalassemia

Answer 12

• failure to thrive
• severe anaemia from 3-6 months
• thalassemic faces
• bone abnormalities

Question 13

Diagnosis of beta thalassemia

Answer 13

blood film

• reticulocytosis
• microcytic anaemia
• nucleated RBCs in circulation

Question 14

Treatment of beta thalassemia

Answer 14

regular life long

• transfusions
• iron-chelating agents → deferipone
• ascorbic acid
• folic acid

Question 15

What is tumour lysis syndrome?

Answer 15

collection of metabolic disturbances occurring with rapid destruction of neoplastic cells

Question 16

Signs of tumour lysis syndrome

Answer 16

following chemo, rapid development of:

• hyperuricaemia, hyperkalaemia, hyperphosphatemia
• hypocalcemia
• AKI

Question 17

Risk factors of tumour lysis syndrome

Answer 17

occurs more frequently with aggressive treatment of

• non-Hodgkin lymphoma
• leukaemia

Question 18

Treatment for tumour lysis syndrome

Answer 18

allopurinol alongside chemo

Question 19

What is heparin-induced thrombocytopenia

Answer 19

1. heparin administration
2. antibodies bind to drug
3. prothrombotic state

problem with primary haemostasis

Question 20

Presentation of heparin-induced thrombocytopenia

Answer 20

• onset of emboli → PE, DVT, CSVT
• suspect in any patient on heparin who’s platelets fall >50%
• bloods → low platelets, high D-dimer

Question 21

Treatment of heparin-induced thrombocytopenia

Answer 21

• stop heparin
• anticoagulate

Question 22

What is myelodysplasia

Answer 22

• heterogenous group of conditions
• defined by cell dysplasia
• often manifests as anaemia and bone marrow failure
• haemopoietic tissue is displaced by dysplastic cells

Question 23

Presentation of myelodysplasia

Answer 23

• signs and symptoms of anaemia
• neutropenia → frequent infections

Question 24

Investigations for myelodysplasia

Answer 24

• histological diagnosis
• wide variety of abnormalities