Haematology

Question 1

Where does haemoglobin synthesis occur?

Answer 1

Cytoplasm

Defects in haem synthesis = small RBCs

Question 2

Causes of microcytic anaemia?

Answer 2

Iron deficiency
Thalasseamia
lead poisoning
Congenital sideroblastic anaemia

Question 3

What is circulating iron bound to?

Answer 3

Transferrin

Question 4

What does transferrin saturation show?

Answer 4

Iron supply

Question 5

When might transferrin saturation be raised?

Answer 5

Haemochromatosis

Question 6

When is transferrin saturation decreased?

Answer 6

Iron deficiency

AOCD

Question 7

Causes of chronic blood loss?

Answer 7

Menorrhagia
GI - Ulcers, tumours, NSAID
Haematuria

Question 8

Epithelial changes in iron deficiency?

Answer 8

Pale
Koilonychia
Angular chelitis

Question 9

Prescribing oral iron - names & side effects

Answer 9

Ferrous sulphate, ferrous fumarate and ferrous gluconate
Best taken on an empty stomach
Can irritate the gut - dark stool, constipation, N&V, abdo pain
Typically need to take for 2-3 months to replenish stores

Question 10

Causes of MACROcytic anaemia

Answer 10

Megaloblastic anaemia
Non megaloblastic
Spurulous - reticulocytosis as reticulocytes are bigger or cold agglutinins which cause RBCs to clump together

Question 11

Causes of megaloblastic anaemia?

Answer 11

B12 and folate deficiency

Question 12

What does B12 bind to in small bowel ?

Answer 12

Intrinsic factor

Question 13

What are some causes of B12 deficiency?

Answer 13

Vegan - comes from meat and eggs
Pernicious anaemia, gastritis, PPIs - prevent production of IF
Small bowel - malabsorption (crohns)

Question 14

Where is folate absorbed?

Answer 14

Jejunum

Question 15

Causes of folate deficiency

Answer 15

Haemolysis 
Pregnancy 
Exfoliating dermatitis 
Malignancy
Inadequate intake 
Anticonvulsants 
Malabsorption

Question 16

Dietary source of B12 and folate?

Answer 16

B12 = meat and eggs
Folate = leafy green veg, fortified cereals

Question 17

How much body stores of B12 and folate do we have?

Answer 17

B12 = 2-4 years 
Folate = 4 months

Question 18

Daily dietary requirements for B12 and folate?

Answer 18

B12 = 1.5
Folate = 200

Question 19

Are neurological symptoms more suggestive of B12 or folate deficiency?

Answer 19

B12

Question 20

Changes seen in B12/folate deficiency?

Answer 20

Hypersegmented neutrophils

Question 21

Treatment of magaloblastic anaemia

Answer 21

Treat cause:
Pernicious anaemia - lifelong B12 (hydroxycalbamin) injections
5mg oral folic acid

ONLY if life threatening - transfuse red cells

Question 22

Cause of non-megaloblastic anaemias?

Answer 22

Alcohol
Liver disease
hypothyroid

^may not be associated with anaemia
Marrow failure - myelodysplasia, myeloma, aplastic anaemia
^always asssociated with anaemia

Question 23

What’s raised HbA2 diagnostic of?

Answer 23

Beta thalassaemia trait

Question 24

What are the normal quantities of :
HbA
HbF
HbA2

Answer 24

HbA >80%
HbF <1% (in adults)
HbA2 1.5-2%

Question 25

Management of leukaemia?

Answer 25

MDT
Chemotherapy
Steroids
Bone marrow transplant

Question 26

List some complications of chemotherapy?

Answer 26

Immunosuppression 
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicity
Tumour lysis syndrome

Question 27

What is tumour lysis syndrome?

Answer 27

Uric acid release from cells killed by chemotherapy, uric acid crystals in interstitial tissue and tubules of kidneys –> AKI

Question 28

Management of tumour lysis?

Answer 28

Allopurinol or rasburicase are used to reduce the high uric acid levels

Question 29

Treatment of flare of acute intermittent porphyria

Answer 29

IV Haem arginate