Haematology Flashcards
1
Q
What is the different between leukaemia, lymphoma and myeloma?
A
Leukaemia - cancer of bone marrow and other blood-forming organs causing production of abnormal leukocytes circulating the in blood.
Lymphoma - cancer of lymphatic system causing leukocytes to aggregate forming tumours in lymphatic tissues.
Myeloma - cancer of bone marrow affecting plasma cells.
2
Q
Which cancers metastasise to bone?
A
Breast, lung, prostate, thyroid, kidney, lymphoma, multiple myeloma.
3
Q
Plasma vs serum
A
Plasma contains rbc, wbc, platelets and clotting factors.
Serum contains glucose, electrolytes, immunoglobulins and hormones.
4
Q
Where is bone marrow mostly found?
A
Pelvis, vertebrae, ribs and sternum.
5
Q
Name blood cells from myeloid lineage
A
Platelets, rbc, basophil, neutrophil, eosinophil and macrophage.
6
Q
Name blood cells from lymphoid lineage
A
B cell, T cell and NK cell.
7
Q
Are dendritic cells myeloid or lymphoid cells?
A
Neither - they differentiate directly from pluripotent haematopoietic stem cell lineage.
8
Q
What are the precursors to rbc?
A
Reticulocytes.
9
Q
How long do rbc survive for?
A
120 days.
10
Q
What are the precursors to platelets?
A
Megakaryocytes.
11
Q
How long do platelets survive for?
A
10 days.
12
Q
Where is iron mainly absorbed?
A
Duodenum and jejunum.
13
Q
Why do PPIs interfere with iron absorption?
A
Stomach acid is required to keep iron soluble (Fe2+) and easily absorbed. Therefore as PPIs reduce stomach acid secretion, they also interfere with iron absorption.
14
Q
Which medications trigger haemolysis?
A
Primaquine (antimalarial), ciprofloxacin, sulfonylureas, sulfasalazine.
15
Q
A patient turns jaundice and becomes anaemic after eating broad beans, developing an infection or being treated with antimalarials. What’s your top differential?
A
G6PD deficiency.
16
Q
Differentials for abnormal or prolonged bleeding?
A
Thrombocytopenia, haemophilia, Von Willebrand disease, disseminated intravascular coagulation (secondary to sepsis).
17
Q
What are the concerning signs of bleeding?
A
Persistent headaches and melaena.
18
Q
How does thrombotic thrombocytopenic purpura cause thrombocytopenia?
A
Tiny blood clots develop throughout small blood vessels leading to the body using up platelets and causing thrombocytopenia. Blood clots develop due to a deficiency in ADAMTS13 protein.
19
Q
How does immune thrombocytopenic purpura cause thrombocytopenia?
A
Auto-abs attack platelets.
20
Q
How can heparin cause thrombocytopenia?
A
Exposure to heparin results in development of Abs against platelets. Heparin induced Abs specifically target platelet factor 4 (PF4) and activate clotting causing thrombosis, but also break down platelets leading to thrombocytopenia.
21
Q
MOA of ruxolitinib?
A
JAK2 inhibitor.
22
Q
What are the causes of petechiae?
A
Thrombocytopenia leading to bleeding under the skin and bruising.
23
Q
Differentials for petechiae (non-blanching rash)?
A
Leukaemia, meningococcal septicaemia, vasculitis, HSP, idiopathic thrombocytopenia purpura, non-accidental injury (abuse - children and vulnerable adults).
24
Q
What are B symptoms?
A
Fever, night sweats and weight loss.
25
Where is a bone marrow biopsy usually taken from?
The iliac crest.
26
Measures to prevent alloimmunisation during pregnancy?
Anti-D immunoglobulin therapy binds to and neutralises any RhD+ cells.
27
Management of DVT/VTE?
Anticoagulation e.g. apixaban or rivaroxaban.
Catheter-directed thrombolysis.
Long-term anticoagulation - DOACs, warfarin, LMWH.
28
Management of Von Willebrand disease?
- Tranexamic acid
- Desmopressin - stimulates release of VWF.
- Factor VIII.
29
What is the inheritance pattern of haemophilia?
X linked recessive.
30
Management of haemophilia?
Factor VIII or IX infusion.
31
Risk factors for DVT/VTE?
Immobility, recent surgery, long haul travel, pregnancy, combined pill, HRT, malignancy, polycythaemia, SLE, thrombophilia.
32
Anaemia is defined by…
Decreased number of circulating rbc or decreased amount of Hb (<130g/L in males and <120g/L in females).
33
Types of microcytic anaemia
Thalassaemia, anaemia of chronic disease, iron deficiency, lead poisoning, sideroblastic anaemia.
34
Types of normocytic anaemia
Acute blood loss, anaemia of chronic disease, aplastic anaemia, haemolytic anaemia, hypothyroidism, renal disease, cancer and pregnancy.
35
Types of macrocytic anaemia
Megaloblastic anaemia (B12 or folate deficiency) and normoblastic macrocytic anaemia (alcohol, reticulocytosis, hypothyroidism, liver disease, haematological malignancies, methotrexate, azathioprine).
36
What are the general symptoms of anaemia?
Fatigue, SOB, palpitations, headaches, dizziness, angina, confusion.
37
What are the general signs of anaemia?
Pale skin, conjunctival pallor, tachycardia, tachypnoea.
38
General investigations for anaemia?
FBC, B12, folate, ferritin, blood film, endoscopy, colonoscopy, bone marrow biopsy.
39
Causes of iron deficiency anaemia?
Blood loss (menstruation, GI cancer, oesophagitis, gastritis), dietary insufficiency, poor iron absorption (IBD, coeliac), increased requirements during pregnancy.
40
What are the specific features of iron deficiency anaemia?
Pica, hair loss, atrophic glossitis, koilonychia, angular cheilitis, conjunctival pallor.
41
Investigations for iron deficiency anaemia?
FBC (low MCV, low MCHC), serum ferritin (low), total iron binding capacity (high), transferrin saturation (low), coeliac screen, endoscopy, colonoscopy.
42
Management of iron deficiency anaemia?
Treat cause - blood transfusion, iron infusion (cosmofer), oral iron 200mg TSD.
43
What is the cause of thalassaemia?
Genetic mutation in alpha or beta globin chain leading to absent or decreased production of Hb chains. Rbc broken down more easily.
44
What clinical features of thalassaemia are linked to increased removal of rbc?
Jaundice and splenomegaly.
45
What is the inheritance pattern of thalassaemia?
Autosomal recessive.
46
Why are serum ferritin levels monitored in thalassaemia?
Due to iron overload risk from faulty rbc creation, recurrent blood transfusions and increased iron absorption. Managed via iron chelation.
47
Defects in which chromosome lead to alpha thalassaemia?
Chromosome 16.
48
Defects in which chromosome lead to beta thalassaemia?
Chromosome 11.
49
What are the 3 types of beta thalassaemia?
Thalassaemia minor, thalassaemia intermedia and thalassaemia major.
50
What is the management for thalassaemia?
Blood transfusions, splenectomy, bone marrow transplant.
51
What is sideroblastic anaemia?
Iron is inadequately used to make Hb, despite normal amounts of iron. Iron accumulates in rbc creating ringed sideroblasts. X-linked recessive or acquired.
52
What is anaemia of chronic disease?
Anaemia due to chronic inflammation from underlying infection, malignancy or systemic disease e.g. RA, crohns, TB, CKD. IL-6 causes hepcidin-induced block of iron absorption and release, impairing rbc synthesis.
53
What is aplastic anaemia?
Bone marrow failure leading to pancytopenia (anaemia, infections, bleeding and bruising).
54
What are the main clinical features of haemolytic anaemia?
Anaemia, jaundice, splenomegaly.
55
What would you see in a blood film for haemolytic anaemia?
Schistocytes.
56
Name the types of inherited haemolytic anaemia
Hereditary spherocytosis, hereditary elliptocytosis, G6PD deficiency, thalassaemia and sickle cell anaemia.
57
Name the types of acquired haemolytic anaemia
Autoimmune haemolytic anaemia, alloimmune haemolytic anaemia, paroxysmal nocturnal haemoglobinuria, microangiopathic haemolytic anaemia, prosthetic valve haemolysis.
58
What is the most common inherited haemolytic anaemia?
Hereditary spherocytosis.
59
What is the cause of hereditary spherocytosis?
Autosomal dominant defect in rbc membrane creating spherocytes that are easily broken down.
60
Why does G6PD deficiency cause haemolysis?
It predisposes rbc to oxidative damage.
61
What is G6PD deficiency triggered by?
Infections, medications or fava beans.
62
What are the changes seen in blood film of G6PD deficiency?
Heinz bodies.
63
What is the difference between warm and cold type of autoimmune haemolytic anaemia?
In the warm type auto-Abs cause agglutination at >37 degrees and is idiopathic, whereas in the cold type the auto-Abs function at <32 degrees and is secondary to infections or cancer.
64
What are the 2 types of alloimmune haemolytic anaemia?
Haemolytic transfusion reaction and haemolytic disease of the newborn.
65
Which haemolytic anemia causes activation of complement leading to haemolysis?
Paroxysmal nocturnal haemoglobinuria.
66
What is megaloblastic anaemia?
Immature rbc with large nuclei due to abnormal DNA synthesis.
67
What are the neurological symptoms in B12 deficiency?
Peripheral neuropathy, loss of vibration sense or proprioception, visual changes, mood/cognitive changes.
68
What are the causes of B12 deficiency?
Dietary deficiency (vegans), malabsorption (pernicious anaemia, IBD), surgical e.g. gastrectomy.
69
Pathophysiology of pernicious anaemia?
Auto-Abs against gastric parietal cells or intrinsic factor, causing decreased B12 absorption in ileum.
70
What is the first line investigation for pernicious anaemia?
Intrinsic factor Ab.
71
Management for B12 deficiency?
Dietary - oral cyanocobalamin.
Pernicious anaemia - 1mg IM hydroxycobalamin, x3 per week for 2 weeks, then every 3 months.
72
Where is folate absorbed?
Duodenum and jejunum.
73
What are the causes of folate deficiency?
Dietary, malabsorption (coeliac or crohns), increased requirements (pregnancy, malignancy), increased loss (chronic liver disease).
74
Management for folate deficiency?
5mg folic acid OD for 4 months.
75
In the presence of both folate and B12 deficiency which would you treat first and why?
Treat B12 deficiency first before correcting folate, because treating with folic acid first would cause subacute combined degeneration of the cord if there was underlying B12 deficiency.
76
Describe sickle cell anaemia
Inherited autosomal recessive condition characterised by sickle shaped rbc, which cause widespread organ dysfunction due to vaso-occlusion.
77
Sickle cell anaemia vs sickle cell trait
Sickle cell anaemia - inheritance of 2 abnormal sickle genes.
Sickle cell trait - inheritance of one abnormal sickle gene (carrier).
78
The defect in beta globin gene is caused by a mutation in which chromosome in sickle cell?
Chromosome 11.
79
What is the management for a patient with sickle cell anaemia?
Hydration, antibiotic prophylaxis, hydroxycarbamide (stimulates production of HbF), blood transfusion and bone marrow transplant.
80
Describe the types of sickle cell crises
Vaso-occlusive crisis - sickle rbc blocking capillaries causing distal ischaemia.
Splenic sequestration crisis - rbc blocking blood flow into spleen causing severe anaemia and circulatory shock.
Aplastic crisis - transient arrest of erythropoiesis induced by infection (parvovirus B19).
Acute chest syndrome - fever or respiratory symptoms with new infiltration on CXR. Due to infection or occlusion.
81
Is leukocyte alkaline phosphatase increased or decreased in CML?
Decreased.
82
What is the treatment for CML?
Imatinib - tyrosine kinase inhibitor.
83
What is the treatment for CLL?
Fludarabine, cyclophosphamide and rituximab (FCR).
84
What is the treatment for non-hodgkin’s lymphoma?
Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP).
85
CLL is associated with what type of haemolytic anaemia?
Warm autoimmune haemolytic anaemia.
86
67 year old male presents with AKI, hypercalcaemia, proteinuria, anaemia and thrombocytopenia. What is the underlying diagnosis?
Multiple myeloma.
87
What is the first line treatment for an anaphylactic blood transfusion reaction?
Transfusion terminated and IM adrenaline 1:1000.
88
What is the most common form of non-Hodgkin lymphoma in UK?
Diffuse large B cell lymphoma.
89
Alcohol induced painful lymph nodes are characteristic of…
Hodgkin’s lymphoma.
90
Describe the staging for lymphoma
Stage 1 - one node affected.
Stage 2 - more than one node affected on same side of diaphragm.
Stage 3 - nodes affected on both sides of diaphragm.
Stage 4 - extra-nodal involvement e.g. spleen, bone marrow or CNS.
91
What is LDH a marker of?
Increased cell turnover.
92
What are the causes of disseminated intravascular coagulation (DIC)?
Inflammation from infection, injury or illness. Common cause is sepsis.
93
What is cryoprecipitate?
Blood product made from plasma, precipitate of thawed FFP, contains factor VIII and fibrinogen. Indications: massive haemorrhage or uncontrolled bleeding e.g. haemophilia.
94
What is the treatment for neutropenic sepsis?
IV piperacillin with tazobactam (tazocin).
95
Transmission of which type of infection is most likely to occur following platelet transfusion?
Bacterial.
96
What does myelodysplastic syndrome encompass?
Anaemia, neutropenia, thrombocytopenia.
97
Myelodysplastic syndrome has an increased risk of developing into which cancer?
Acute myeloid leukaemia (AML).
98
What is the clinical presentation of myelodysplastic syndrome?
Anaemia - pallor, SOB, fatigue.
Neutropenia - infections.
Thrombocytopenia - purpura, bleeding, bruising.
99
Investigations for myelodysplastic syndrome?
FBC, blood film, bone marrow aspiration and biopsy.
100
What is the cause of myeloproliferative disorders?
Associated with JAK2 mutation causing uncontrolled proliferation of a single type of stem cell.
101
Myeloproliferative disorders can progress into which type of cancer?
AML.
102
Which diseases encompass myeloproliferative disorders and which cell lines do they affect?
Primary myelofibrosis - haematopoietic stem cells.
Polycythaemia vera - erythroid cells (EPO).
Essential thrombocythaemia - megakaryocyte.
103
What is myelofibrosis?
Proliferation of stem cells leads to fibrosis of bone marrow, causing anaemia and leukopenia. Extramedullary haematopoiesis in liver and spleen —> hepatosplenomegaly.
104
What are the clinical features of polycythaemia vera?
Conjunctival plethora, ruddy complexion, splenomegaly, headache and pruritis (after hot bath).
105
FBC results for polycythaemia?
Increased Hb and increased haematocrit.
106
FBC for thrombocythaemia?
Increased platelets.
107
Dry bone marrow aspiration…
Myelofibrosis.
108
Management of primary myelofibrosis?
Allogenic stem cell transplant, chemotherapy.
109
Management of polycythaemia vera?
Venesection, aspirin, chemotherapy.
110
Management of essential thrombocythaemia?
Aspirin, chemotherapy.
111
Define leukaemia
Uncontrolled proliferation of a single type of leukocyte.
112
What is the general presentation of leukaemia?
Fatigue, fever, petechiae, bruising, bleeding, infections, weight loss, SOB, night sweats, pallor, lymphadenopathy, hepatosplenomegaly.
113
Investigations for leukaemia?
FBC, blood film, LDH, bone marrow aspiration and biopsy, CXR, lymph node biopsy, lumbar puncture, CT, MRI, PET scans.
114
What is the general management for leukaemia?
Chemotherapy, steroids, radiotherapy, bone marrow transplant, surgery.
115
List some of the complications of chemotherapy
Immunodeficiency, neutropenic sepsis, secondary malignancy, infertility, tumour lysis syndrome.
116
The breakdown of cancer cells releasing intracellular contents into the blood, such as uric acid, K+ and phosphate, is called…
Tumour lysis syndrome.
117
What is the most common leukaemia in children?
Acute lymphoblastic leukaemia (ALL).
Peaks at 2-4 years old.
118
Down’s syndrome is associated with which type of leukaemia?
Acute lymphoblastic leukaemia (ALL).
119
ALL affects which type of cell?
B cells.
120
What are the clinical features of ALL?
Pancytopenia, lymphadenopathy, hepatosplenomegaly, bone pain.
121
What’s the most common translocation in ALL?
t(12;21).
122
What’s the most common leukaemia in adults overall?
Chronic lymphocytic leukaemia (CLL).
123
Which cells does CLL most commonly affect?
B cells.
124
What’s the average age of diagnosis for CLL?
72. Affects adults >55.
125
What are the clinical features of CLL?
Often asymptomatic - but can present with lymphadenopathy and B symptoms.
126
What is Richter’s transformation?
Transformation of CLL into a high-grade lymphoma.
127
A blood film for CLL would show…
Smear/smudge cells.
128
Describe the 3 stages of CML
Chronic phase - last 5 years, asymptomatic, incidental finding.
Accelerated phase - abnormal blast cells account for 10-20% of cells in blood and bone marrow, symptomatic.
Blast phase - >30% blast cells, severe symptoms, pancytopenia, fatal.
129
Philadelphia chromosome is associated with which type of leukaemia?
Chronic myeloid leukaemia (CML).
130
Which translocation creates the BCR-ABL gene in CML?
t(9;22).
131
Common presentation of CML
50&60s, B symptoms and hepatosplenomegaly.
132
What is the most common acute adult leukaemia?
Acute myeloid leukaemia (AML).
133
What would a blood film for AML show?
Myeloblasts with Auer rods in cytoplasm.
134
Define lymphoma
Uncontrolled proliferation of lymphocytes within the lymph nodes causing lymphadenopathy.
135
What is the age distribution for Hodgkin’s lymphoma?
Bimodal - 20&75 years old.
136
What type of cells are found in Hodgkin’s lymphoma biopsy?
Reed-Sternberg cells. Abnormally large B cells that have multiple nuclei (owl face).
137
Clinical presentation of lymphoma
Lymphadenopathy (non-tender, rubbery), B symptoms (weight loss, fever, night sweats), fatigue, itching, hepatosplenomegaly.
138
Investigations for lymphoma
FBC, LDH, lymph node biopsy (diagnostic), PET/CT, CXR, MRI.
139
Treatment for Hodgkin’s lymphoma
Chemotherapy - doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD).
Radiotherapy.
140
Are B or T cell lymphomas more common?
B cell.
141
Epidemiology of non-Hodgkin’s lymphoma
80-84 more commonly affected, but one of the more common cancers in young people.
142
Name some types of non-Hodgkin’s lymphoma
Burkitt lymphoma, MALT lymphoma, diffuse large B cell lymphoma, follicular lymphoma, mantle cell lymphoma.
143
What is Burkitt lymphoma?
High-grade, rapidly proliferating, B cell lymphoma, commonly affecting children.
144
MALT lymphoma is associated with what type of infection?
H.pylori
145
Common presentation of diffuse large B cell lymphoma
Rapidly growing painless mass in >65s.
146
Define myeloma
Abnormal proliferation of a single clone of plasma cells, resulting in large quantities of a single type of Ab being produced (monoclonal paraprotein).
147
Define monoclonal gammopathy of undetermined significance (MGUS)
Excess of a single type of Ab without other features of myeloma. Incidental finding and may progress to myeloma.
148
Define smouldering myeloma
Progression of MGUS with increased levels of Ab. Premalignant and more likely to progress to myeloma.
149
What’s the name for a subtype of smouldering myeloma with an excess of IgM?
Waldenstrom’s macroglobulinemia.
150
Which Ab is commonly found in myeloma?
IgG.
151
Light chains of Ab found in urine of myeloma patients are called…
Bence Jones protein.
152
What are the classical clinical features of myeloma?
Anaemia, osteolytic lesions, hypercalcaemia, renal failure (AKI), hyperviscosity and bacterial infections.
153
When should you suspect myeloma?
In anyone >60 with persistent bone pain, especially back pain or unexplained fractures.
154
List the investigations for myeloma
Initial: FBC, Ca2+, ESR, plasma viscosity.
Urine and serum protein electrophoresis, serum free light chains assay, serum immunoglobulins.
Bone marrow biopsy (diagnostic).
Imaging: MRI, CT, skeletal survey.
155
What characteristic feature of myeloma would you find on an X ray?
Raindrop skull - punched out lytic lesions.
156
Is myeloma curable?
No, it is incurable.
157
Management for myeloma?
Chemotherapy - bortezomid, thalidomide, dexamethasone.
Bisphosphonates.
158
Name the types of blood products, their storage and use
Red cells - stored at 4 degrees, correction of anaemia or blood loss.
Platelets - stored at room temperature, treatment of bleeding in platelet dysfunction.
Fresh frozen plasma - stored at -25 degrees, treatment of DIC, factor V deficiency, TTP, liver disease and massive haemorrhage.
159
Investigations for transfusion reaction?
Direct anti globulin test, ABO testing on post-transfusion sample, post-transfusion urinalysis.
160
Treatment of neutropenic sepsis?
Antibiotics —> infection.
G-CSF —> increase neutrophil count.
161
In patients with an inflammatory disorder, what will happen to their ferritin levels?
Raised (as ferritin is an acute phase protein).
162
In iron deficiency anaemia, is the total iron-binding capacity high or low?
High
163
In anaemia or chronic disease, is the total iron-binding capacity high or low?
Low/normal
164
What is the role of transferrin in iron metabolism?
Transport iron from body stores into tissues.
165
Once in the tissues, what is iron stored as?
Ferritin - a soluble iron store that is readily available.
166
How long can red cells, platelets and plasma be stored for?
Red cells - 35 days.
Platelets - 7 days.
Plasma - 3 years.
167
Name some complications of CLL
Anaemia, recurrent infections, warm autoimmune haemolytic anaemia, transformation to high grade lymphoma.
168
Describe the management of a sickle cell crisis
Analgesia, oxygen, IV fluids, +/- antibiotics (infection), +/- transfusion (low Hb).
169
What is the most common inherited clotting disorder?
Von Willebrand's disease
170
What is the gold standard investigation for diagnosis of sickle cell anaemia?
Hb electrophoresis
171
Describe the cause and presentation of acute haemolytic transfusion reaction
- Cause: ABO incompatibility.
- Presentation: fever, hypotension, red urine.
172
Describe the presentation of transfusion-related acute lung injury (TRALI)
Sudden onset dyspnoea, severe hypoxaemia, hypotension, fever.
173
Describe the presentation of an anaphylactic transfusion reaction
Itchy rash, angioedema, SOB, vomiting, lightheadedness, hypotension.
174
Anisocytosis on blood film
Variation in size of rbc - myelodysplasic syndrome.
175
Target cells on blood film
Iron deficiency anaemia and post-splenectomy.
176
Heinz bodies on blood film
G6PD deficiency and alpha-thalassaemia.
177
Howell-Jolly bodies on blood film
Post-splenectomy and severe anaemia.
178
Reticulocytes on blood film
Haemolytic anaemia.
179
Schistocytes on blood film
HUS, DIC, TTP, metallic heart valves and haemolytic anaemia.
180
Sideroblasts on blood film
Sideroblastic anaemia and myelodysplastic syndrome.
181
Smudge cells on blood film
CLL
182
Spherocytes on blood film
Autoimmune haemolytic anaemia and hereditary spherocytosis.
183
Myeloblasts with Auer Rods
AML
184
Describe the typical presentation of Von Willebrand disease
Unusually easy, prolonged or heavy bleeding - bleeding gums, epistaxis, menorrhagia.
FHx of heavy bleeding or VWD.
185
Haemophilia A vs B
A - deficiency in factor VIII
B - deficiency in factor IX
186
Which sex does haemophilia almost exclusively affect?
Males
187
Describe clinical presentation of haemophilia
Excessive bleeding or spontaneous haemorrhage e.g. intracranial, haematomas.
Spontaneous bleeding into joints (haemoathrosis) and muscles.
188
What is a complication of haemophilia treatment?
Formation of antibodies against the clotting factor resulting in the treatment becoming ineffective.
189
Hypersegmented neutrophils on blood film
B12/folate deficiency
190
Tear-drop poikilocytes on blood film
Myelofibrosis
191
Pencil poikilocytes on blood film
Iron deficiency anemia
192
List the poor prognostic signs in Hodgkin’s lymphoma
B-symptoms, increasing age, male sex, stage IV disease and lymphocyte depleted subtype.
193
Rouleaux formation on blood film
Myeloma - due to increased serum protein levels (such as immunoglobulins), resulting in the characteristic stacking of red blood cells resembling a stack of coins.
194
Irradiated blood products are used to avoid what?
Transfusion-associated graft versus host disease by destroying T cells.
195
What is the most common inherited thrombophilia?
Activated protein C resistance (Factor V Leiden).
196
Name some causes of inherited thrombophilia
Antiphospholipid syndrome.
Factor V Leiden.
197
What is the first line imaging investigation for multiple myeloma?
Whole body MRI
198
What is thrombophilia?
Conditions that predispose patients to develop blood clots.
199
How often is the pneumococcal vaccine given to patients with sickle cell disease?
Every 5 years
200
What is the threshold for a platelet transfusion?
- Platelet count of < 30 with clinically significant bleeding.
- Platelet count of < 100 with severe bleeding or CNS bleeding.
- Platelet count of < 10 and no active bleeding.
201
What are the contraindications for a platelet transfusion?
- Chronic bone marrow failure
- Autoimmune thrombocytopenia
- Heparin-induced thrombocytopenia
- Thrombotic thrombocytopenic purpura
202
Outline features of CML
- Anaemia.
- Massive splenomegaly —> sense of fullness/satiety.
- Increase in granulocytes at different stages of maturation.
203
Is HbA2 raised or reduced in beta thalassaemia major?
Raised
204
Prolonged APTT, normal PT and normal platelet count suggest what?
Deficiency in intrinsic pathway of coagulation cascade e.g. Haemophilia.
205
Prolonged PT and prolonged APTT suggest what?
A deficiency in extrinsic pathway e.g. factor VII and III.
206
Describe the difference in bleeding patterns for platelet disorders and coagulation disorders
- Platelet disorders (ITP, TTP, vWD): mucocutaneous bleeding e.g. nosebleeds, menorrhagia, bleeding gums.
- Coagulation disorders (haemophilias): joint/muscle bleeding, bleeding from trauma.
207
From what age should patients presenting with iron deficiency anaemia be investigated for colorectal cancer?
> 60
208
A ‘starry sky appearance’ on lymph node biopsy is pathognomonic for which lymphoma?
Burkitt lymphoma
209
With which blood product is most likely to cause an iatrogenic septicaemia with a Gram-positive organism?
Platelets
210
Iatrogenic infection with gram negative organisms is more likely with which blood product?
Packed red cells
211
What is the first line treatment for ITP?
Oral prednisolone
212
Bite and blister cells on blood film
G6PD deficiency
213
Deranged coagulation in sepsis
DIC
214
Define Richter’s transformation
When CLL transforms into a high-grade non-Hodgkin’s lymphoma
215
EMA binding test is used to diagnose what?
Hereditary spherocytosis
216
Outline the symptoms of acute haemolytic reaction
- Fever
- Abdominal pain
- Hypotension during blood transfusion
217
Describe the features of lead poisoning
- Abdominal pain
- Constipation
- Neuropsychiatric features
- Basophilic stippling
218
Aplastic crisis in patients with hereditary spherocytosis is triggered by what?
Parvovirus infection
219
Lab results for sideroblastic anaemia
- Hypochromic microcytic anaemia
- High ferritin iron & transferrin saturation
220
Treatment of cancer patients with VTE
DOAC for 6 months
221
Red blood cell transfusion threshold
- 70g/L
- Patients with ACS: 80g/L
222
Disproportionate microcytic anaemia
Beta-thalassaemia trait
223
In a non-urgent scenario, how quickly should RBC be transfused?
Over 90-120 mins
224
Retro-orbital headache, fever, facial flushing, rash and thrombocytopenia in a returning traveller
Dengue fever
225
Pancytopaenia 5 years post-chemotherapy/radiotherapy
?myelodysplastic syndrome
226
What is the universal donors for blood and FFP?
- Blood: O-
- FFP: AB-
227
What is the most common cause of neutropenic sepsis associated with central line infections?
Staphylococcus epidermidis
228
What is used in the prophylactic management of sickle cell anemia to prevent painful episodes?
Hydroxyurea
229
Blood test results in Von Willebrand’s disease
- Prolonged bleeding time
- APTT may be prolonged
230
What is the universal plasma?
AB
