Haematology

Question 1

Why can PPIs reduce iron absorbtion

Answer 1

Need acid to keep iron in soluble fe2+ form

Question 2

4 Main causes of iron deficiency

Answer 2

Blood loss, Dietary insufficiency, poor absorption, pregnancy (requirements)

Question 3

Microcytic anaemia causes

Answer 3

T - Thalassaemia
A - Anaemia of chronic disease
I - Iron deficiency
L - Lead poisoning
S - Sideroblastic anaemia

Question 4

Causes of normocytic anaemia

Answer 4

3 As, 2 Hs
A - Acute blood loss
A - Anaemia of chronic disease
A - Aplastic anaemia
H - Haemolytic anaemia
H - Hypothyroidism

Question 5

Causes of Macrocytic anaemia (megaloblastic)

Answer 5

B12 deficiency
Folate deficiency

Question 6

Causes of macrocytic anaemia (normoblastic)

Answer 6

Alcohol
Reticulocytosis
Hypothyroid
Liver disease
Drugs (e.g. azathioprine)

Question 7

First line mx for iron deficiency anaemia

Answer 7

1. Correct cause
   Then depending on severity either:
   - Blood transfusion (corrects anaemia not deficiency)
   - Oral ferrous sulfate tablets.

Question 8

Name 5 Inherited Haemolytic anaemias (HHTSG)

Answer 8

Hereditary Spherocytosis
Hereditary Elliptocytosis
Thalassaemia
Sickle cell anaemia
G6PD deficiency

Question 9

5 Acquired haemolytic anaemias (AAPMP)

Answer 9

Autoimmune haemolytic anaemia
Alloimmune haemolytic anaemia (tranfusion reactions + rhesus shenanigans)
Paroxysmal nocturnal haemoglobinuria
Microangiopathic Haemolytic anaemia
Prosthetic valve related haemolysis

Question 10

Features of haemolytic anaemia

Answer 10

Anaemia
Splenomegaly (full of dead blood cells)
Jaundice (loads of bilirubin)

Question 11

Investigations for haemolytic anaemia

Answer 11

FBC
Blood film
Direct coombs test

Question 12

Describe hereditary spherocytosis + classic presentation

Answer 12

Sphere shaped RBCs that are easily destroyed, presents with jaundice, gallstones, splenomegaly & aplastic crisis (parvovirus)

Question 13

Management of hereditary spherocytosis

Answer 13

Folate supplementation + splenectomy

Question 14

Describe hereditary elliptocytosis

Answer 14

Same as spherocytosis but instead of sphere shaped RBCs are ellipse shaped

Question 15

Commonest leukaemia in kids

Answer 15

ALL

Question 16

Blood film for ALL + associated disease

Answer 16

Circulating lymphoblasts with little cytoplasm, associated with Down syndrome.
Good prognosis

Question 17

Commonest leukaemia in adults

Answer 17

AML + CLL

Question 18

Blood film of AML + associated disease

Answer 18

Auer rods in cytoplasm
Commonly transforms from other disorders e.g. myelofibrosis + polycythaemia)

Question 19

Complications of AML

Answer 19

Leukostasis & Tumour lysis syndrome

Question 20

Commonest leukaemia in adults

Answer 20

CLL

Question 21

Blood film CLL

Answer 21

Smear/smudge cells, richters transformation

Question 22

Rarest leukaemia

Answer 22

CML

Question 23

Blood film of CML

Answer 23

Eoisinophilia, basophilia, immature granulocytes

Question 24

Chromosome commonly present in CML

Answer 24

Philadelphia chromosome

Question 25

Lymphoma presentaion

Answer 25

Fatigue, pruittus, non tender lymphadenopathy, cough, SOB, recurrent infections.

Question 26

Hodgkins lymphoma cell finding

Answer 26

Reed sternberg cells (Googly eyes)

Question 27

Hodgkins vs non-hodgkins

Answer 27

Hodgkins have better prognosis however less common.

Question 28

Non-hodgkins lymphoma risk factors

Answer 28

EBV, HIV, H. Pylori.

Question 29

What is myeloma

Answer 29

Cancer of plasma cells

Question 30

Myeloma on blood film

Answer 30

Rouleax formation, RBCs stick together

Question 31

Diagnosis of myeloma

Answer 31

Inc plasma cells on biopsy, monoclonal paraprotein, evidence of end organ damage Calcium Renal failure Anaemia Bone pain & lesions

Question 32

Most common monoclonal paraprotein in myeloma

Answer 32

IgG

Question 33

Thrombotic inherited clotting disorder (most common clotting disorder)

Answer 33

Factor V leiden Factor V cant be broken down by APC More clotty

Question 34

Acquired thrombotic clotting disorder

Answer 34

Antiphospholipid syndrome C coagulation defect L Livedo reticularis (mottled skin) O obstetric complications T Thrombocytopenia

Question 35

Test for antiphospholipid syndrome

Answer 35

Anticardiolipin antibodies

Question 36

Haemorrhagic inherited clotting disorder

Answer 36

Von willebrand disease (dont treat) Haemophilias (x-linked recessive) most pts boys A - factor 8 B - factor 9

Question 37

Haemorrhagic acquired clotting disorder

Answer 37

Liver disease (less clotting factors produced) DIC (sepsis, trauma, pregnancy all causes) use up clotting factors so give heparin + consider platelets

Question 38

What clotting disorder associated with SLE

Answer 38

Antiphospholipid syndrome

Question 39

Reactions to transfusion

Answer 39

Febrile non-haemolytic, TACO, TRALI

Question 40

What is TACO

Answer 40

Transfuision associated circulatory overload Acute LVF too much fluid or given too quickly. Mx, diuretics, oxygen, STOP

Question 41

What is TRALI

Answer 41

transfusion related acute lung injury Within 6 hrs of transfusion ARDS, cough, SOB, Batwing on CXR Mx, stop transfusion, senior help, supportive

Question 42

Inheritance pattern of thalassaemia

Answer 42

Autosomal recessive

Question 43

What is sickle cell disease

Answer 43

RBCs normal until they are stressed (hypoxia, infection, cold etc) then will transform to sickle shape.

Question 44

Sickle cell prevents what

Answer 44

Malaria, therefore selective pressure for sickle cell

Question 45

Complicatipns of sickle cell

Answer 45

Vaso-occlusive crisis, can block microcirculation anywhere => pain and ischaemia. Aplastic crisis, temporary cessation of erythropoeisis Sequestration crisis, sudden splenomegaly due to haemorrhage within it

Question 46

Mx of sickle cell

Answer 46

Preventative Prevent triggers Prevent infection etc