Haematology

Question 1

Polycythaemia differentials (7)

Answer 1

-Dehydration
-Polycythaemia vera (or other myeloproliferative disorders)
-COPD
-OSA
-High altitude
-EPO producing tumours e.g renal cell carcinoma, HCC)
-Androgen (steroid) use

Question 2

Polycythaemia investigations (initial (6) + secondary)

Answer 2

Initial -
FBE
UEC
LFT
Iron studies
O2 sats
EPO level

Secondary - JAK2/BCR ABL, sleep study, abdo USS (EPO tumours), TTE, CXR, Hb electrophoresis)

Question 3

Easy bleeding DDx (7)

Answer 3

○ Inherited bleeding disorder
§ Von Willebrand disease
§ Platelet function defect
§ Haemophilia
○ Acquired bleeding disorder
§ Liver/renal disease
§ NSAID use
§ Acquired haemophilia
§ Bone marrow failure

Question 4

Thrombocytopenia Aetiology (8 categories)

Answer 4

○ Pregnancy (mild)
○ Medications- heparin, tetracyclines, vancomycin, penicillin, cephalosporins, trimethoprim, NSAIDs
-ITP
-Infection (viral, rickets, H.pylori, malaria, sepsis)
○ Chronic liver disease
○ Autoimmune conditions (SLE)
○ Haematological malignancy/chemo
○ Pseudo-thrombocytopenia - platelet clumping

Question 5

next step - if a woman has thal gene abnormalities?

Answer 5

Need to test father to assess foetal risk of clinically significant haemoglobinopathy

Question 6

Thalassaemia - NTDT women - things to note (3)

(non-transfusion dependant thal)

Answer 6

-May become severely anaemic during pregnancy
-Trasnfusion threshold dependant on symptoms rather than Hb count
-Check Hb monthly during pregnancy

Question 7

1st line imaging Ix for ?multiple myeloma

Answer 7

Whole body low dose skeletal survey (XR) OR low dose CT skeletal survey