Haematology

Question 1

Initial treatment of acute promyelocytic leukaemia?

Answer 1

All-trans retinoic acid (APML); promotes maturation of promyelocytes, alleviating the symptoms ofDIC.

Question 2

In CLL, why do patients get recurrent infections?

Answer 2

Reduction in immuunoglobulins

Question 3

Anaphylactic/ allergic transfusion reaction

Answer 3

Type 1 hypersensitivity; recipients mast cells react to plasma proteins

Question 4

Acute haemolytic transfusion reaction

Answer 4

Usually due to ABO mismatch
e.g. recipient has type A blood and is given type B blood. Recipient will have Abs against B and cause intravascular haemolysis –> Jaundice and AKI
Can happen immediantly or up to 24 hours post transfusion.

Question 5

Delayed haemolytic transfusion reaction

Answer 5

> 24 hours post transfusion
Usually due to Rh incompatibility
Recipient must have been exposed to these antigen previously, i.e. prev pregnancy/ transfusion
Extravascular haemolysis as happens in the RES

Question 6

Febrile nonhaemolytic transfusion reaction

Answer 6

Fever following blood transfusion due to cytokine release or type II hypersensitivity reaction (Donor HLA reacts with recipient antibodies and causes release of cytokines)

Question 7

How can reduce risk of Febrile nonhaemolytic transfusion reaction?

Answer 7

Remoce leukocytes from donor blood prior to transfusion (Leukoreduction)

Question 8

TRALI

Answer 8

Within minutes to 6 hours
Trauma causes recruitments of neutrophils to lungs e.g. in sepsis. Then patient given tranfusion and neutrophils release ++ cytokines which increase pulmonary capillary permeability –> non cardiogenic pulmonary oedema –> resp distress

Question 9

TACO

Answer 9

Fluid overload after transfusion
Treat with diuretics

Question 10

How does desmopressin work in haemophilia treatment?

Answer 10

Promotes release of stores vWF and factor VIII

Question 11

What should you check for when you suspect ITP?

Answer 11

HIV and Hep C

Question 12

CD19 CD20 positive

Answer 12

B cells

Question 13

t(11;14)

Answer 13

Mantle cell lymphoma

Question 14

Graft vs host disease

Answer 14

HLA mismatch; if non-irradiated blood is given to immunocompromised e.g. lymphoma patients–> fever, diarrhoea, rash, deranged LFTs

Question 15

CML treatment

Answer 15

Imatinib

Question 16

Warfarin increases…

Answer 16

INR/PT

Question 17

Warfarin MOA

Answer 17

Vitamin K antagonist
Inhibits synthesis of factors 2, 7, 9 10 and protein c

Question 18

Heparin MOA

Answer 18

Activates antithrombin III which binds to and inhibits factor X

Question 19

Heparin increases….

Answer 19

APTT and anti-factor Xa

Question 20

DOAC MOA

Answer 20

Inhibits activated factor Xa

Question 21

DOAC increases

Answer 21

APTT

Question 21

DOAC increases

Answer 21

APTT

Question 22

Reptilase time is used for…

Answer 22

Determining if heparin is in the sample.
It is similar to thrombin but resistant to inhibition by antithrombin III, so the reptilase time is not prolonged in samples containing heparin.