Haematology

Question 1

Bloods in keeping of a iron def

Answer 1

Low ferritin - the intracellular store (can be raised slightly after acute illness)
Low serum iron - the extra cellular stores (variable, like INR - more affective by random things
Low transferrin sat - calculated from TIBC + iron = falls in def
High transferrin - the transported, trying to transport iron

Question 2

What are beans, nuts, dried foot, whole grains, fortified cereals, dark green veg good source of

Answer 2

Iron

Question 3

Guide for iron supplement

Answer 3

Take on an empty stomach
Recheck in 1 month - aiming 10-20g/l
If improvement - continue, recheck Hb. Once normal = for further 3months then stop
Low - adherence check, consider referral

Question 4

How is the majority of B12 absorbed

Where is folate

Answer 4

Through IF - then at duodenum and small bowl/ileum

Terminal ileum and liver

Macroyostisis - but 1/4 will have normal MCV

Question 5

What might anaemia, gloss it is and parathesia indicate

when do you recheck levels

Tx

Answer 5

B12 deficiency (control normal folate prior)

10 days

LOW levels = start Tx then check anti-instructions factor
Normal but still suspicious = start Tx + check second line tests

Intrinsic factor antibodies are a food rule in test (specific) but not a rule out (sensitive - only 50% will be positive)

Non-diet (PA, coeliac, IBD) = IM hydroxococbalamin 1mg 3x a week for 2 weeks
Then 2-3monthly for life

Diet = oral supplements of BD yearly injection
Increase meat, cod, eggs, milk, diary
Reflect FBC in 2 weeks, b12 6 months

Question 6

Different cause of high MCV

Answer 6

Alcohol, liver disease, methotrexate, azothiprine, pregnancy (hence normal MCV in iron def)

Question 7

What are asparagus, broccoli, brown rices, sprouts, chickpeas good source of

Duration of tx

Some drugs causes

Answer 7

Folic acid

5mg for 4 months

Trimethoprim, alcohol ,anticovulsatns, methotrexate

Question 8

What parts of the FBC might indicate malignancy

Answer 8

MCV +/- low Hb - colorectal, lung ca
Thrombocytosis (platete >400) - LEGO-C - lung, endometrial, gastric, oesophageal, colorectal

Question 9

Causes of thrombocytosis

Answer 9

Iron deficiency, infection (bacterial), rheumatoid, surgery/trauma, hyposlenism, splenectomy

Myeloproliferative neoplasms (essential thrombocythaemia, PCV,

LEGO-C

Question 10

Causes of low platelets

Answer 10

Reduction production = BM failure, megblastic anaemia (myelodysplasic syndrome), alcohol

Reduce survival = preg, ITP, viral, DIP, TTP, hyper splenic

Heparin

Omeprazole, Fursomide, quinine, trimethorprim

Question 11

> 60yr + persistent bone pain (particularly back pain) or unexplained fracture or hypercalcaemia or leucopenia

> 60y with renal dysfunction and anaemia

Answer 11

Consider myeloma screen

Question 12

What are some of the complications of myeloma

Answer 12

Complications are consequent to paraproteinaemia: kidney failure, peripheral neuropathy, hyper-viscosity leading to thromboembolism, cognitive problems

Question 13

What is the paraprotien cut of for urgent Is fro myeloma

Answer 13

> 30

Question 14

Rate of conversion myeloma from MGUS

Answer 14

1%

Question 15

Treatment course for B12 def
- when repeat FBC
- different between diet and non-diet related
- what if neuro symptoms

Answer 15

1mg IM three times a week for 2 weeks
Then 1mg every 2-3months
Repeat FBC on day 10

Maintenance treatment with hydroxocobalamin 1 mg intramuscularly every 3 months for life — where B12 deficiency is not thought to be diet related.
Maintenance treatment with oral cyanocobalamin tablets or a twice-yearly hydroxocobalamin 1 mg injection — where vitamin B12 deficiency is thought to be diet related.

neuro sym = urgent haem

Question 16

Warfarin reversal
- INR 6, with minor bleed ?

Answer 16

Stop, give IV warfarin, restart when warfarin less than 5

Question 17

osmotic fragility test is useful for diagnosis of?

Answer 17

The hereditary spherocytic hemolytic anemia.
Spherocytes are osmotically fragile cells that rupture more easily in a hypotonic solution than do normal RBCs

Question 18

what are some causes of folate deficiency
6 drugs

Answer 18

Drugs — alcohol, anticonvulsants, nitrofurantoin, sulfasalazine, methotrexate, trimethoprim.
Excessive requirements in pregnancy, malignancy, blood disorders, or malabsorption.
Excessive urinary excretion.
Liver disease

Question 19

what are the rules for Hb and reticuloytes monitoring in folate and b12 def

Answer 19

1. Perform a full blood count and reticulocyte count:
   Within 7–10 days of starting treatment.
   A rise in the haemoglobin level and an increase in the reticulocyte count to above the normal range indicates that treatment is having a positive effect.
   If there is no improvement, check serum folate level (if this has not been done already).
2. After 8 weeks of treatment, and also measure iron and folate levels.
   The mean cell volume (MCV) should have normalised.
3. On completion of folic acid treatment to confirm a response. (3month)

No need yearly check unless symptoms