Haematology

Question 1

Thrombotic thombocytopaenic purpura

?signs

Answer 1

Fever, neuro signs, thrombocytopaenia, haemolytic anaemia, renal failure

Question 2

Factor V Leiden

Answer 2

Most common inherited Thrombophilia

Activated protein C resistance

Question 3

Anti-phospholipid syndrome

Answer 3

Arterial and venous thrombosis
Foetal loss
Thrombocytopaenia

Question 4

Basophilic stippling (conditions)

Answer 4

Heavy metal poisoning e.g. lead
Myelodysplastic syndrome

Question 5

Heinz bodies

Answer 5

G6PD deficiency
Removed by spleen resulting in bite cells

Question 6

Howell-Jolly bodies

Answer 6

Hyposplenism e.g coeliac disease

Question 7

Target cells

Answer 7

Hyposplenism e.g coeliac disease

Question 8

Acanthocytes

Answer 8

Hyposplenism e.g coeliac disease

Question 9

Immune thrombocytopenia (ITP)

Antibodies against…
Signs/symptoms
Treatment

Answer 9

Antibodies against glycoprotein IIa/IIIb or Ib-V-IX complex

Purpura, petechiea, bleeding (eg epistaxis)

Oral prednisolone

Question 10

Low haemoglobin 2/52 post-transfusion
Positive direct antiglobulin test
Raised unconjugated bilirubin
Reticulocytosis
High LDH

Answer 10

Delayed transfusion reaction

Question 11

Factor V Leiden prevalence

Answer 11

5%

Question 12

TTP - cells seen on film

Answer 12

Fragmented cells

Question 13

central cyanosis (blue lips, nails, body)
Steel-grey complexion
Elevated/normal pO2 but low saturations

Answer 13

Methaemoglobinaemia

Question 14

Left shift of oxygen dissociation curve

Answer 14

Increased binding affinity with decreased release into the tissues

Question 15

Hypersegmented neutrophils

Answer 15

Vitamin B12 deficiency

Question 16

Microangiopathic haemolytic anaemia = non-immune haemolytic anaemia (Coombs negative)

Causes

Answer 16

DIC
TTP
HUS
Atypical HUS

Question 17

Haemolytic uraemic syndrome

Features

Answer 17

Abdominal pain, bloody diarrhoea -> Shiga toxin
AKI
Haemolytic anaemia
Coombs test negative

Question 18

Atypical uraemic syndrome

Features

Answer 18

Diarrhoea/abdo symptoms not present
AKI
Haemolytic anaemia
Coombs test negative

Question 19

TTP

Answer 19

Haemolytic anaemia
Coombs test negative
Neurological symptoms
GI symptoms
AKI can occur but is rare

Question 20

Paroxysmal nocturnal haemoglobinuria

diagnostic test

Answer 20

flow cytometry of blood to detect low levels of CD59 and CD55

Question 21

TTP treatment

Answer 21

Plasma exchange

Question 22

Medication used in prevention of sickle cells crises

Answer 22

Hydroxycarbamide

Question 23

Immune thrombocytopaenia (ITP)

Features
Treatment

Answer 23

Thrombocytopaenia

Platelet >30, nil effects - observation
Platelet <30 or effects on daily life - Oral prednisolone

Life threatening/organ threatening bleeding - platelet transfusion, IV methylpred, IV Immunoglobulin

Question 24

Most common haemophilia

Answer 24

Haemophilia A

Question 25

Haemophilia A

Affects what test and clotting factor?

Answer 25

APTT - intrinsic
Factor VIII

Question 26

smudge cells

Answer 26

CLL

Question 27

Basophilic stippling

Answer 27

Lead poisoning
Beta-thalassaemia

Question 28

Leukemoid reaction vs CML

Answer 28

Leukemoid reaction
- high leucocyte alkaline phosphatase
- toxic granulation (dohle bodies) in WC
- ‘left shift’ of neutrophils

CML
- cytogenics = presence of Philadelphia chromosome

Question 29

Hereditary spherocytosis

Investigation of choice

Answer 29

EMA binding test

Question 30

G6PD deficiency haemolysis

Investigation of choice

Answer 30

Beutler fluorescent spot test

Question 31

low ADAMTS13

diagnosis

Answer 31

TTP