Haematology

Question 1

What is normal adult haemoglobin made of?

Answer 1

2 alpha and 2 beta chains.

Question 2

What is foetal haemoglobin made of?

Answer 2

2 alpha and 2 gamma chains.

Question 3

What is haemoglobin S?

Answer 3

Haemoglobin S is a variant of Hb arising from a point mutation in the beta globin gene. The mutation leads to a single amino acid change, valine -> glutamine.

Question 4

What organs are responsible for removal of RBC’s?

Answer 4

1. Spleen.
2. Liver.
3. Bone marrow.
4. Blood loss.

Question 5

Give 5 causes of iron deficiency.

Answer 5

1. Blood loss.
2. Poor absorption.
3. Decreased intake in diet.
4. Hook worm!
5. Breastfeeding, low iron in breast milk.

Question 6

Give 3 symptoms of anaemia.

Answer 6

1. Fatigue.
2. Faintness.
3. Breathlessness.
4. Reduced exercise tolerance.

Question 7

What hormone is responsible for regulating RBC production?

Answer 7

Erythropoietin.

Question 8

What stimulates EPO?

Answer 8

Tissue hypoxia.

Question 9

What is neutrophilia?

Answer 9

Too many neutrophils.

Question 10

Where are platelets produced?

Answer 10

In the bone marrow. They are fragments of megakaryocytes.

Question 11

What hormone regulates platelet production?

Answer 11

Thrombopoietin - produced mainly in the liver.

Question 12

What is the lifespan of a a platelet?

Answer 12

7 - 10 days.

Question 13

What organ is responsible for platelet removal?

Answer 13

The spleen.

Question 14

What can cause platelet dysfunction.

Answer 14

1. Reduced platelet number (thrombocyotpenia).
2. Reduced platelet function.

Question 15

Give 4 causes of bleeding.

Answer 15

1. Trauma.
2. Platelet deficiency e.g. thrombocytopenia.
3. Platelet dysfunction e.g. aspirin induced.
4. Vascular disorders.

Question 16

Give 5 signs/symptoms of hypercalcaemia.

Answer 16

1. Confusion.
2. Bone pain.
3. Constipation.
4. Nausea.
5. Abdominal pain.

Question 17

What might you see in the ECG taken from someone with hypercalcaemia.

Answer 17

Shortened QT interval.

Hypercalcaemia = risk of MI.

Question 18

What is the treatment for hypercalcaemia?

Answer 18

IV hydration and bisphosphonates.

Question 19

What does rituximab target?

Answer 19

Targets CD20 on the surface of B.

Question 20

What is the commonest cause of microcytic anaemia?

Answer 20

Iron deficiency.

Question 21

What is the affect of sickle cell anaemia on reticulocyte count?

Answer 21

Reticulocyte count is raised.

Question 22

Why is reticulocyte count raised in sickle cell anaemia?

Answer 22

Sickle cell disease is haemolytic, there is increased degradation of RBC’s. Production therefore increases in order to keep up with degradation and so reticulocyte count is raised.

Question 23

What clotting factors depend on vitamin K?

Answer 23

2, 7, 9 and 10.

Question 24

What kind of anaemia could methotrexate cause?

Answer 24

Macrocytic due to folate deficiency.

Question 25

Give 4 causes of folate deficiency.

Answer 25

1. Dietary. 2. Malabsorption. 3. Increased requirement e.g. in pregnancy. 4. Folate antagonists e.g. methotrexate.

Question 26

Give 3 things that can cause coagulation disorders.

Answer 26

1. Vitamin K deficiency. 2. Liver disease. 3. Congenital e.g. haemophilia.

Question 27

How does warfarin work?

Answer 27

It antagonises vitamin K and so you get a reduction in clotting factors 2, 7, 9 and 10.

Question 28

How does heparin work?

Answer 28

It activates antithrombin which then inhibits thrombin and factor Xa.

Question 29

Give 5 risk factors for DVT.

Answer 29

1. Increasing age. 2. Obesity. 3. Pregnancy. 4. OCP (hyper-coagulability). 5. Major surgery. 6. Immobility. 7. Past DVT.

Question 30

Give 3 symptoms of DVT.

Answer 30

Unilateral warm, tender, painful, swollen leg.

Question 31

What forms the differential diagnosis for a DVT?

Answer 31

Cellulitis.

Question 32

What investigations might you do in someone to see if they have a DVT?

Answer 32

1. D-dimer in those patients with a low clinical probability. 2. US compression.

Question 33

What is the name of the score used to determine someones probability of having a DVT?

Answer 33

The Wells score.

Question 34

The Wells score determines someones clinical probability of having a DVT. Give 3 factors the score takes into account.

Answer 34

1. Active cancer. 2. Recently bedridden or major surgery. 3. Tenderness along deep venous system. 4. Swollen leg/calf. 5. Unilateral pitting oedema.

Question 35

Describe the management for a DVT.

Answer 35

Aim of management is to prevent a PE! - Anticoagulants e.g. warfarin/heparin.

Question 36

Where would you normally take a bone marrow biopsy from?

Answer 36

Posterior iliac crest.

Question 37

What is the most important medical treatment for DVT prophylaxis?

Answer 37

LMWH.

Question 38

What is the difference between Raynaud's disease and Raynaud's phenomenon?

Answer 38

Raynaud's disease is idiopathic. Raynaud's phenomenon can be due to SLE, scleroderma, RA, drugs e.g. beta blockers.

Question 39

Describe the pathophysiological mechanism behind Raynaud's disease.

Answer 39

Peripheral digital ischaemia due to intermittent spasm in arteries that supply the fingers/toes. Precipitated by cold/stress.

Question 40

Describe the colour changes that are seen in Raynaud's.

Answer 40

- Pale - due to vasoconstriction. - Cyanotic - due to deoxygenation. - Red - due to hyperaemia.

Question 41

Describe the treatment for Raynaud's disease.

Answer 41

1. Physical protection. 2. Vasodilators. 3. Nifedipine (CCB). 4. Stop smoking.