Haematology

Question 1

Examples of significant bleeding: grade 2

Answer 1

Haematemesis, malaena, prolonged epistaxis

Question 2

Examples of severe bleeding: grades 3,4

Answer 2

CNS, airway, abdo, intraarticular, intramuscular

Question 3

Platelet threshold for transfusion in grade 2 bleed

Answer 3

<30

Question 4

Platelet threshold for transfusion in grade 3, 4 bleed

Answer 4

<100

Question 5

When do you tranfuse most patients who are thrombocytopaenic before surgery?

Answer 5

> 50

Question 6

When do you tranfuse patients at high risk of bleeding who are thrombocytopaenic before surgery?

Answer 6

50-75

Question 7

When do you tranfuse patients who are thrombocytopaenic before surgery at a critical site?

Answer 7

> 100

Question 8

When is fresh frozen plasma indicated and whats the universal donor?

Answer 8

Abnormal PT or APTT

AB blood

Question 9

When is cryoprecipitate indicated?

Answer 9

Low fibrinogen (<1.5) e.g. DIC and liver failure

Question 10

Management of antiphospholipid syndrome?

Answer 10

Primary thromboprophylaxis: low-dose aspirin
Secondary thromboprophylaxis: warfarin

Question 11

Platelets, fibrinogen, PT, and APTT in DIC

Answer 11

Low platelets and fibrinogen
High PT and APTT

Question 12

DIC treatment

Answer 12

Platelet transfusion if platelets below 20
FFP if fibrinogen is low

Question 13

Specific test for autoimmune haemolytic anaemia

Answer 13

Positive DAT (Coombs’)

Question 14

What usually causes haemolytic uraemic syndrome?

Answer 14

Shiga toxin-producing E. coli

Question 15

What blood changes seen HUS?

Answer 15

Microangiopathic haemolytic anaemia, thrombocytopaenia, schistocytes

Question 16

HUS management

Answer 16

Supportive e.g. fluids, blood transfusion
No antibiotics

Question 17

Abnormal blood test in haemophilia, and factors affected in A and B?

Answer 17

Prolonged APTT
A - factor 8
B - factor 9

Question 18

ITP laboratory findings

Answer 18

Isolated thrombocytopaenia with normal coagulation

Question 19

ITP management

Answer 19

1) Oral predinsolone
2) IVIG

Question 20

Leukaemia with testicular and thymic enlargement

Answer 20

ALL

Question 21

Genetic syndrome associated with acute leukaemia

Answer 21

Down’s

Question 22

Auer rods leukaemia

Answer 22

AML

Question 23

Most common leukaemia in the west

Answer 23

CLL

Question 24

Leukaemia mostly diagnosed on routine bloods, with symmetrical painless lymphadenopathy?

Answer 24

CLL

Question 25

Leukaemia with Philadelphia chromosome

Answer 25

CML

Question 26

Richter's transformation

Answer 26

CLL to large cell lymphoma

Question 27

Hodgkin's lymphoma associated sex and virus

Answer 27

Males EBV

Question 28

Most common lymphoma

Answer 28

Non-Hodgkin's

Question 29

Treatment for B cell and T cell lymphoma

Answer 29

B - Rituximab T - Alemtuzumab

Question 30

Multiple myeloma diagnosis

Answer 30

Narrow gamma band in serum electrophoresis Bence-Jones protein in urine

Question 31

What does FBC, U&Es and bone profile show for multiple myeloma?

Answer 31

Anaemia Renal failure (high creatinine) Hypercalcaemia

Question 32

How does myelodysplasia present on FBC and what cancer can it progress to?

Answer 32

Anaemia, neutropaenia, thrombocytopaenia AML

Question 33

Patient has pruritus, splenomegaly, thrombosis, and low ESR. What is the mutation seen in 95% of patients?

Answer 33

JAK2 (polycythaemia vera)

Question 34

Polycythaemia vera management

Answer 34

Aspirin Venesection Hydroxyurea

Question 35

Young patient has failure to thrive, hepatosplenomegaly, microcytic anaemia, HbA2 and HbF raised. Condition?

Answer 35

Beta-thalassaemia major

Question 36

What causes TTP?

Answer 36

Deficiency of ADAMTS13 Can't break down long strands of vWF (platelets clumping) RBCs are cute up

Question 37

TTP blood change apart from thrombocytopaenia

Answer 37

Microangiopathic haemolytic anaemia

Question 38

Most common inherited bleeding disorder

Answer 38

vWD

Question 39

vWD bloods

Answer 39

Prolonged bleeding time APTT may be prolonged Factor 8 reduced

Question 40

vWD management

Answer 40

Tranexamic acid Desmopressin (raises vWF) Factor 8 concentrate

Question 41

Which sickle cell crisis is associated with a reduced reticulocyte count?

Answer 41

Aplastic crisis

Question 42

Which sickle cell crisis is associated with an increased reticulocyte count?

Answer 42

Sequestraiton crisis

Question 43

When is an exchange transfusion indicated in sickle cell crisis?

Answer 43

Acute vaso-occlusive e.g. stroke, acute chest syndrome, multiorgan failure, splenic sequestration crisis

Question 44

What analgesia is required for sickle cell crisis?

Answer 44

IV opiates