Haematology

Question 1

Peripheral signs of iron deficiency anaemia

Answer 1

Pale
Koilonychia (spoon shaped nails)
Atrophic glossitis
Angular cheilitis (cracked, sore skin at edges of mouth)
Brittle hair and nails

Question 2

Pathology of pernicious anaemia

Answer 2

Autoimmune condition where antibodies form against the parietal cells or intrinsic factor. A lack of intrinsic factor prevents the absorption of vitamin B12 and the patient becomes vitamin B12 deficient.

Question 3

Key symptom of pernicious anaemia

Answer 3

Peripheral neuropathy (i.e pins and needles)

Question 4

Treatment for pernicious anaemia

Answer 4

In pernicious anaemia oral replacement is inadequate because the problem is with absorption rather than intake.

They can be treated with 1mg of intramuscular hydroxycobalamin 3 times weekly for 2 weeks, then every 3 months.

Question 5

Treat B12 or folate deficiency first?

Answer 5

Important to treat the B12 deficiency first before correcting the folate deficiency. Treating patients with folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord.

Question 6

Common complication of hereditary spherocytosis

Answer 6

Aplastic crisis in the presence of the parvovirus

Question 7

Triggers for G6PD crises

Answer 7

Infections, medications or fava beans (broad beans).

Medications = primaquine (an antimalarial), ciprofloxacin, sulfonylureas, sulfasalazine and other sulphonamide drugs.

Question 8

What is tumour lysis syndrome? Effects on blood results.

Answer 8

Tumour lysis syndrome is caused by the release of uric acid from cells that are being destroyed by chemotherapy.

The uric acid can form crystals in the interstitial tissue and tubules of the kidneys and causes acute kidney injury.

Other chemicals such as potassium and phosphate are also released so these need to be monitored and treated appropriately. High phosphate can lead to low calcium, which can have an adverse effect, so calcium is also monitored.

Question 9

How is tumour lysis syndrome prevented?

Answer 9

Allopurinol or rasburicase are used to reduce the high uric acid levels.

Question 10

Sickle cell crisis management

Answer 10

The main components for managing sickle cell crisis should be analgesia, oxygen, and IV fluids. You can also consider antibiotics if you suspect an infection, and transfusion if the Hb is low

Question 11

DVT treatment

Answer 11

DOAC

Question 12

Fever, abdominal pain, hypotension during a blood transfusion –>

Answer 12

Acute haemolytic reaction

Question 13

Hodgkin’s lymphoma with best prognosis

Answer 13

= lymphocyte predominant

Question 14

Empirical antibiotic of choice for neutropenic sepsis

Answer 14

Pip-taz

Question 15

Blood transfusion risk in patient with low IgA

Answer 15

Patients with a low IgA count are much more likely to have anti-IgA antibodies in their blood.

This means that when foreign IgA antibodies are encountered in the transfused blood, the patient’s anti-IgA antibodies mount an immune response causing an anaphylactic reaction.

Question 16

Treating anaphylactic blood transfusion reaction

Answer 16

Anaphylactic reaction to blood transfusion should be immediately treated with IM adrenaline, corticosteroids, antihistamines, bronchodilators, supportive care and the transfusion terminated.

Question 17

Positive lab results for tumour lysis syndrome

Answer 17

Positive laboratory TLS requires 2 or more of the below within 7 days of chemotherapy or 3 days before:
uric acid > 475umol/l or 25% increase
potassium > 6 mmol/l or 25% increase
phosphate > 1.125mmol/l or 25% increase
calcium < 1.75mmol/l or 25% decrease

Question 18

Positive clinical results for tumour lysis syndrome

Answer 18

Positive clinical TLS requires any one of:
increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure

Question 19

DIC management

Answer 19

The RCOG has provided guidance on management of disseminated intravascular coagulation (Green-top Guideline No.63).

It states that ‘Clotting studies and a platelet count should be urgently requested and advice from a haematologist sought. Up to 4 units of FFP and 10 units of cryoprecipitate may be given whilst awaiting the results of the coagulation studies.’

Since cryoprecipitate is not an option, FFP as the first-line therapy is the correct answer.

Question 20

Investigation for myeloma

Answer 20

The immunoglobulin produced by dysplastic plasma cells shows up as a monoclonal band on serum electrophoresis.

Question 21

CML vs AML

Answer 21

CML is characterized by anaemia, splenomegaly, and an increase in granulocytes at different stages of maturation, occasionally accompanied by thrombocytosis (seen in this patient).

AML = immature cells and blasts, less likely splenomegaly,

Question 22

Major bleed pt on warfarin - manage?

Answer 22

Warfarin must be discontinued, vitamin K 5mg should be given intravenously and the patient should be given prothrombin complex concentrate (PCC).

Question 23

A 10-year-old child with a history of neonatal jaundice develops pallor and jaundice after an upper respiratory tract infection associated with erythematous cheeks. Splenomegaly is noted on examination

Answer 23

Hereditary spherocytosis