Haematology

Question 1

Main causes of macrocyclic anaemia
(MCV>100)

Answer 1

Liver disease
Pregnancy
Hypothyroidism
High reticulocyte count (maybe they’re just bled)

Question 2

Main cause of megakoblastic anaemia (oval macrocytes)

Answer 2

Ineffective DNA synthesis
B12 deficiency
Folate deficiency

Question 3

What does B12 deficiency lead to

Answer 3

Anaemia (megaloblastic)
Peripheral neuropathy
Spastic paraparesis
Dementia

Question 4

Smear findings in Megaloblastic anaemia

Answer 4

Oval macrocytes and neutrophils with hypersegmented nucleus

Question 5

Blood work In megaloblastic

Answer 5

Hugh LDH Chemistry – very high LDH(>1000 often 4000+) due to ineffective erythropoiesis in marrow with cell lysis

Question 6

Management of B12 malabsorption

Answer 6

Lifelong Monthly injections with B12

Question 7

Causes B12 defiency (leading to megaloblastic)

Answer 7

Total gastro removal
Pathology of terminal ileum (small intestine)
Non specific malabsorption in elderly (medication)
Pernicious anaemia

Question 8

How long do folate stores last

Answer 8

4months

Question 9

Causes of folate defiency

Answer 9

-low intake (rare with food fortification)-increased requirements (pregnancy, haemolysis)-drugs-rarely malabsorption

Question 10

Management of folate deficiency

Answer 10

Draw blood for S –B12 and s-folate
Start treatment with B12 injections and oral folic acid
Never give folate alone –may improve anaemia even in B12 deficiency – can lead to irreversible neurological damage
Do not transfuse unless in failure –one unit with diuretic cover
Monitor for hypokalaemia

Question 11

How would you confirm haemolytic anaemia

Answer 11

High LDL and haptoglobin, high reticulocytess

Question 12

What are some of the smear findings in haemolytic anaemia

Answer 12

Sickle cell (small red cells without central pallor, in autohaemolytic or erythrospherocytosis)- spleen break down part of cell membrane
Spherocytes (also in
Blister cells and bite cells (G6PD deficiency)

Question 13

Test for autoimmune haemolysis

Answer 13

Coombs

Question 14

List the causes of haemolysis

Answer 14

Red cell abnormalities(Inherited)-Membrane Spherocytosis-Enzyme G6pd Deficiency-Hemoglobin Sickle cell disease

Causes outside the red cell (Acquired)-Autoimmune Warm antibody Cold antibody Drugs -Fragmentation Valves MAHA-Hypersplenism-Infections Malaria Clostridia-Toxins-PNH

Question 15

Causes of anaemia of pure red cell aplasia in HIV

Answer 15

Causes in HIV-Parvovirus – do PCR-ARV’S –lamivudine, rarely emtricitabine

Question 16

Tx of Idiopathic Thrombocytopenia

Answer 16

-steroids –dexamethasone pulses or oral prednisone
-steroid sparing agents like azathioprine
-splenectomy
-monoclonal antibodies
-thrombopoetin receptor agonists

Platelet transfusions not indicated unless life-threatening bleed

Question 17

Causes of DIC

Answer 17

SepsisObstetric causesTraumaMaligancies

Question 18

Thrombotic microangiopathy

Answer 18

Lack of enzyme to break down Von Wildebrand or functional

Question 19

When do we not give platelets

Answer 19

ITP
TTP

Question 20

Causes of prolonged PTT

Answer 20

heparinclotting factor deficienciesInhibitors of clotting factorsLupus anticoagulant

Question 21

Which clotting factors affected in haemophilia A

Answer 21

VIII

Question 22

Which clotting factor is affected in haemophilia B

Answer 22

IX

Question 23

Causes of prolonged INR

Answer 23

DIC
Liver disease
Vit K deficiency
Warfarin
Poor nutrition,
prolonged antibiotics

Question 24

What to give in warfarin toxicity

Answer 24

Vit k

Question 25

What are the differentials for splenomegaly

Answer 25

Infections
- viral:HIV,CMV
-bacterial-TB, IE
Parasitic-malaria

Infiltration
Malignancies
Amyloidosis
Storage disease Gaucher’s

Inflammatory
SLE
RA

Congestion
Cirrhosis
Portal vein thrombosis

Question 26

Causes of massive splenomegaly

Answer 26

Gauchers
Thallasemia
Malaria
CML
Lymphoma
Idiopathic myelofibrosis