Haematology

Question 1

Hodgkins lymphoma features
most dangerous type ?
Most common ?

Answer 1

Reed Sternberg cells
Painful after drinking alcohol
younger adults

Most dangerous is lymphocyte depleted

Most common is nodular sclerosisng ( think of roses )

Question 2

Non Hodgkins lymphoma

Answer 2

More common than Hodgkins lymphoma

B cells is more common
- Diffuse large B cell lymphoma
- Burkitt lymphoma associated with EBV, starry sky appearance , causes tumor lysis syndrome

Question 3

Polycythemia rubra vera definition

features and treatment

Answer 3

JAK2 mutation , increase in red cell volume and overproduction of neutrophils and platelets

Itchy after a hot bath
hyperviscousity
hypertension
high haematocrit

treatment :
- aspirin to prevent clots
- regular venesection

Question 4

neutropenic sepsis

Answer 4

A complication of cancer therapy because of low neutrophils
- PIP + TAZ

Question 5

CML features

Answer 5

• Marked splenomegaly - abdominal discomfort
• Philadelphia chromosome
• may undergo transformation to ALL

Treatment is Imatinib

Question 6

pathophysiology of beta thalassemia minor

Answer 6

Beta thalassemia = microcytic anemia
chromosome 11

Defect in the Beta global chain
1) hemotetromas form and are insoluble so they ppt in RBCs , haemolysis occurs in spleen = ineffective erythropeosis

2) Decreased globin , decreased Hb, decreased RBC ‘s but HbF increased and HBA2 is increased too

Minor :
- Heterogenous
- microcytic RBCs , increased HBA2 and HbF
-Autosomal recessive

Question 7

pathophysiology of beta thalassemia major

Answer 7

Major :
-Homogenous where there are no B global chains so the alpa globin ppts and RBC dies
- haemolytic anemia from spleen
- so kidney increases EPO to increase RBC numbers , causing erythroid hyperplasia meaning more immature RBC
- but we still need more mature RBC –> Bones and liver increase production = Hepatosplenomegaly and enlarged skull

Question 8

Alpha thalassemia features

Answer 8

defect in chromosome 8
microcytic anaemia from defective alpha chain production

very severe mutation x4 = hydrops fatales

Question 9

sickle cell anemia features

Answer 9

anemia and high reticulocyte count

Question 10

treatment of thalassemia

Answer 10

life long blood transfusion and desferroxamine to stop iron overload

Question 11

Myelofibrosis

Answer 11

bone marrow is replaced by connective tissue
+Pancytopenia
+tear drop cells
+massive splenomegaly

treatment
1) EPO for anaemia
2) blood transfusion for pancytopenia

Question 12

G6pd disease features

Answer 12

think of Heinz sauce on a burger you want to Bite into
+ Heinze bodies
+ Bite and blister cells
+ neonatal jaundice
+ meditteran and African descent
+X linked recessive

drugs that can ppt this :
- ciprofloxacin
- sulfa drugs
- anti-malarials

Question 13

CLL features

Answer 13

Most common leukaemia in adults
smear/smudge cells
increased WBC, decreased Platelets, RBCs

+ AIHA
+ increased risk of infections
+ increased lymphocytes with sparse cytoplasm

Sudden change in CLL = Richters transformation

Question 14

Coeliacs disease haematological cells

Answer 14

Howell jolly bodies
Target cells
Seen due to hyposplenism

Question 15

Acute haemolytic reaction to transfusion features

Answer 15

Fever, abdominal pain, hypotension during a blood transfusion

Question 16

TRALI

Answer 16

TRALOWWW = low bp

Question 17

TACO

Answer 17

TACOVER ! hypertension

Question 18

Sickle cell disease complications

Answer 18

1) vaso occlusive crisis ( iv opiates and fluids ), acute onset with no significant drop in Hb
2) Acute chest syndrome
3) sequestration crisis , where blood pools in spleen => worsening anaemia, abdominal pain , palpable mass in LUQ, pallor, high reticulocytes ( because you have to get up on a horse)
4) Aplastic crisis - reticulocytes less than 1% , tachypnoea , tachycardia , no splenomegaly
due to : parvovirus B19

Question 19

Myeodysplastic syndromes

Answer 19

group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, peripheral blood cytopenias, and a risk of progression to acute myeloid leukaemia (AML).

Question 20

Multiple Myeloma features

Answer 20

CRAB
Ca2+ raised
Renal failure
Anaemia
Bone pain and back pain

+ rouleaux formation
+paraprotein spike of IgG

Question 21

DVT investigations
- If wells score is less is 1 or less
- If wells score is more than 1

Answer 21

• if less than one and you want to rule out DVT then D DIMER
• If more than one and you want to find DVT - proximal vein USS within 4 hrs

Question 22

Signs of haemolytic Anemia

Answer 22

-Jaundice
-Pallor
-Reticulocytosis = increased reticulocytes
- Raised LDH
- Spherocytes and reticulocytes on blood film ( AIHA)
- Low haptoglobin ( attaches to free Hb)

Question 23

Macrocytic anaemia causes

Answer 23

B12 deficiency
- Administer Hydroxocobalamin

-Folate deficiency
- chronic alcohol use
- Hypothyroidism - dysregulation of EPO

Question 24

Treatment for a mild bleed in patient with VWD

Answer 24

desmopressin

Question 25

man ages 65 with new microcytic anaemia management ?

Answer 25

AGE >60 = new iron deficiency anemia is a red flag referral
+ 2 week wait for colonoscopy as this is a sign of colorectal cancer

Question 26

Haemophilia A features

Answer 26

factor 8
deep bleeds , X linked recessive
Increased APTT ( factor 8 is in the intrinsic pathway)
+ recurrent haemoarthrosis
+ bleeding lasts long

management is factor 8 , desmopressin

Question 27

Haemophilia B

Answer 27

Factor 9
increased APTT too (in intrinsic pathway )
- defective platelet function

give factor 9 if bleeding and desmopressin

Question 28

ALL

Answer 28

seen in children
pancytopenia
BUT INCREASES LYMPHOBLASTS

Question 29

AML

Answer 29

AUER RODS, most common
associated with myelodyspastic syndromes

+ infection
+ easy bleeding
+ anemia

increased pre curser WBC = leucocytosis

Increased BLASTS, acute leukemias increased the number of malignant precursor cells ( they have nucleus in them and they are big )

Question 30

Aplastic anaemia

Answer 30

• pancytopenia , due to hypocellular bone marrow