Haematology Flashcards
Platelets
Young woman with easy bruising and bleeding gums. Fever and myalgia last week. Platelets 20. Diagnosis?
a) Primary Immune thrombocytopenia
b) Aplastic anaemia
c) Von Willebrand disease
d) Lymphoma
Primary Immune thrombocytopenia
A 20-year-old Greek male comes back from his elective in Africa. Has malaria. He is jaundiced and a peripheral blood smear shows Heinz bodies. Treated with anti-malarials. What is causing is prolonged recovery?
a) G6PD
b) Thalassemia
c) Sickle cell
G6PD
No sx until the patient is exposed to an environmental factor (anti-malarial = oxidative
stress) increased oxidant stress oxidized Hb denatures + precipitates intracellular
inclusions (Heinz bodies
Guy with DVT, on warfarin and heparin passed smelly black bowel motions. INR 9.2, Hb is tanking.
What do you do?
a) FFP + platelets
b) Blood transfusion
c) Cryoprecipitate
d) Tranexamic acid
e) FFP + prothrombinex
f) FFP + tranexamic acid
FFP + prothrombinex (+ vitamin K) = warfarin reversal
Older man had routine blood results which showed lymphocytosis and smear cells on blood film. Diagnosis?
a) CLL
b) Myelodysplastic syndrome
c) CML
d) AML
CLL
Greek boy with microcytic hypochromic anaemia, target cells and high HbA2. Dx?
a) Thalassemia
b) Sickle cell
c) G6PD
d) Iron deficiency anaemia
Thalassemia
African man with normocytic normochromic anaemia. Blood film shows target cells. HbF present. Dx?
a) Thalassemia
b) Sickle cell
c) Iron deficiency anaemia
Sickle cell
Protection from malaria - common in Africa
74 year old with night sweats, fever, enlarged non-tender inguinal lymph node, weight loss. Bloods show anaemic with mild raised CRP. Dx?
a) Non-Hodgkin’s lymphoma
b) Colorectal cancer
c) Cervical cancer
d) Multiple myeloma
Lymphoma B sx = painless lymphadenopathy, bone marrow failure (anaemia, low platelets, predisposition to infection), constitutional B sx (weight loss, night sweats, fever)
Pregnant lady with blood results (low Hb and low MCV). She got pregnant within 6 months of having last baby. What is most likely cause
a) Folate deficiency
b) Pernicious anaemia
c) Iron deficiency
d) Thalassaemia trait
Iron deficiency
6 year old child with 1 week history of petechiae and bruising. Otherwise well. What is the most important initial investigation?
a) Coagulation screen
b) FBC examination
c) Skeletal survey
FBC
Kid with a recent viral illness, but otherwise well. Bruises all over the body. Petechiae on face, limbs, trunks. Looking well. Diagnosis?
a) ITP
b) Acute leukaemia
c) Meningococcal septicaemia
d) Henoch-Schonlein Purpura
e) Haemophilia A
ITP
Asian man with splenectomy when he was 20, severe anaemia. Few months ago transfusion, another transfusion now. Bloods show increased reticulocytes, polychromasia, spherocytes. Thrombocytosis few years ago. Blood bank struggled with the phenotype matching and noted polychromasia on blood film. Which investigation would give the definitive diagnosis?
a) All sorts of haem tests
b) Direct antiglobulin test (Coombs)
c) G6PD test
d) Bone marrow aspirate
DAT test
This could be autoimmune or hereditary spherocytosis
25 year old whose cousin has been diagnosed with haemochromatosis. Wants to know if he has it as well. What initial test to do?
a) LFTs
b) Transferrin sats
c) FBC
d) Hb electrophoresis
e) GTT
Hemochromatosis = autosomal recessive disorder – body stores too much iron iron overload accumulate in skin, heart, liver, pancreas, pituitary gland, and joints tissue + organ damage
- Ix = transferrin sats, serum ferritin
Man with tanned skin, arthritis and palpable liver. Dx a) Hemochromatosis
b) Hepatitis
Hemochromatosis sx = fatigue, weight loss, joint pain, bronzed skin, abdo pain, reduced sex drive, hepatomegaly (cirrhosis/HCC), nail changes, diabetes, hypothyroid
Man moved to NZ from Britain aged 4, recently visited Asia/Africa, contracted malaria. Since being treated for malaria he has had worsening jaundice and anaemia. Heinz bodies are seen on his blood film. What is causing delayed recovery?
a) G6PD deficiency
b) Pharmacogenetic variant
c) Autoimmune haemolytic anaemia
G6PD deficiency
86 year old man presents with fatigue. Bloods show microcytic, hypochromic anaemia and elevated CRP (12). Lymphocytes and platelets normal. Dx?
a) Multiple myeloma
b) Occult blood loss
c) Nutrient deficiency
d) Pernicious anaemia
Iron deficiency
24 year old Maori dude tired and bruising. FBC shows pancytopenia (low platelets, WBC + neutrophils), low Hb, normal MCV. Normal blood film.
a) Aplastic anaemia
b) Acute leukemia
c) Vitamin B12 deficiency
Aplastic anaemia
Guy with bleeding with dental procedure and recurrent nosebleeds in childhood. Sister, aunt, granddad had it too. INR normal. Bleeding time increased. Dx?
a) Von Willebrand disease
b) Haemophilia A
c) Haemophilia B
d) ITP
vWD
Woman referred to gynaecologist for menorrhagia. Gynaecologist found normal. Prolonged APTT and PFA-100 (platelet function analyser). Most likely diagnosis?
a) Von Willebrand disease
b) Haemophilia A
c) Haemophilia B
d) ITP
vWD = prolonged APTT + PFA
Girl with a DVT, had been started on clexane (LMWH) as bridging therapy to warfarin. After 5 days still has pain and INR was 1.7. What do you do?
a) Increase warfarin dose
b) Start IV heparin
c) Switch to a direct thrombin inhibitor (rivaroxaban)
d) Continue current regime
e) Repeat ultrasound
Bridging therapy for 5 days or INR >2 for >=2 consecutive days (whichever is longer) Therapeutic INR = 2-3
Warfarin starting dose = 5mg incr if INR subtherapeutic (<2)
Pernicious anaemia, patient is positive for?
a) Antibodies to parietal cells
b) Antibodies for intrinsic factor
c) Antibodies to vitamin B12
Antibodies to parietal cells
Hodgkins
Patient has routine blood test for work. Increased IgG, electrophoresis shows serum lambda. Otherwise asymptomatic. Dx?
a) Idolent myeloma
b) Multiple myeloma
c) MGUS
Idolent myeloma
Women with Crohn’s presents with megaloblastic anaemia. Cause? a) Ileostomy
b) Antibodies against IF
Crohn’s tx = ileostomy B12 no longer absorbed in ileum deficiency
4 year old boy, pale and malaise for 3 weeks, with pancytopenia and fever of 38, hepatosplenomegaly. Hb 60, platelets 35, low WBCs, monocytes 0.75 (normal), lymphocytes 2x normal, neutrophils low. Diagnosis?
a) ALL b) CMV c) EBV d) ITP
ALL
Young man. Microcytic anaemia and iron deficient. Next investigation?
a) CT
b) Coeliac screen
c) Colonoscopy
d) Gastroscopy
e) FIT
FIT
Kid is diagnosed with Duchenne muscular dystrophy, parents told it is an X linked recessive disease. What is the chance the next kid will have it too?
a) 1 in 2 males will have the condition, 1 in 2 females will be a carrier
b) All boys will be carriers, all women carriers
c) All males will have the condition, all females will be carriers
DMD carriers at risk of cardiomyopathy
