Haematology

Question 1

Clinical fts of non-haemolytic febrile reaction (to blood products)

Answer 1

fever, chills

Question 2

Mx of non-haemolytic febrile reaction (to blood products)

Answer 2

slow/stop transfusion
paracetamol
monitor

Question 3

Pathophys of non-haemolytic febrile reaction (to blood products)

Answer 3

(thought to be)
antibodies reacting with white cell fragments (HLA antibodies) of the blood product and cytokines leaked from the blood cell during storage

prev sensitization (pregnancy/transfusion)

Question 4

Pathophys minor allergic reaction (transfusion)

Answer 4

(thought to be)
foreign plasma proteins

Question 5

Clinical fts of minor allergic reaction (transfusion)

Answer 5

pruritis, urticaria

Question 6

Mx of minor allergic reaction (transfusion)

Answer 6

temporarily stop transfusion - resume once reaction resolves
antihistamine
monitor

Question 7

Pathophys of anaphylaxis (to blood transfusion)

Answer 7

pts with IgA deficiency who have anti-IgA antibodies

Question 8

Clinical fts of anaphylaxis (to blood transfusion)

Answer 8

hypotension
dyspnoea, wheezing
angiodoema

Question 9

Mx of anaphylaxis (to blood transfusion)

Answer 9

Stop transfusion
IM adrenaline
ABC support (oxygen, fluids)

Question 10

Pathophys of acute haemolytic reaction (to blood products)

Answer 10

ABO- incompatible blood (2ry to human error)
red blood cell destructio by IgM-type antibodies

Question 11

Clinical fts of acute haemolytic reaction (to blood products) - incl time of onset

Answer 11

Onset - minutes from start
fever
abdominal pain
hypotension
agitation

Question 12

Mx of acute haemolytic reaction (to blood products)

Answer 12

Stop transfusion
Confirm diagnosis (pt identity on pt and product; send bloods for direct coombs test, repeat typign and cross-matching)
Supportive (fluid resus)

Question 13

Pathophys of transfusion-associated circulatory overload (TACO)

Answer 13

excessive rate of transfuion
pre-existing heart failrue

Question 14

Clinical fts of transfusion-associated circulatory overload (TACO)

Answer 14

pulmonary oedema
hypertension

Question 15

Mx of transfusion-associated circulatory overload (TACO)

Answer 15

slow/stop transfusion
consider IV loop diuretic (furosemide) + oxygen

Question 16

Pathophys of transfusion-related acute lung injury (TRALI)

Answer 16

non-cardiogenic pulmonary oedema
thought to be 2ry to incr vascular permeability caused by host neutrophils activated by substanced in donated blood

Question 17

Clinical fts of transfusion-related acute lung injury (TRALI) - incl time of onset

Answer 17

Onset - 6hrs of transfusion
Hypoxia
Hypotension
Fever
Pulmonary infiltrates of CXR

Question 18

Mx of transfusion-related acute lung injury (TRALI)

Answer 18

Stop transfusion
O2 and supportive care

Question 19

Complications of acute haemolytic transfusion reaction

Answer 19

disseminated itntravascular coagulation
renal failure

Question 20

Mx fpr Well’s score DVT 2 or more

Answer 20

= DVT ‘likely’
- prox leg vein USS within 4hrs
- OR interim anticoag while awaiting USS within 24hrs

If USS positive - start/cont anticoag
if USS negative - do D-dimer
- if positive - stop/no anticoag + rpt USS in 6-8 days
- if negative stop/no anticoag + consider other dx

Question 21

anticaog in DVT
- 1st line
- c/o to first line + second option
- length of tx

Answer 21

• 1st line DOAC (apixaban/rivaroxaban)
• is c/o then LMWH when suspected followed by dabigatran or edoxaban (or warfarin id renal impairment eGFR <15 or antiphospholipid syndrome)

length: 3mo for provoked; 3-6 mo of active ca; 6 mo if unprovoked

Question 22

Causes of macrocytic, megaloblastic anaemia

Answer 22

• vit B12 deficiency
• folate deficiency
• 2ry to methotrexate

Question 23

Causes of marcocytic, normoblastic anaemia

Answer 23

• alcohol
• liver disease
• hypothyroidism
• pregnancy
• reticolcystosis
• myelodysplasia
• drugs: cytotoxics

Question 24

Mx of pneumocystis jiroveci pneymonia

Answer 24

co-trimaxazole abx (IV pentamidine in severe cases)
steroids if hypoxic

Question 25

causes of normocytic anaemia

Answer 25

• anaemia of chronic disease
• chronic kidney disease
• aplastic anaemia
• haemolytic anaemia
• acute blood loss

Question 26

causes of microcystic anaemia

Answer 26

• iron-deficiency
• thalassaema (beta-thalassaemia minor — microcytosis disproportionate to the anaemia)
• congenital sideroblastic anaemia
• anaemia of chronic disease (usually more normocytic)
• lead poisoning

Question 27

Fts of polycythamiea rubra vera

Answer 27

• 60s
• hyperviscosity of blood
• pruritis
• splenomegally

Question 28

tx of poycythaemia rubra vera

Answer 28

• aspirin - prophylaxis for VTE
• venesection - 1st line to keep Hb down
• chemotherapy - hydroxyurea (risk of 2ry leukaemia) or phosphorus-32

Question 29

Typical presentation of multiple myeloma (acronym) + pathophys

Answer 29

CRABBI
Calcium - hypercalcaemia (bone resorption from cytokines released by myeloma cells) –> consipation/nausea/anorexia/confusion
Renal - light chain deposits in renal tubules –> dehydration and incr thirst
Anaemia - bonw marrow crowding suppresses erythripoesis –> fatigue + pallor
Bleeding - bone marrow crowding results in thrombocytopenia
Bones – bone marrow infiltration by plasma cells and cyokine-mediated osteoclast overactivity = lytic bone lesions = pain (back) + pathological fractures
Infection = reduction in normal immunoglobulins

Question 30

Other clinical fts of multiple myeloma

Answer 30

• amyloidosis (i.e: macroglossia)
• carpal tunnel syndrome
• neuropathy
• hyperviscosity

Question 31

Investigation findings in multiple myeloma

Answer 31

Bloods - anaemia, renal failure, hypercalcaemia
Peripheral blood film - rouleaux formation
Protein electrophoresis - raised conc monoclonal IgA/IgG in serum; Bence Jones proteins in urine
Imaging - XR ‘rain-drop skull (dark spots of lytic lesions); full body MRI shows bone lesions

Bone marrow aspiration - confirms dx with incr number of plasma cells

Question 32

Blood film in hyposplenism

Answer 32

• target cells
• Howell-Jolly bodies
• Pappenheimer bodies
• siderotic granules
• acanthocyts

Question 33

Main causes of hyposplenism

Answer 33

post-splenectomy
coeliac disease (30%)

Question 34

blood film in iron-deficiency anaemia

Answer 34

• target cells
• ‘pencil’ poikilocytes
• if B12/folate as well = ‘dimorphic’ film with mixed microcytic and macrocytic cells

Question 35

blood film in myelofibrosis

Answer 35

• tear-drop poikilocytes

Question 36

intravascular haemolysis findings in blood film

Answer 36

schistocytes

Question 37

blood film in megaloblastic anaemia

Answer 37

hypersegmented neutrophils

Question 38

Target cells in blood film - associated conditions

Answer 38

• sickle cell/thalassaemia
• iron-deficiency anaemia
• hyposplenism
• liver disease

Question 39

Heinz bodies in blood film associated conditions

Answer 39

• G6PD deficiency
• alpha-thalassaemia

Question 40

Fts of H6PD deficiency

Answer 40

• neonatal jaundice
• intravascular haemolysis
• gallstones
• splenomegaly
• haeinz bodies on films

Question 41

Ann-Arbor staging of Hodgkin’s lymphoma

Answer 41

I - single lymph node
II - 2 or more lymph nodes/regions on the same side of diaphragm
III: nodes on both sides of diaphragm
IV: spread beyond lymph nodes

A: no sx symptoms (other than pruritis)
B: weight loss >10% in 6mo, fever >38C, night sweats

Question 42

post-thrombotic syndrome fts

Answer 42

• painful, heavy calves
• pruritis
• swelling of legs
• varicose veins in leg
• venous ulceration in leg

Question 43

what is post-thrombotic syndrome?

Answer 43

complication following DVT
venous outflow obstruction + venous insuffiency = chronic venous hypertension

Question 44

Mx of post-thrombotic syndrome

Answer 44

compression stockings + elevate legs

compression stockings used to be recommeded as prophylaxis after DVT, but not anymore