Haematology

Question 1

What are the features of physiologic anaemia of infancy

Answer 1

Dip in Hb from 6-9 weeks
High Hb levels due to high oxygen delivery in first few weeks causes neg feedback

Erythropoeitin is suppressed in the kidneys so reduced production of bone marrow

Question 2

What are the features of Haemolytic disease of the newborn

Answer 2

Haemolysis and jaundice
Incompatibility between rhesus antigen
When mum is rhesus D neg and Baby is rhesus D positive

Haemolysis with anaemia and high bilirubin levels

A direct Coombs test will be positive in this case

Question 3

What are the causes of Microcytic anaemia

Answer 3

TAILS
Thalassaemia
Anaemia of chronic disease
Iron def anaemia
Lead poisoning
Sideroblastic anaemia

Question 4

What are the causes of normocytic anaemia

Answer 4

3A’s and 2H’s

Acute blood loss
Anaemia chronic disease
Aplastic anaemia
Hameolytic anaemia
Hypothyroid

Question 5

What are the causes of macrocytic anaemia

Answer 5

Megaloblastic
B12 def
Folate def

Normoblastic microcytic
Alcohol
Reticulocytosis
Hypothyroid
Liver disease
Azathioprine

Question 6

What are the age incidences of leukaemia

Answer 6

AML- under 2
ALL- 2-3

Question 7

What are the features of idiopathic thrombocytopenic purpura

Answer 7

Spontaneous low platelets causing a purpuric rash (Non-blanching rash)

Type 2 hypersensitivity reaction
Antibodies that target and destroy platelets
(Type 2 has the letter B because antibodies are the second in the alphabet)

Usually under 10s with history of recent viral illness
Bleeding, bruising and non blanching rash

Management
Urgent FBC
Treatment
Pred
IV immunoglobulins
Blood transfusions
Platelet transfusions (only work temporarily)

Avoid contact sports and IM injections + Lumbar punctures
Avoid NSAIDs and blood thinners
Safety net for internal bleeding injury

Question 8

What are the features of sickle cell crisis

Answer 8

Sickle cell crisis - can happen due to infection dehydration of cold weather

Manage supportively

Question 9

What are the features of vaso-occlusive crisis

Answer 9

Painful crisis
RBCs clogging capillaries causing distal ischaemia
Hands and feet usually- fever
Priapism

Question 10

What are the features of aplastic crisis

Answer 10

Absence of new RBCS
Triggered by parvovirus B19
Significant anaemia

Question 11

What are the features of acute chest syndrome

Answer 11

Vessels supplying the lungs become clogged
CXR will show pulmonary infiltrates
Fever, SOB, chest pain,, cough, hypoxia

Analgesia, good hydration, abx and antivirals, blood transfusions, incentive spirometry

Question 12

What is the general management of sickle cell anaemia

Answer 12

Avoid triggers
Vaccines
Antibiotic prophylaxis - Pen V
Hydrozycarbamine to stimulate HbF
Crinzanlizmab
Blood transfusions
Bone marrow transplant

Question 13

What are the features of hereditary spherocytosis

Answer 13

Jaundice
Anaemia
Gallstones
Splenomegaly

Autosomal dominant

Haemolytic crisis- anaemia and jaundice worsen
Can also have aplastic crisis with parvovirus B19

MCHC is raised on FBC
Reticulocytes are raised due to high turnover

Treat with folate and splenectomy
Gall bladder removal if needed