Haematology

Question 1

what are rouleaux and why do they occur?

Answer 1

stacks of aggregated RBS, they occur when the plasma protein concentration is high like in paraproteinaemias, inflammatory disorders and malignancies

Question 2

what is basophilic stippling?

Answer 2

The blue staining of ribosomal precipitates within the cytoplasm of red blood cells.
seen in megaloblastic anaemia, thalassaemias, sideroblastic anaemia and alcohol abuse

Question 3

what are Howell-Jolly bodies?

Answer 3

Peripheral bodies within red cells representing DNA material, typically removed by the spleen. If they are on a blood film it suggests hyposplenism

Question 4

what are shistocytes?

Answer 4

Schistocytes are fragments of red blood cells seen in microangiopathic haemolytic anaemia

Question 5

what is the difference between a right and left shift in haematology?

Answer 5

Left shift describes the presence of maore immature neutrophils with unlobed, band shaped nuclei-seen in infection or haem malignancy if severe
Right shift describes increased presence of hypermature neutrophils with greater than five nucleus lobes

Question 6

when are target cells seen?

Answer 6

They are seen in obstructive liver disease, haemoglobinopathies (thalassaemia and sickle cell disease), and post-splenectomy. small numbers may be seen in iron deficiency anaemia

Question 7

what is leukoerythroblastosis?

Answer 7

combined presence of immature red blood cells and left shift (immature white cells).
It is suggestive of marrow fibrosis or invasion

Question 8

what are myeloproliferative neoplasms?

Answer 8

disease of the bone marrow where excess cells are produced, arising from mutations in precursors of the myeloid lineage

Question 9

what are causes of polycythaemia?

Answer 9

polycythaemia vera
increased EPO- high altitude, COPD, renal carcinoma, renal artery stenosis
relative- decrease in plasma volume

Question 10

what are symptoms of polycythaemia?

Answer 10

thrombosis, haemorrhage, headache, plethora, erythromyalgia, pruritus, splenomegaly

Question 11

what is the treatment of polycythaemia?

Answer 11

venesection, aspirin to reduce clot risk. hydroxycarbamide can reduce cell production

Question 12

what kind of mutations are common causes of polycythaemia vera, myelofibrosis and essential thrombocythaemia?

Answer 12

JAK2 mutations

Question 13

what are common symptoms of essential thrombocythaemia?

Answer 13

numbness in the extremeties, thrombosis, hearing and vision disturbances, headaches, erythromyalgia

Question 14

how is essential thrombocythaemia treated?

Answer 14

low risk patients are given aspirin for clot risk
high risk patients given hydroxycarbamide to reduce platelet count

Question 15

what is the mean survival for myelofibrosis?

Answer 15

5 years

Question 16

what are some treatment options for myelofibrosis?

Answer 16

treatment is mostly supportive
hydroxycarbamide, JAK2 inhibitors, folic acid, allopurinol, bloodtransfusions. some may require splenectomy

Question 17

What features can be seen on a blood film post-splenectomy?

Answer 17

Howell jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes

Question 18

what blood results are seen with antiphospholipid syndrome?

Answer 18

presence of lupus anticoagulant and anti cardiolipin antibodies in two separate tests twelve weeks apart

Question 19

what is primary thromboprphylaxis in antiphospholipid syndrome?

Answer 19

low dose aspirin

Question 20

what is secondary thromboprophylaxis for antiphospholipid syndrome?

Answer 20

warfarin, aiming for an INR between 2-3

if they develop a clot while on warfarin, increase INR to 3-4 target and consider adding in low dose aspirin

Question 21

with what condition can acute haemolysis occur following eating fava beans?

Answer 21

G6PD deficiency