Haematology

Question 1

Anemia- macrocytic; low versus high retics

Answer 1

low retics; vitamin B12/ folate deficiency; bone marrow disorder; high retics: hemolytic anemia

Question 2

Anemia- microcyctic with low retics versus high retics

Answer 2

Low retics- iron deficiency; thalasemia high retics- thalasemia

Question 3

Anemia- normocytic- low versus high retics

Answer 3

Low retics- anemia of chronci disease; multiple myeloma high retics- Gi bleed; bleeding ; hemolytic anemia

Question 4

Benefits of leukodepleted blood

Answer 4

decrease non hemolytic transfusion rxn decreased cmv transmission reduction in storage lesions reduction in graft verssu host disease

Question 5

Causes and complications of DIC

Answer 5

Causes: Sepsis Trauma Malignancy obstetric complications shock pancreatitis burns surgery ECMO transfusions Complications: thrmobosis renal dysfunction hepatic dysfunction respiratory dysfunction bleeding shock

Question 6

Causes of hemolytic anemia

Answer 6

Intravascular versus extravascular Intrasvular: immune versus non-immune Immune: ABO incompatability; IgG ‘warm’ auto-immune (drugs; SLE; RA; ); complement ‘cold’ autoimmune (EBV; mycoplasma); Non-immune: TTP/HUs;HELLP; DIC: mechanical valves; CRRT; ECMO Extravascular (usually due to breakdown in spleen) enzyme deficits: G6PD; pyruvate kinase; thalasemia; sickle cell; hyperspenism

Question 7

Causes of nucleated red blood cells

Answer 7

marrow replacement therapies; hemolytic anemia; post-splenectomy

Question 8

Causes of pancytopenia

Answer 8

leukemia/lymphoma myellodyspplastic syndromes aplastic anemia: drugs (phenytoin; isoniazid; cytotoxics); infection (parvovirus); radiation therapy hypersplenism SLE

Question 9

Causes of target cells

Answer 9

post splenectomy; chronic liver disease; sickel cel ldisease; thalasemia

Question 10

Causes of thrombocytopenia

Answer 10

1.increased destruction: TTP/HUS; DIC, ITP, HIT, SLE, 2. decreased production: lekemia, myleodysplastic syndromes; alcoholic liver diease; sepsis; drugs (methotrexate) 3. increased splenic sequestration: malaria dilutional: massive blood transfusion/ fluid resusitation

Question 11

Causes of TTP

Answer 11

Congenital Aquired: infectioms- E.coli; CMV; Drugs: cytotoxic agents Pregancy SLE GVHD

Question 12

Clinical features of TTP

Answer 12

fever; microangiopathic anemia; fluctuant neurologic deficit; renal insufficiency; thrombocytopenia (mnemonic FAT RN)

Question 13

Indications for plasma exchange

Answer 13

removal of large molecules unabe to be reomved by other means i.e antibodies; plasma proteins; immune complexes: Multiple myeloma (antibodies) GBS (autoantibodies) CIDP MG (autoantibodies) TTP/HUS (plasma proteins) SLE (immunecomplexes) Goodpasture syndrome

Question 14

patient factors leading to increased risk of bleeding with heparin therapy

Answer 14

Age >65; thrombocytopenia; antiplatelet therapy; previous bleed; recent surgery; Hx of falls; stroke Hx; Diabetes; Liver Failure; Renal failure; EtOH abuse;

Question 15

Predisposing factors for thromboembolism

Answer 15

Immobilisation Trauma Malignancy OCP Pregnancy Antiphospholipid syndrome Protein C deficiency Protein S deficiency Factor V leiden mutation Antiththrombin III deficiency Prothrombin gene mutation

Question 16

Substances reomved by plasma exchange

Answer 16

Auto-antibodies immune complexes cryoglobulins myeloma light chains endotoxins triglcyerides cholesterol contianing lipoproteins

Question 17

What are and causes howell Jolly bodies

Answer 17

remnant of nuclear proteins in RBC Causes: hyposplenism; asplenia; megaloblastic anemia

Question 18

what are and Causes of Heinz bodies

Answer 18

Hb precipitates Glucose -6- phosphate dehydrogenase deficiency post-splenectomy liver disease, thalasemia

Question 19

What is a shistocyte and what causes them

Answer 19

shistocyte: fragemented RBC causes: microangiopathic hemolytic anemia: TTP; HUS; HELLP; DIC

Question 20

What is an acanthocyte and what causes it

Answer 20

Acantocytes: spiculated RBC Causes: alcoholic liver disease (malnutrition); hypothyoridism

Question 21

What is and causes anicytosis

Answer 21

Variation in size of RBC Causes: iron deficiency anemia; thallasmiea

Question 22

What is and causes poikilocytosis

Answer 22

Variation in cell shape iron deficency anemia; thalasemia

Question 23

What is echis time and retiplase time

Answer 23

Echis time: provides prothrombin- helps distinguish between liver dysfunction (PT not corrected) compared to vitmain K deficiency (PT corrected) retiplase time: thrombin like molecules. Helps differentiate causes of prlonged TCT (abnormal retiplase time if due to hypofibrinogenemia)