Haematology

Question 1

First line treatment of ITP?

Answer 1

Oral prednisolone

Question 2

Most important factor to determine if cryoprecipitate should be given in bleeding?

Answer 2

A low fibrinogen level
Cryoprecipitate contains concentrated amounts of fibrinogen, factor VIII, and von Willebrand factor. It is primarily indicated for the treatment of hypofibrinogenaemia, which can occur in DIC

Question 3

What is the typical blood picture of DIC?

Answer 3

DIC typical blood picture:
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products (D-dimer)

Question 4

What sort of blood would you see in the blood film following DIC?

Answer 4

Schistocytes

Question 5

When should COCP be stopped before an operation to mitigate VTE risk?

Answer 5

4 weeks before

Question 6

How do you differentiate between haemophilia A and B?

Answer 6

normal factor VIIIc activity points to a diagnosis of haemophilia B (lack of factor IX)

Question 7

How often should sickle cell patients receive the pneumococcal polysaccharide vaccine?

Answer 7

Every 5 years

Question 8

How is iron overload prevented in someone receiving a lot of transfusions for beta-thalassemia?

Answer 8

iron chelation therapy (e.g. desferrioxamine) is important to prevent the complications of iron overload due to repeat transfusions

Question 9

Thrombotic crises in sickle cell can be precipitated by what 3 things?

Answer 9

Infection, dehydration or deoxygenation

Question 10

Provoked VTE treatment is usually 3 months except for?

Answer 10

If the patient has active cancer

Question 11

Why do patients with hereditary spherocytosis often present with biliary colic?

Answer 11

HS -> chronic haemolysis -> increased bilirubin -> increased stone formation

Question 12

Why does Bechets disease increase the risk of VTE

Answer 12

Vasculitis -> inflammation of vessels -> hypercoagulability -> VTE

Question 13

What is associated with poor prognosis in lymphoma?

Answer 13

‘B’ symptoms in Hodgkin’s lymphoma are associated with a poor prognosis
weight loss > 10% in last 6 months
fever > 38ºC
night sweats
As well as increasing age, male sex

Question 14

What type of blood product has the greatest risk of bacterial contamination when compared to other blood products?

Answer 14

Platelets; they have a shelf life of only five days from donation to reduce the risk of contamination.

Question 15

Which blood products need to be irradiated for patients who are immunocompromised to reduce the risk of transfusion-associated graft vs host disease

Answer 15

This is only necessary for blood products containing lymphocytes, including whole blood and packed red cells but not plasma or cryoprecipitate.

Question 16

What is used for prophylaxis for tumour lysis syndrome prior to chemotherapy? What is used as an alternative?

Answer 16

Allopurinol (either IV or oral), with Rasburicase as an alternative

Question 17

In someone with combined folate and B12 deficiency, what should be treated first?

Answer 17

The vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord
If folate is corrected before B12, the haematological symptoms may improve, masking the underlying B12 deficiency and allowing irreversible neurological complications, such as weakness, sensory loss, and unsteady gait, to progress.

Question 18

What is the blood transfusion for someone with ACS?

Answer 18

80 g/L

Question 19

Which antibiotic is used to help diagnose VWD and what result would it show if positive?

Answer 19

Ristocetin
In VWD, platelet agglutination is reduced or absent in response to ristocetin because:
vWF levels are decreased (quantitative deficiency in VWD types 1 and 3).
vWF function is defective (qualitative deficiency in VWD type 2).
Ristocetin should cause platelet aggregation and clot formation in normal blood