Haematology

Question 1

non-Hodgkins lymphoma risk factors

Answer 1

elderly, caucasian, FHx
viral infection -EBV
history of chemo/radiotherapy
immunodeficiency- HIV, DM, transplant
AI- SLE, shortens, coeliac

Question 2

most common lymphoma in UK

Answer 2

diffuse large B cell

Question 3

sickle cell anaemia blood count

Answer 3

normocytic anaemia with raised reticulocyte count

Question 4

Thrombotic thrombocytopenia purpura

Answer 4

fever
altered mental state
thrombocytopenia
haemolytic anaemia- schistocytes
reduced renal function

Question 5

non-hodgkin lymphoma diagnostic investigation of choice

Answer 5

excisional node biopsy

Question 6

VWD blood tests

Answer 6

bleeding time increase, APTT prolonged, platelets normal

Question 7

haemolytic anaemia blood tests

Answer 7

low Hb, high reticulocytes
low haptoglobin
high LDH
high indirect bilirubin

blood film –> spherocytes and reticulocytes

Question 8

drugs associated with increased risk of VTE

Answer 8

COCP
HRT
raloxifene and tamoxifen
antipsychotics- olanzapine

Question 9

Hodgkins lymphoma poor prognosis

Answer 9

B-symptoms,
increasing age,
male sex,
stage IV disease
lymphocyte depleted subtype

Question 10

Children and young people (0-24yrs) with unexplained petechiae or hepatosplenomegaly

Answer 10

Refer for immediate specialist assessment for leukaemia

Question 11

warm AIHA

Answer 11

IgG , extravascular

causes:
AI e.g. SLE
neoplasia e.g. lymphoma CLL
drugs e.g. methyldopa

Question 12

warm AIHA treatment

Answer 12

treat underlying disorder
steroids +/- rituximab

Question 13

cold AIHA

Answer 13

IgM, intravascular

causes:
neoplasia - lymphoma
infections- mycoplasma, EBV

Question 14

lead poisoning

Answer 14

Abdominal pain,
constipation,
neuropsychiatric features,
basophilic stippling
Burton’s lines (blue lines on gum margin)

Question 15

Platelet transfusion indication

Answer 15

platelet count < 30 x 109 and clinically significant bleeding

Question 16

ITP treatment

Answer 16

plt count>30 –> observation

plt count<30 –> oral prednisolone

emergency treatment life threatening/organ threatening bleeding –> plt transfusion, IV methylprednisolone and IVIG

Question 17

Factor V Leiden mutation results in

Answer 17

activated protein C resistance

Question 18

CLL transformation

Answer 18

high-grade lymphoma (Richter’s transformation) making patients suddenly unwell

Question 19

polycythaemia vera management

Answer 19

aspirin
venesection
chemotherapy- hydroxyurea

Question 20

SCA acute sequestration vs aplastic crisis (parvovirus) infection

Answer 20

acute sequestration- high reticulocyte count
aplastic crisis (parvovirus) low reticulocyte count

Question 21

Sideroblastic anaemia:

Answer 21

hypochromic microcytic anaemia
high ferritin iron & transferrin saturation
- basophilic stippling of red blood cells

Question 22

Sideroblastic anaemia: causes

Answer 22

congenital
acquired:
- myelodysplasia
-alcohol
-lead
-anti-TB medications

Question 23

DIC typical blood picture

Answer 23

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products

Question 24

causes of massive splenomegaly

Answer 24

myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher’s syndrome

Question 25

In a non-urgent scenario, a unit of RBC is usually transfused over

vs urgent scenario

vs history of HF

Answer 25

non-urgent= 90-120 minutes

urgent= STAT

Hx of HF= 3 hours

Question 26

Rivaroxaban and apixaban reversal agent

Answer 26

andexanet alfa

Question 27

A blood film shows that 60% of the white cells are small mature lymphocytes.

Answer 27

CLL

Question 28

Prosthetic heart valves may result in

Answer 28

haemolytic anaemia

Question 29

TRALI is differentiated from TACO by

Answer 29

The presence of hypotension in TRALI vs hypertension in TACO

Question 30

Pancytopaenia 5 years post-chemotherapy/radiotherapy →

Answer 30

myelodysplastic syndrome

Question 31

Acute haemolytic transfusion reactions are usually the result of

Answer 31

RBC destruction by IgM-type antibodies

Question 32

Irradiated blood products are used to avoid

Answer 32

transfusion-associated graft versus host disease

Question 33

empirical antibiotic of choice for neutropenic sepsis

Answer 33

Piperacillin with tazobactam (Tazocin)

Question 35

treat flares of acute intermittent porphyria

Answer 35

IV haem arginate

Question 36

increase in granulocytes at different stages of maturation (myeloblasts)

Answer 36

CML

Question 37

blood film shows anisocytosis, macrocytosis and hyposegmentation of the neutrophils

Answer 37

myelodysplasia