Haematology

Question 1

Acute lymphoblastic leukaemia

Answer 1

bone marrow makes large numbers of lymphoblasts, mostly affects children
low RBC and platelets, high lymphoblasts

Question 2

Acute myeloid leukaemia

Answer 2

bone marrow makes large numbers of myeloblasts, uncommon, >50
low RBC and platelets, high myeloblasts, see Auer rods on blood smear

Question 3

Chronic lymphocytic leukaemia

Answer 3

most common leukaemia, >60, stage A doesn’t require treatment
high lymphocytes, little or no immature WBCs

Question 4

Chronic myeloid leukaemia

Answer 4

least common leukaemia, abnormal translocation where of chromosome 9 to 22, Philadelphia chromosome is an unusually short chromosome 22 present in 95% CML, normal and abnormal myeloid cells present
low RBC, very high WCC

Question 5

Myeloma

Answer 5

malignant plasma cells produce diffuse bone marrow infiltration causing bone destruction and BM failure, overproduction of paraprotein, present in serum and urine
Px: Hypercalcaemia (thirst, constipation, nausea, confusion), anaemia, renal impairment and bone pain
See osteolytic bone lesions

Question 6

Hodgkins lymphoma

Answer 6

Reed-Sternburg cells present in 95%
peak 20-34 then >70
link to EBV
Px: enlarged non painful rubbery lymph node in lower neck
B symptoms: night sweats, fever, weight loss >10% in 6m
Ann Arbor staging

Question 7

Non-Hodgkins lymphoma

Answer 7

divided into low grade and high grade

high grade px: bulky disease, b symptoms more common, hepatosplenomegaly

Question 8

Henoch-Schönlein purpura

Answer 8

Small vessel vasculitis, usually occurs in children post URTI
Px lower limb erythematous macular rash develops into purpuric lesions, low fever, arthritis (commonly involving ankles, knees and elbows), and abdominal pain. Possible haematuria

Question 9

Von Willebrand disease

Answer 9

Nosebleeds, bruising, gum bleeding, prolonged bleeding from minor wounds. Prolonged activated partial thromboplastin time, normal prothrombin time.

Question 10

Factor V Leiden mutation

Answer 10

Autosomal dominant, most common cause of inherited thrombophilia
Usually diagnosed following thrombophilia screening due to VTE in patient or close relative

Question 11

thrombotic thrombocytopenic purpura

Answer 11

lack of enzyme that breaks up von willebrand factor so clots form, use up the clotting factors –> bleeding
risk factors: pregnancy/HIV
prodrome of a flu-like illness
symptoms: thrombocytopenia (nosebleeds etc), neurological abnormalities, fever, renal dysfunction
blood smear shows schistocytes (fragmented RBCs)
treatment: plasma exchange