Haematology

Question 1

What is the most common cause of anaemia in the world ?

Answer 1

Iron deficiency

Question 2

Which Histological cells are characteristic of Hodgkin’s lymphoma ?

Answer 2

Reed-steinberg cells - mirror-image nuclei

Question 3

What are the peak incidence of Hodgkin’s lymphoma ?

Answer 3

• 20-34 (young adults)

- >70 (elderly)

Question 4

What signs may be found in Hodgkin’s lymphoma ?

Answer 4

• lymphadenopathy (usually cervical, axilliary)
• cachexia
• anaemia
• splenomegaly or hepatomegaly

Question 5

Which virus is known to increase the risk of lymphoma ?

Answer 5

EBV

Question 6

Symptoms of Hodgkin’s lymphoma ?

Answer 6

• enlarged, painless, rubbery superficial lymph nodes
• fever, night sweats
• weight loss
• lethargy
• pruritis
• if mediastinum involvement = bronchial, SVC obstruction

Question 7

Tests for suspected lymphoma ?

Answer 7

• lymph node excision biopsy

- full bloods

Question 8

What is the link with alcohol and Hodgkin’s lymphoma ?

Answer 8

After ingesting causes pain at site of lymph node involvement

Question 9

What is the difference between Hodgkin’s and non Hodgkin’s lymphoma ?

Answer 9

Non Hodgkin’s originates in the WBC , T and B lymphocytes whereas Hodgkin’s originate in the lymph nodes
- non Hodgkin’s more likely to disseminate to extra nodal sites

Question 10

Which type of lymphoma is H pylori associated with ?

Answer 10

Gastric mucosa-associated lymphoid tissue (MALT)

Question 11

What are the common extra nodal sites of non Hodgkin’s lymphoma ?

Answer 11

Bone, gut, CNS or lung

Question 12

What is burkitts lymphoma ?

Answer 12

Childhood disease with characteristic jaw lymphadenopathy

Example of high-grade non Hodgkin’s lymphoma

Question 13

What are the causes of macrocytic anaemia ? (8)

Answer 13

• B12/folate
• Alcohol excess/liver disease
• Reticulocytosis
• cytotoxics (e.g. Hydroxycarbamide)
• myelodysplastic syndromes
• marrow infiltration
• hypothyroidism
• anti folate drugs e.g. Phenytoin, trimethoprim

Question 14

What are the causes of iron deficiency anaemia ? (4)

Answer 14

• blood loss, e.g. Periods, GI bleed
• poor diet (usually in children)
• malabsorption e.g.coeliacs
• parasitic e.g.hookworm in the tropics

Question 15

What is the treatment for iron deficiency anaemia ?

Answer 15

• treat underlying cause

- oral iron tablets

Question 16

What else should be considered if microcytic anaemia not responding to iron replacement ?

Answer 16

Sideroblastic anaemia

Question 17

Which vitamin enhances absorption of iron ?

Answer 17

Vitamin C

Question 18

Which drugs may impair absorption of iron ?

Answer 18

antacids and PPIs - as increase pH

Question 19

Which bacteria can impair uptake of iron ?

Answer 19

h pylori - also increases iron loss

Question 20

What is the symptoms of iron Deficiency anaemia ?

Answer 20

• fatigue
• SOB
• palpitations
• pruritis
• Headache
• tinnitus

Question 21

What signs may you find in someone with iron deficiency anaemia ?

Answer 21

• koilonychia
• atrophic Glossitis
• angular chelitis
• pallor in conjunctiva, palmar creases etc

Question 22

Define anisocytosis ? When is it seen ?

Answer 22

= variation in RBC size

As in megaloblastic anaemia, thalassaemia etc

Question 23

Define poikilocytosis, when does it occur ?

Answer 23

= variation in RBC shape

As in IDA, myelofibrosis, thalassaemia

Question 24

What a Reticulocytes?

Answer 24

Young, larger RBCs - signify active erythropoiesis

Question 25

What do neutrophils do ? When might they be increased ?

Answer 25

Ingest and kill bacteria, fungi and damages cells Increased in: - bacterial infections - inflammation e.g. MI - myeloproliferative disorders - drugs e.g. Steroids - stress e.g. Trauma, surgery, burns

Question 26

When might neutrophil count be low ?

Answer 26

- viral infections - drugs e.g. Chemo - severe sepsis - bone marrow failure

Question 27

What do lymphocytes do ?

Answer 27

Cell mediated immunity and antibody production

Question 28

When might lymphocyte count be increased ?

Answer 28

- acute viral infections - chronic infections e.g. Hepatitis, syphilis - leukaemias, lymphomas

Question 29

Which virus typically causes large amounts of atypical lymphocytes ?

Answer 29

EBV

Question 30

What may cause lympopenia

Answer 30

- steroid therapy - SLE - legionnaires - HIV - chemo

Question 31

What do eosinophils do ?

Answer 31

Mediate allergic reactions and defend against parasites

Question 32

What are monocytes ?

Answer 32

Precursors of tissue macrophages

Question 33

What is the role of basophils ?

Answer 33

On binging IgE, release histamine

Question 34

What drugs would you ask about in a history of suspected IDA ?

Answer 34

- NSAIDS - SSRIs - clopidogrel - corticosteroids

Question 35

What is a megaloblast?

Answer 35

A cell in which nuclear maturation is delayed compared to cytoplasm

Question 36

What are the megaloblastic causes if macrocytic anaemia ?

Answer 36

B12 and Folate as these are required for DNA synthesis (and so causes maturation to be delayed due to impaired synthesis)

Question 37

What are the non megaloblastic causes of macrocytic anaemia ?

Answer 37

- alcohol - reticulocytosis (e.g. Haemolysis) - liver disease - hypothyroidism - pregnancy

Question 38

Why would you not treat folate deficiency alone without B12 treatment as well ?

Answer 38

As low B12 states may precipitate or worse subacute combined degeneration of the cord

Question 39

Who is macrocytic anaemia most likely to present in ?

Answer 39

Women over 60 years old

Question 40

What is the management of macrocytic anaemias?

Answer 40

- correct the deficiency that caused the macrocytosis | - treat the underlying condition that lead to the deficiency

Question 41

What type of anaemia is iron deficiency ?

Answer 41

Macrocyctic, hypochromic