Haematology

Question 1

Is haptoglobin increased or decreased in intravascular haemolytic anaemia?

Answer 1

Decreased

Question 2

Is intravascular or extravascular haemolytic anaemia associated with splenomegaly?

Answer 2

Extravascular haemolytic anaemia

Question 3

Poor prognostic factors for ALL in children

Answer 3

Age 9 years Male sex Relapse on treatment

Question 4

What are erythrocyte tear drop cells on blood film characteristic for?

Answer 4

Myelofibrosis or B12 deficiency

Question 5

How does the thalassaemia trait normally present?

Answer 5

With low MCV and normal Hb

Question 6

What is a Coomb’s test?

Answer 6

Looks for (i.e. is positive in the context of) auto-antibodies against RBCs that cause autoimmune haemolytic anaemia

Question 7

What does the coagulation profile look like in prothrombotic disorders?

Answer 7

Normal (it assesses bleeding not clotting)

Question 8

What are the criteria to determine a Well’s score for DVT risk? (9)

Answer 8

Active cancer Recent paralysis/immbolity/plaster/surgery past 4 weeks Localised tenderness along deep venous system Entire leg swollen Asymmetrical swelling of calf >3cm c/f other side Asymmetrical pitting oedema Collateral superficial veins Previously documented DVT -2 for alternative diagnosis more likely

Question 9

Secondary causes of a hypercoagulable state (8)

Answer 9

Malignancy Pregnancy Surgery Stasis Myeloproliferative disorders Antiphospholipid syndrome Age Drugs

Question 10

What is Trousseau’s syndrome?

Answer 10

VTE as presenting feature of malignancy

Question 11

Primary causes of a hypercoagulable state (7)

Answer 11

Prothrombin gene mutation Factor V Leiden Antithrombin III deficiency Protein C deficiency Protein S deficiency Homocysteinaemia Abnormal fibrinolysis

Question 12

Where are platelets made, and from what cell type?

Answer 12

In the bone marrow, from megakaryocytes

Question 13

Life span of platelets

Answer 13

10 days

Question 14

3 pathological mechanisms resulting in low platelets

Answer 14

1. Decreased production (bone marrow) 2. Increased destruction (bleeding, autoimmune, increased use) 3. Sequestration (hypersplenism)

Question 15

What is Immune Thrombocytopenic Purpura?

Answer 15

Autoimmune destruction of platelets, resulting in thrombocytopenia in a previously healthy person. This is generally following a viral illness.

Question 16

How do you diagnose ITP?

Answer 16

Mix test (Immune assay - not actually used clinically)

Question 17

Treatment of ITP? (5)

Answer 17

Prednisone 1mg/kg PO daily (or other immunosuppressive medication) - Response rate around 70% within about 5 days IV immunoglobulin 1g/kg BD Splenectomy Rituxumab (monoclonal anti-CD20) - In NZ can only be used if they have failed 2 lines of therapy and are not eligible to have a splenectomy Thrombopoietic growth factors - Romiplastim and Eltrombopag

Question 18

What is this? What does it signify?

Answer 18

Pelgur-Huet cell - neutrophil with hyposegmented nucleus

May congenital or acquired in acute myelogenous leukemia or chronic myelogenous leukemia and in myelodysplastic syndrome