Haematology Flashcards
A 65-year-old man who has smoked heavily all his life presents with lymph node over sub-mandibular gland.
Which of the following is the most likely diagnosis?
(Please select 1 option)
Cancer of the floor of maxilla
Cancer of the lateral anterior two thirds of tongue
Cancer of the mandible
Cancer of the pancreas
Testicular teratoma
Cancer of the lateral anterior two thirds of tongue
Seventy five per cent of lingual cancers arise on the anterior two thirds of the tongue.
Metastasis occurs unilaterally to the submental, submandibular and then the lower deep cervical lymph nodes.
Rare posterior third tumours spread bilaterally and have a poor prognosis due to their late presentation.
A 30-year-old woman is seen in the haematology clinic for follow up of a coagulation defect of the extrinsic pathway. Which of the following factors is likely to be affected as part of her condition? (Please select 1 option) Factor VII Factor VIII Factor IX Factor XI Factor XII
FVII
Factor VII and tissue factor are involved in the extrinsic pathway of the coagulation cascade whereas the intrinsic pathway is dependent on factors XII, XI, IX and VIII.
A defect in the extrinsic pathway will show as a prolonged prothrombin time whereas an activated partial thromboplastin time (APTT) will be prolonged with a defect of the intrinsic pathway.
A 28-year-old female attends clinic with a history of multiple venous thromboses.
You suspect she has a prothrombotic disorder.
Which one of the following disorders is most likely to be responsible?
(Please select 1 option)
Antithrombin III deficiency
Disseminated intravascular coagulation (DIC)
Thrombocytopenia
Vitamin C deficiency
Vitamin K deficiency
Antithrombin III deficiency is an autosomal dominant disorder.
Less than 70% of the normal value increases the risk of venous thrombosis because of the role of antithrombin in the inactivation of thrombin, factors VIIa, IXa, Xa, XIa, kallikrein and plasma.
DIC is a systemic thrombohaemorrhagic disorder with variable clinical presentation. Most patients present with easy bruising and haemorrhage and this results from serious underlying disease, such as obstetric complications or massive trauma.
Thrombocytopenia and vitamin K deficiency are types of acquired bleeding disorders.
Vitamin C deficiency can result in an acquired vascular defect.
A 27-year-old woman undergoes excision of a lipoma on the day list and is surprised how quickly the wound heals. Which cell type is involved almost immediately in wound healing following tissue injury? (Please select 1 option) Basophils Fibroblasts Macrophages Monocytes Platelets
Platelets This is the correct answerThis is the correct answer
Damage to blood vessel walls during tissue injury leads to the rapid formation of a platelet plug to prevent bleeding.
Vasodilation and increased vascular permeability is then followed by the influx of inflammatory cells and fibroblasts.
Neutrophils initiate phagocytosis and are the predominant cell type in the first 24 hours.
Macrophages secrete cytokines and continue phagocytosis as they become the predominant cell type after 48 hours.
On an evening ward round you glance at the blood results of a patient from another team.
The results show an increased prothrombin time (PT), an increased activated partial thromboplastin time (APPT), an increased thrombin time (TT) and a low platelet count.
Which of the following is the most likely underlying explanation for this set of blood results?
(Please select 1 option)
Disseminated intravascular coagulation (DIC)
Haemophilia
Heparin
Liver failure
Warfarin
DIC is a systemic thrombo-haemorrhagic disorder with variable clinical presentation.
There is activation of the coagulation process with consumption of platelets and coagulation factors with thrombin formation overwhelming the normal inhibition system and resulting in systemic fibrin deposition.
Most patients present with easy bruising and haemorrhage as a pathological response to serious underlying disease.
Conditions associated with DIC include
Malignancy
Massive tissue injury and trauma
Obstetric complications and infections.
Liver disease can result in a similar pattern of blood results but the thrombin time is usually normal.
A 70-year-old gentleman was admitted with difficulty swallowing, abdominal pain and vomiting.
Past medical history included a gastrectomy for carcinoma.
Initial investigations showed a macrocytic anaemia and thrombocytopenia.
Of the following, which is the likely diagnosis?
(Please select 1 option)
B12 deficiency
Iron deficiency anaemia
Pernicious anaemia
Sickle cell anaemia
Sideroblastic anaemia
B12
Intrinsic factor of Castle which is produced by the parietal cells is required for the normal absorption of vitamin B12.
Lack of intrinsic factor may arise from deficient production by parietal cells due to antiparietal cell antibodies in pernicious anaemia or following gastrectomy.
In the absence of intrinsic factor vitamin B12 will not be absorbed in the terminal ileum, and megaloblastic anaemia will result.
An 80-year-old lady with a history of ischaemic heart disease is transfused three units.
Following this she starts complaining of increasing shortness of breath. It is noted that her saturations have dropped and on examination she had bilateral basal crackles.
Of the following, which is the likely diagnosis?
(Please select 1 option)
Air embolism
Anaphylaxis
Circulatory overload
Hyperkalaemia
Thrombophlebitis
Circulatory overload
In elderly patients fluid overload is a potential complication following a transfusion.
Furosemide may be given in these cases to reduce the risk.
A 75-year-old lady who has had four units of blood prior to surgery is found to have peaked T waves and a slightly prolonged QRS complex on an ECG. What is the cause of her condition? (Please select 1 option) Anaphylaxis Haemolytic reaction Hyperkalaemia Iron overload Thrombophlebitis
Hyperkalaemia
The most common changes associated with hyperkalaemia are
Tall peaked T-waves
Reduction in amplitude
and eventually
Loss of the P-wave and
Bizarre widening of the QRS interval.
A 60-year-old gentleman is transfused two units prior to surgery.
Within thirty minutes of its commencement he starts complaining of feeling generally unwell with back pain and shortness of breath.
Observations reveal hypotension, reduced saturations and pyrexia.
What is the cause of his condition?
(Please select 1 option)
Air embolism
Haemolytic reaction
Hyperkalaemia
Iron overload
Thrombophlebitis
Haemolytic reaction
Acute haemolytic reactions may occur after infusion of a small volume of incompatible blood.
It is associated with a high morbidity and mortality and occurs soon after the start of transfusion.
The patient feels unwell and agitated and symptoms include back pain and pain at infusion site with associated shortness of breath and rigors.
Management includes discontinuation of the transfusion and fluid resuscitation.
A 30-year-old gentleman of African origin was admitted with severe back pain.
Investigations revealed a normocytic normochromic anaemia with a high reticulocyte count.
Which of the following is the likely diagnosis?
(Please select 1 option)
B12 deficiency
Iron deficiency anaemia
Pernicious anaemia
Sickle cell anaemia
Sideroblastic anaemia
Sickle cell anaemia is a disorder of varying degrees.
It may present in childhood with anaemia and mild jaundice. In the older patient, vaso-occlusive problems occur due to sickling in the small vessels of any organ, mimicking many medical and surgical emergencies.
Typical infarctive sickle crises include
Bone pain Pleuritic pain Hemiparesis Fits Splenic infarcts and Priapism.
A 20-year-old Caucasian man presents with a six month history of upper abdominal pain and leg ulcers.
He was noted by his family to be jaundiced.
Investigations showed a slight rise in bilirubin and mild anaemia.
An ultrasound scan of the abdomen showed evidence of splenomegaly.
Of the following, which is the likely diagnosis?
(Please select 1 option)
Hereditary spherocytosis
Iron deficiency anaemia
Sickle cell anaemia
Sideroblastic anaemia
Thalassaemia
Hereditary spherocytosis is the most commonly inherited haemolytic anaemia in northern Europe, affecting 1 in 5000.
It is inherited in an autosomal dominant manner but in 25% of patients neither parent is affected.
It may present with jaundice at birth however sometimes it is delayed for many years and some patients may go through life with no symptoms.
The patient may eventually develop anaemia, splenomegaly and ulcers on the leg.
A 65-year-old gentleman was admitted with a two month history of jaundice, pale stool, dark urine and bruising following minimal trauma.
A coagulation screen revealed a prolonged APTT and PT.
Which of the following is the likely diagnosis?
(Please select 1 option)
DIC
Ehlers-Danlos syndrome
Haemophilia A
Vitamin K deficiency
von Willebrand disease
Vitamin K is necessary for the y-carboxylation of glutamic acid residues on factors II, VII, IX and X and on proteins C and S.
The prothrombin time (PT) and activated partial thromboplastin time (APTT) are prolonged and there may be bruising, haematuria and gastrointestinal or cerebral bleeding.
A 30-year-old gentleman was in an industrial accident leading to 60% burns requiring intensive care and surgery.
A coagulation screen revealed a prolonged APTT, PT and low levels of fibrinogen.
Which of the following is the likely diagnosis?
(Please select 1 option)
DIC
Haemophilia A
Haemophilia B
Vitamin K deficiency
von Willebrand disease
Disseminated intravascular coagulation (DIC) is an acquired syndrome characterised by the intravascular activation of coagulation with loss of localisation arising from different causes.
It can originate from and cause damage to the microvasculature which can produce organ dysfunction.
DIC is seen in sepsis, major trauma, and placental abruption.
An 18-year-old boy was admitted with RIF pain.
On a recent visit to the dentist he had problems with bleeding after a tooth extraction. A clotting screen was requested which showed a prolonged APTT, normal PT and bleeding time. A further coagulation screen showed low levels of factor VIII.
Which of the following is the correct diagnosis?
(Please select 1 option)
DIC
Ehlers-Danlos syndrome
Haemophilia A
Haemophilia B
von Willebrand disease
Haemophilia A is an X linked disorder. The clinical features depend on the level of factor VIII.
Levels of less than 1% are associated with frequent spontaneous bleeding from early life.
Levels of less than 5% are associated with severe bleeding following injury and occasional spontaneous episodes.
Levels above 5% produce mild disease, usually with bleeding after injury or surgery.
A 36-year-old female who is on warfarin after suffering a deep vein thrombosis, presents with an INR of 8.2 and a conjunctival haemorrhage.
The blood pressure is 125/55 mmHg, heart rate is 65 bpm and the ECG reveals a normal sinus rhythm.
Which of the following is the most appropriate treatment for this patient?
(Please select 1 option)
Factor VII
FFP
Oral vitamin K 1 mg
Prothrombin complex concentrate
Stop warfarin only
oral vit K 1mg
A conjunctival bleed is defined as a minor bleed, and current guidelines suggest that oral or IV vitamin K together with the omission of warfarin, is the treatment of choice. Local guidelines should also be available.
One must always weigh up the risks and benefits of reversing the anticoagulation. The patient described is at low risk if the warfarin-induced coagulopathy is reversed. There is no suggestion from the ECG and the haemodynamic status that there is pulmonary embolus.
Major bleeds are defined as
Intraorbital Intracranial Retroperitoneal or Muscular bleeding causing compartment syndrome.
Any acute bleeding with BP less than 90 mmHg, oliguria or Hb drop to less than 9 g/l, also count as major bleeding episodes and require aggressive reversal of the coagulopathy with vitamin K, stopping warfarin and prothrombin complex concentrate or fresh frozen plasma (FFP).
