Haematology

Question 1

What would hypotension with fever signal post transfusion?

Answer 1

• Bacterial contamination (sepsis)
• Acute haemolytic reaction

Transfusion allergy: pruritus and urticaria

Question 2

With a raised MCV (>100fL), what tests should you order?

Answer 2

Thyroid function test, liver function tests, reticulocytes, vitamin B12 and folate levels

Question 3

Causes of Macrocytic Anaemia

Answer 3

ABCDE 
Alcoholism / cirrhosis 
B12 deficiency - (hypersegmented polymorphs)
Cytotoxic drugs (MTX)
Dysplasia
Endocrine (hypothyroidism)
Folate deficiency/ foetus

Question 4

Causes of Microcytic Anaemia

Answer 4

TAILS 
Thalassaemia (globin dysfunction)
Anaemia of chronic disease (Fe low)
Iron deficiency (Fe low)
Lead poisoning (porphyrin def.)
Sideroblastic anaemia (porphyrin def.)

Question 5

Gold standard for diagnosing thalassaemia

Answer 5

Hb electrophoresis

Question 6

Causes of normocytic anaemia (haemolytic-with high reticulocyte count)

Answer 6

PH GAS 
PNH 
Hereditary spherocytosis 
G6PD deficiency 
Autoimmune haemolytic anaemia (AIHA)
Sickle cell anaemia

Question 7

Causes of normocytic anaemia (production issue- low reticulocyte count)

Answer 7

MR CALM 
Marrow failure 
Renal failure 
Chronic disease
Aplastic anaemia 
Leukaemia/ lymphoma 
Myelofibrosis

Question 8

Signs and Symptoms of iron deficiency anaemia and

Answer 8

Symptom: pica and pagophagia,
Sign: Koilonychia (thin flat nails), angular stomatitis, hair loss, glossitis

Question 9

What Ix would you order for Fe deficiency?

Answer 9

FBC: low Hb, low MCV, high platelets, low reticulocytes
Blood film: microcytic RBC
Iron studies: low Fe, low ferritin, high transferrin, low transferrin sat.

Question 10

Unexplained backache, pathological fractures, recurrent bacterial infection

Answer 10

Multiple myeloma

Dx by plasma cells on bone marrow aspirate

Pathologic # / Backache= osteolytic bone lesions
Immunoparesis from monoclonal proliferation of plasma cell/ marrow infiltration= intermittent infection

Question 11

Febrile neutropenia

Answer 11

• At day 7-10 post chemo, bone marrow is at its lowest, nadir.
• Treat as neutropenic sepsis with broad spectrum IV Abx. Tazocin