Haematology

Question 1

How do you know whether an anemia is microcytic, normocytic or macrocytic?

Answer 1

Check the MCV (mean cell volume)

Question 2

What are the causes of a microcytic anaemia?

Answer 2

Iron deficiency

Thalassaemia

Question 3

What are the causes of a normocytic anaemia?

Answer 3

Anaemia of chronic disease
Blood loss
Aplastic

Question 4

What are the causes of a macrocytic anaemia?

Answer 4

B12 deficiency (pernicious)
Folate deficiency
Hypothyroid
Alcohol (especially raised MCV without anaemia)

Question 5

What are the causes of a pancytopenia?

Answer 5

Aplastic
SLE
Drug induced - clozapine, sulfonamides, and rifampicin

Question 6

What does iron deficiency anaemia look like on the blood film?

Answer 6

Hyperchromic with target and pencil cells

Question 7

What are the blood results you would expect with iron deficiency anaemia?

Answer 7

Microcytic anaemia

Iron low
Ferritin low (storage in liver)
TIBC/transferrin high (spare spaces on the transporter proteins in the blood)

Nothing to go around. Relatively acute

Question 8

What are the signs of iron deficiency anaemia?

Answer 8

koilonychia
atrophic glossitis
angular stomatitis

Question 9

What are the blood results you would expect with haemochromatosis?

Answer 9

Polycythaemia
Iron high
Ferritin high (storage in liver)
TIBC low (few spare spaces)

Body overloaded, stores as much as it can

Question 10

What are the blood results you would expect with anaemia of chronic disease?

Answer 10

Normocytic anaemia
Iron low
Ferritin high (storage in liver)
TIBC low (few spare spaces)

Body has gone into storage mode due to paucity of available iron over time

Question 11

What factors affect iron uptake?

Answer 11

Vitamin C increases

Antacids eg sodium bicarbonate decrease

Question 12

What is being measured in a haematinic screen?

Answer 12

Iron
Ferritin - storage in the liver
TIBC - total iron binding capacity. A measure of transferrin transporter proteins in the blood

Folate
B12
EPO

Question 13

What factors affect the uptake of B12 and folate?

Answer 13

Intrinsic factor in stomach - think pernicious anaemia
Terminal ileal health - think IBD
Drugs - trimethoprim, methotrexate

Question 14

What is pernicious anaemia?

Answer 14

Autoimmune attack on the parietal cells in the stomach that produce intrinsic factor. This is the hormone that helps uptake of B12 in the terminal ileum

Question 15

What is indicated by a raised MCV without anaemia?

Answer 15

Alcohol abuse

Question 16

What are the signs and symptoms of multiple myeloma?

Answer 16

Bone disease: bone pain, osteoporosis + pathological fractures (typically vertebral), osteolytic lesions

Hypercalcaemia
Renal failure

Question 17

How would you test for multiple myeloma?

Answer 17

Raised serum IgG or IgA and all the others reduced (Monoclonal hyperglobulinaemia)
Urine - Bence Jones proteins

Biopsy - bone marrow

Question 18

What is the mechanism of action of heparin?

Answer 18

Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, Xia and XIIa

Question 19

What are the common side effects of heparin?

Answer 19

Thrombocytopenia (HIT)
Osteoporosis
Bleeding

Question 20

What shifts the oxygen dissociation curve right? What does this mean

Answer 20

Temperature
2,3 BPG
Acid

Means more given up at the tissues