Haematology

Question 1

Acanthocytes

Answer 1

Spike rbc

Seen in liver disease and hyposplenism

Question 2

Basophilic RBC stippling

Answer 2

Accelerated erythropoiesis or defective Hb synthesis

Due to lead poisoning, liver disease and thalassaemia

Question 3

Burr cells

Answer 3

Irregularly shaped cells

Uraemia, GI bleed or stomach cancer

Question 4

Heinz bodies

Answer 4

Denatured Hb inclusion in RBC

G6PD deficiency or chronic liver disease

Question 5

Howell Jolly body

Answer 5

Basophilic nuclear remenant in RBC

Seen in hyposplenism ie sickle cell or coeliacs

Question 6

Leucoerythroblastic anaemia

Answer 6

Nucleated RBC and primitive WBCs due to marrow infiltration

Seen in myelofibrosis

Question 7

Pelger Heut cells

Answer 7

Hyposegmented neurtrophils

Myelodysplastic syndromes

Question 8

Reticulocytes

Answer 8

Mesh like network of rRNA visible with methylene blue

Increased in haemolytic anaemia

Decreased in aplastic anaemia and chemotherapy

Question 9

Right shift

Answer 9

Hyper mature WBCs with more than five lobes

Seen in megaloblastic anaemia, uraemia and liver disease

Question 10

Rouleaux formation

Answer 10

Stacked RBCs

Seen in myeloma and paraproteinaemia

Question 11

Schistocytes

Answer 11

Fragmented RBCs

Due to microangiopathic anaemia - DIC, haemolytic uraemia syndrome, thrombotic thrombocytopenic purpura

Question 12

Target cells

Answer 12

Bulls eye appearance

Seen in liver disease, hyposplenism, iron deficiency anaemia and thalassaemia.

Question 13

Blood Hb levels below which one is considered anaemic for:

• men
• women

Answer 13

Men <13.5g/dl

Women < 11.5g/dl

Question 14

Causes of a low MCV and anaemia (4)

Answer 14

Fe deficiency
Anaemia of chronic disease
Sideroblastic
Thalassaemia

=FAST

Question 15

Anaemia and high MCV (7)

Answer 15

Foetus 
Antifolates - phenytoin 
Thyroid (low)
Reticulocytosis 
B12/folate deficiency 
Cirrhosis 
Myelodysplastic syndromes 

=FAT RBCM

Question 16

A 45 year old lady with brittle hair and angular cheilosis.

Blood film shows hypochromatic anisocytosis and pencil cells

Answer 16

Iron deficiency anaemia

Question 17

Poikilocytosis and pencil cells are seen in what

Answer 17

Iron deficiency anaemia

Question 18

Causes of iron deficiency anaemia (5)

Answer 18

Blood loss 
Increased utilisation - pregnancy or lactation
Decreased intake
Decreased absorption - coeliac
Intravascular haemolysis 

NB it is bleeding until proven otherwise in the acute setting

Question 19

Two mechanisms behind anaemia of chronic disease.

Answer 19

Cytokines driven RBC production inhibition
1. TNF/IFNs cause a decrease in production of EPO receptors –> decrease in kidney EPO production

2. IL6/LPS cause an increase in liver hepcidin production –> decreased gut iron absorption and increased macrophage iron levels

Question 20

What is sideroblastic anaemia and what causes it?

Answer 20

Ineffective erythropoeisis leading to iron loading in the bone marrow –> endocrine, liver and cardiac damage

Due to myelodysplasia, chemotherapy, excess alcohol or myeloproliferative disease

Question 21

Low iron, high total iron binding capacity and low ferritin

Answer 21

Iron deficiency anaemia

Question 22

Low iron, low total iron binding capacity and raised ferritin

Answer 22

Anaemia of chronic disease

Question 23

High iron, low total iron binding capacity and high ferritin

Answer 23

Chronic haemolysis

Question 24

High iron and high ferritin

Answer 24

Haemochromatosis or sideroblastic anaemia

Question 25

What is ferritin?

Answer 25

Acute phase protein therefore levels increase with inflammation NB always check the CRP

Question 26

Three causes of vitamin B12 deficiency

Answer 26

Poor diet Malabsorption due to lack of intrinsic factor from the gastric parietal cells - pernicious anaemia Loss of the terminal ileum - Crohn's disease, resection

Question 27

Patient with absent ankle reflexes, anaemia and glossitis

Answer 27

Vitamin b12 deficiency

Question 28

Treatment for vitamin b12 deficiency

Answer 28

I.m. Hydroxocobalamin

Question 29

Autoantibody in pernicious anaemia

Answer 29

90% parietal cell antibodies

Question 30

Five causes of folate deficiency

Answer 30

Poor dietary intake Increased demand - pregnancy Increased cell turnover - haemolysis/inflammatory disease Malabsorption - coeliacs Drugs - phenytoin/methotrexate/alcohol/trimethoprim

Question 31

Normal RBC lifespan

Answer 31

120 days

Question 32

Raised unconjugated bilirubin, raised LDH and reticulocytosis

Answer 32

Haemolytic anaemia

Question 33

Three inherited causes of haemolytic anaemia

Answer 33

Membrane defect - hereditary spherocytosis Enzyme defect - G6PD, pyruvate kinase deficiency Haemoglobinopathies - sickle cell

Question 34

Two acquired causes of haemolytic anaemia

Answer 34

Immune - cold/warm or transfusion reaction Non-immune - mechanical/MAHA

Question 35

Inheritance of hereditary spherocytosis

Answer 35

Autosomal dominant

Question 36

Deficiency which results in hereditary spherocytosis

Answer 36

Ankyrin or spectrin membrane protein deficiency

Question 37

Key investigation to identify hereditary spherocytosis

Answer 37

Osmotic fragility

Question 38

Inheritance of G6PD

Answer 38

X linked

Question 39

Rapid anaemia, bite cells and Heinz bodies in previously well individual

Answer 39

G6PD

Question 40

Triggers for G6PD attacks

Answer 40

Oxidants i.e. Sulphonamides, aspirin, primaquine or broad beans

Question 41

Severe neonatal jaundice, splenomegaly and a haemolytic anaemia which is Coombs negative

Answer 41

Pyruvate kinase deficiency