Haematology

Question 1

Non-Hodgkin’s lymphoma

Answer 1

Non-tender, firm, rubbery lymphadenopathy

Most Non-Hodgkins is B cell

Question 2

Aplastic anaemia

Answer 2

Pancytopenia w/ hypoplastic marrow

Infection/drugs/pregnancy

Question 3

G6PD deficiency

Answer 3

Heinz bodies

Mediterranean/drugs

Haemolytic (normocytic) anaemia

Question 4

Pernicious anaemia

Answer 4

Autoimmune failure of intrinsic factor

Macrocytic anaemia

Question 5

AIHA

Answer 5

MC in women and SLE

Normocyctic anaemia, spherocytosis, reticulocytosis

POSITIVE Coombs’ test

Cold agglutinins

jaundice, hepatosplenomegaly, Raynaud phenomenon

Question 6

Anaemia of Chronic Disease

Answer 6

Chronic inflammatory conditions / malignancy

Mild, normocytic anaemia

Diagnosis of EXCLUSION

Question 7

Hereditary spherocytosis

Answer 7

Genetic defect in RBC membrane

NEGATIVE Coombs’ test

Question 8

Sickle cell anaemia

Answer 8

Increased HbS

Haemolytic crisis/aplastic anaemia possible

Question 9

Beta-thalassaemia major

Answer 9

Complete absence of beta-globin in Hb

Mediterranean, children

failure to thrive, bossing of skull, hepatosplenomegaly

Question 10

Target cell

Answer 10

Thalasseamia

Liver disease

IDA

Question 11

Microcytic, hypochromic cells

Answer 11

IDA

Thalassaemia

Sideroblastic anaemia

AoCD

Question 12

Agglutination

Answer 12

AIHA (cold)

Question 13

Rouleaux

Answer 13

Myeloma

Question 14

Inclusion bodies/basophilic stippling

Answer 14

Lead poisoning

Question 15

Tear drop cells

Answer 15

Myelofibrosis

Question 16

Heinz bodies

Answer 16

G6PD deficiency +/- schistocytes

Question 17

Howell-Jolly bodies

Answer 17

Splenectomy

Haemolytic anaemia

Laeukaemias

Thalassaemia

Pernicious anaemia

Question 18

Reed-Sternberg cell

Answer 18

Hodgkin’s lymphoma

Question 19

Auer bodies

Answer 19

AML

Question 20

Burr cells

Answer 20

Uraemia

Question 21

Hodgkin’s lymphoma

Answer 21

Reed-Sternberg cells

B symptoms, 20-30yo

painless, firm, rubbery lymphadenopathy

CONFIRM = BIOPSY

Question 22

Non-Hodgkin’s lymphoma

Answer 22

Mc in 70s, EBV, H. Pylori

Painless lymphadenopathy

CONFIRM = BIOPSY

Question 23

Burkitt’s lymphoma

Answer 23

Sub-Saharan africa

EBV!!!

Particularly affects the jaw

Question 24

Multiple myeloma

Answer 24

Bence-Jones proteins

lytic lesions

Hypercalcaemia, renal failure, anaemia, bony pain

CONFIRM = electrophoresis

Question 25

Myelofibrosis

Answer 25

pancytopenia + infection Massive hepatosplenomegaly Tear drop poilikocytes CONFIRM = bone marrow aspirate/trephine biopsy

Question 26

Myelodysplasia

Answer 26

Non-specific symptoms of BM failure Blood film + BM aspirate

Question 27

Acute lymphoblastic leukaemia

Answer 27

CHILDREN Pancytopenia, lymphadenopathy, CNS invasion (headache, meningism, palsies), bony pain CONFIRM = BM aspirate --> hypercullular with 20% blasts

Question 28

Acute myeloid leukaemia

Answer 28

ADULTS Symptoms marrow fialure, rapid progression Auer rods are pathognomonic

Question 29

Chronic lymphocytic leukaemia

Answer 29

Anaemia, infection, painless lymphadenopathy, splenomegaly Blood film --> mature lymphocytosis CONFIRM = BM aspirate --> +++ lymphocytes

Question 30

Chronic myeloid leukaemia

Answer 30

Philadelphia chromosome Massive splenomegaly, anaemia, bruising, infection Blood film --> myeloblasts (granulocytic) CONFIRM = BM aspirate --> hypercellular with increased myeloid:erythroid ratio

Question 31

Coagulation screen --- Heparin

Answer 31

``` INR + PT ++ APTT ++ Platelets = Bleeding time = ```

Question 32

Coagulation screen --- DIC

Answer 32

``` INR ++ PT ++ APTT ++ Platelets =/- Bleeding time + ```

Question 33

Coagulation screen --- Liver disease

Answer 33

``` INR + PT =/+ APTT + Platelets =/- Bleeding time =/+ ```

Question 34

Coagulation screen --- Haemophilia

Answer 34

``` INR = PT = APTT ++ Platelets = Bleeding time = ```

Question 35

Coagulation screen --- Vit K deficiency

Answer 35

``` INR ++ PT = APTT + Platelets = Bleeding time = ```

Question 36

Coagulation screen --- von Willebrand disease

Answer 36

``` INR = PT = APTT ++ Platelets = Bleeding time = ```

Question 37

Coagulation screen --- Platelet defect

Answer 37

``` INR = PT = APTT = Platelets = Bleeding time + ```

Question 38

Idiopathic thrombocytopenic purpura

Answer 38

Purpuric rash and bleeding from skin/mucous membranes (can be more severe!) Normal PT, normal APTT (clotting cascade unaffected) INCREASED bleeding time

Question 39

Aetiology of IDA

Answer 39

Women = menstrual blood loss, pregnancy/lactation (inc. iron requirement) Men = GIT blood loss / cancer Children = inc. iron requirement

Question 40

Presentation of Thalassaemia

Answer 40

Splenomegaly (inc. RBC destruction) Heart failure (Fe deposition) Bone deformities (inc. marrow activity) Slowed growth rates

Question 41

Diagnosis of Thalassaemia

Answer 41

FBC - low Hb, low MCV, iron studies (iron overload) *****Hb electrophoresis

Question 42

Thrombotic thrombocytopenic purpura

Answer 42

ADAMTS-13 deficiency = +++ vWF INCREASED bleeding time, thrombocyopenia The Terrible Pentad (anaemia, thrombocytopenia, fever, neuro Sx, renal dysfunction) Blood film --> schistocytes

Question 43

How do you stage Hodgkin's disease?

Answer 43

Stage I --> 1 lymph node area/organ Stage II --> 2+ lymph nodes same side of diaphragm ***NB: add E to the above if found in extra-lymph organ Stage III --> 2+ lymph nodes on both sides of diagram Stage IV --> wide spread into 1+ organs outside of lymph system ***NB: add B if B symptoms present (10% wt loss in 6mo, PUO >38C, night sweats)

Question 44

What are the types of vWD?

Answer 44

Type I --> heterozygous, reduced levels vWF Type II --> Normal vWF levels w/ structural abnormality Type IIA --> Abnormaly synthesis / proteolysis Type IIB --> Increased function of vWF (spontaneous plt binding) Type III --> homozygous disease, spontaneous bleeding