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PPQ PATH > Haematology > Flashcards

Haematology Flashcards

1
Q

patient had a high fever, high fever (>40), shock, rigors

A

Bacterial contamination of the unit

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2
Q

one history had a patient who had recently been involved in some kind of trauma and had been transfused with O (universal donor) negative blood. He lost consciousness or something a few minutes after the transfusion and the answer was

A

haemorrhage with a splenic haemorrhage after a stab wound rather than ABO incompatibility (because O negative blood).

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3
Q

Woman with O (universal donor) rh+ (can receive both) given A rh- (can only recive rh(-), what happens

A

Immediate haemolytic reaction, e.g. ABO mismatch, massive intravascular haemolysis

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4
Q

Lady who received a blood transfusion and platelets and went home and developed a rash all over and “some shortness of breath”

A

(mild allergic reaction – if severe (wheeze))

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5
Q

Elderly patient after a road traffic collision who required a massive transfusion - What is the most serious complication that could happen, 6 hours post, leading to macrophage infilitration into the lungs (non-cardiopgenic pulmonary oedema)

A

TRALI –trial of dononr antibodies leaving the TRAIL of antibodies into the recipient

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6
Q

Woman who received a transfusion before her hysterectomy who presented with bleeding gums and bruising rash on her shins on discharge

A

Post-transfusion purpura (PTP)

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7
Q

the patient makes an alloantibody in response to platelet antigens in the transfused blood that for a period of time causes destruction of autologous antigen negative platelets

A

. Post transfusion purpura: HLP1A

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8
Q

> 24 hours with extra-vascular haemolysis (jaundice, haemoglobinuria)

A

Delayed Haemolysis Transfusion. Occur if patients had previous transfusions or pregnacies, antibodies agains
red cell antigens

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9
Q

maculopapular rash, diarrhoea

A

GVHD

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10
Q

severe anaphylaxis, laryngeal edema, wheeze, raised pulse

A

IgA deficiency

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11
Q

dry cough, fever, dyspnoea low JVP, anti leukocyte antigens, acute SOB, low sats

A

TRALI

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12
Q

same as TRALI but raised BP

A

TACO

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13
Q

everything else excluded but high fever and hypotension-

A

bacterial infection of the unit

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14
Q

mild symptoms (fever 2-h ago), raised pulse

A

Febrile non haemolytic:

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15
Q

thalassemia patient who looks tanned and has diabetes

A

Transfusion haemosiderosis

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16
Q

Already transfused once before –> sensitized

A

anaphylaxis due to IgA def (Immediate death: wrong blood, anaphylaxis (often goes with IgA) if managed poorly

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17
Q

they have lots of transfusions so might have uncommon antibodies check antibodies in depth

A

Sickle cell

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18
Q

Woman with anti D before C section - CMV neg

A

cross match

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19
Q

Man with AAA repair (elective)

A

cross match

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20
Q

Woman in emergency

A

O neg

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21
Q

Immunocompromised

A

irradiated

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22
Q

Previous severe allergic reaction

A

washed red cell and platelets

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23
Q

A plastic anemia needs monthly transfusion irradiated and filtered

A

platelets if <10,000 and if bleeding, depleted

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24
Q

non-cancerous growth in lymph nodes

A

HHV 8 Castleman’s disease

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25
Q

causes post-transplant lymphoproliferative disease where control of proliferation of latently infected B cells is lostIn HIV patients; oral hairy leukoplakia and lymphomas

A

Rituximab (anti-CD20 mAb) EBV

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26
Q

Complications: Giant cell pneumonia, encephalitis

A

Measles Give Human Normal Ig

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27
Q

affects paediatric post-BMT patients. Weekly PCR surveillance. Tx:

A

Adenovirus

Reduce immunosuppression + Ribavirin

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28
Q

how to test whether it was autoimmune in origin

A

COOMBS test Haemolytic anaemia

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29
Q

Diagnosis of thalassaemia, sickle cell

A

Hb electrophoresis

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30
Q

Polycythaemia monitoring

A

Hct & Hb

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31
Q

Bone marrow response to haemolytic anaemia

A

Reticulocyte

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32
Q

Joint pain, splenomegaly, skin, nerve and kidney. (in Meeran’s book): cryo means cold. This has more systemic presentation - abnormal proteins deposit all over the body

A

Associated with Hep C.type III hypersensitivity CryoglobulinaemiaIn patients with cryoglobulinemia, when the blood gets below normal body temperature, it precipitates an abnormal protein that causes the blood to become jelly-like. The thickening of the blood creates damage to the blood vessels and organs throughout the body. This reaction can lead to complications ranging from skin rashes to organ damage/failure, amputations, strokes and even death.

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33
Q

40 year old man with previous hep B. Muscle pain and joint pain. Spares pulmonary capillaries. Renal involvement is prominent feature, thus high BP. associated with Hep B/C. Fever, fatigue, weakness, arthralgia, skin, nerve and, kidney involvement, pericarditis and MI,

A

Polyarteritis nodosa

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34
Q

EBV, mycoplasma, DAT positive which antibody is involved?

A

IgM Cold haemolytic anaemia:

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35
Q

DAT test plus jaundice, lymphoma on antibiotics

A

Warm IgG

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36
Q

MARCH:

A

MAHA, renal failure, CNS (headaches, hallucinations), haemogobinuria

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37
Q

Young man with fever, leucocytosis and a petechial rash after URTI

A

HSP

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38
Q

AK2, itching after a bath, myelodysplastic disorder

A

Polycythaemia vera:

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39
Q

> 20% blasts, Auer rods, Down’s

A

AML

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40
Q

9;22, myeloid cell

A

CML

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41
Q

general malaise, weight loss, blurred vision, high IgM

A

Waldenstrom

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42
Q

should be able to recognize platelets going up with a pneumonia (to around 450 – patient was feeling feverish and unwell)

A

Infection/Reactive thrombocytosis

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43
Q

platelet count > 600 * 109, both thrombosis (venous or arterial) and haemorrhage can be see, a characteristic symptom is a burning sensation in the hands, a JAK2 mutation is found in around 50% of patients. PMD: DVT, easy bruising Megakaryocyte proliferation results in an overproduction of platelets. T

A

Essential Thrombocytopenia: platelet count > 600 * 109
tx: hydroxyurea, anagrelide

Can presents as both - bleeding and thrombosis

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44
Q

Middle aged, diagnosed on routine blood tests Massive Splenomegaly, Philadelphia Chromosome. Thrombocytosis is observed in 30% to 50% of patients, occasionally at levels higher than 1,000 x 109/L

A

CML:

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45
Q

asymmetrical painless lymphadenopathy, hepatosplneomegaly, deaarange LFT worst after alcohol , cyclical fever, Reed-Stenberg Cells. EBV associated. Stage 3 (on both sides of the diaphragm), 4 extranodal signs

A

Hodgkin’s

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46
Q

Alk1 (liver, BM) t(2;5)

A

Anaplastic Large Cell Lymphoma

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47
Q

Caribbean and Japanese, HTLV-1 infection, aggressive

Lymphocytosis,hypercalcemia, cloverleaf apperance of the attack cells

A

Adult T cell leukaemia/lymphoma

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48
Q

Associated with longstanding coeliac disease

A

Enteropathy-associated T cell lymphoma (EATL)

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49
Q

Associated with mycosis fungoides

A

Cutaneous T Cell Lymphoma

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50
Q

starry sky, EBV, jaw in African children

A

Burkitt’s

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51
Q

H pylori and Sjogren’s (parotid)

A

MALT

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52
Q

The most common cause of testicular mass in 40+,

EBV associated and HHV, eldery men and B-symptoms

A

Diffuse Large B Cell:

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53
Q

CLL (Smear cells) into lymphoma, name this condition

A

Richter transformation ( Diffuse Large B Cell)

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54
Q

JC Virus would be present in which lymphoma?

A

–Progressive multifocal encephalopathy (PML) is a fatal demyelinating disease of the central nervous system (CNS), caused by the lytic infection of oligodendrocytes by a human polyomavirus, JC virus (JCV). PML is rare disease but mostly develops in patients with underlying immunosuppressive conditions, including Hodgkin’s lymphoma, lymphoproliferative diseases, in those undergoing antineoplastic therapy and AIDS.

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55
Q

BCR-­‐ABL Translocation

A

CML (Philadephia Chromosome)

56
Q

t(15;17)

A

seen in acute promyelocytic leukaemia (M3)

fusion of PML and RAR-alpha genes

57
Q

t(8;14

A

)seen in Burkitt’s lymphoma

MYC oncogene is translocated to an immunoglobulin gene

58
Q

t(11;14)

deregulation of the cyclin D1 (BCL-1) gene, lymphadenopathy and GI involvement in form of polyps

A

Mantle cell lymphoma

59
Q

Patient with back pain, high IgG, plasma cells>20%

A

Multiple Myeloma

60
Q

Patient with lump on clavicle and you see a lytic lesion on the Xray. There is also a raised IgA but no other lesions/abnormal calium/anaemia→

A

Solitary plasmacytoma

61
Q

A 49-year-old woman presented with a 6-month history of vague aches and pains in her chest. Protein electrophoresis showed a small paraprotein band in the gamma region; this band was an IgG of lambda type. A bone marrow biopsy showed only 12% plasma cells. There was no protein in her urine

A

Benign paraproteinaemia

62
Q

Patient with no signs or symptoms and just raised IgG/IgA (can’t remember which!)→ MGUS: raised Ig no symptoms, <10% bast cells, <30g/dl paraprotein

A

MGUS

63
Q

10% plasma cells (+ >30g/l) in BM but no CRAB / organ/tissue

A

Smouldering

64
Q

IgM paraprotein (weight loss, fatigue, hyper viscosity syndrome, visual)

A

Waldestrom Hyperglobuinaemia

65
Q

● 70-something year old, overweight patient with diabetes presents with chronic back pain and mildly raised creatinine. GFR was 55? Paraprotein at 12g/dl

A

Secondary?- Secondary Amyloidosis is associated with certain infections. The change in renal function is due to basement membrane thickening=Kimmelstiel nodules = Nephrotic syndrome

66
Q

German woman with recurrent URTIs + UTIs w/ low neutrophils.

A

Cyclic neutropenia? ELA gene?

67
Q

Philadelphia 9,22 BCR ABL present. Middle aged person 3% blasts Indolent. This is where Imatinib is the most effective

A

CML Chronic Pha <5% Imatinib

68
Q

> 10% blasts in bone marrow. Splenomegaly, lasting up for a year.

A

CML Accelerated phase.

69
Q

● Philadelphia 9,22 BCR ABL present, TdT was expressed on cells - 22yr old, 70% blasts! No hepatosplenomegaly. No myelocytes or basophilia. STC treatment

A

CML in blast phase

70
Q

Smear cells, elderly asymptomatic patients, generalised lymphadenopathy

A

CLL

71
Q

High WBC + CD5 =

A

CLL

72
Q

Tartate resistant acid phosphatase –

A

Hairy Cell Leukemia subtype of CLL

73
Q

Patient with puritis + hepatsplenomegaly) raised haemoglobin following showering and Jak 2 Mutation:

A

PRV

74
Q

elderly, massive splenomegaly, low platelets, red cells, normal white cells

A

Myelofibrosis (Massive splenomegaly: CML and fibrosis)

75
Q

associated with DIC (hemmorrhage low platlets) , faggot cell, subtype of AML. ATRA (alpha –trans retinoic acid)

A

Acute promyelocytic leukaemia

76
Q

Monoblstic, monocytes, Skin-gum infiltration plus hypokalemia

A

M4+M5

77
Q

Pelger Huet cells hyposegmented neutrophil -

A

MDS

78
Q

By definition all patients have <20% blasts

A

myelodysplastic disease

79
Q

– just the red blood cells are affected. means the condition doesn’t respond to treatment that doctors would normally use for low blood cell counts.

A

refractory anaemia

80
Q

the red blood cells, white blood cells and platelets are affected

A

refractory cytopenia

81
Q

the red blood cells, white blood cells and platelets are affected, and there’s a higher risk of developing acute leukaemia. Patient presents with recurrent infections (anemia WBC VERY LOW).Pegler huer This can further convert to AML

A

refractory anaemia with excess blasts (RAEB

82
Q

What would you see on the iron studies with low iron??

A

low iron, low ferritin, high TBC, high Transferrin

83
Q

Thalassaemia trait -

A

increased hbA2

84
Q

1st episode DVT or PE, atrial fibrillation (2-3), caridomyopathy, symptomatic inherited thrombophilia, mural thrombus, cardioversion

A

2.5 if:

85
Q

recurrent DVT or PE, mechanical prosthetic valve (2.5-3.5), coronary artery graft thrombosis, antiphospholipid syndrome

A

3.5

86
Q

Anti Xa assay -

A

rivaroXaban, fondaparinuX (they have X’s in them)

87
Q

low in liver disease and in DIC, high in pregnancy

A

Fibrinogen

88
Q

breakdown product of fibrin

A

D dimers

89
Q

Unfractionated heparin:

A

monitor APTT

90
Q

Warfarin

A

PT

91
Q

doesn’t need monitoring except late pregnancy and renal failure. Also aspirin.

A

LMWH (Clopidrogel):

92
Q

When after the surgery patient comes back to the baseline risk of clotting?

A

DVT post surgery - will be back to baseline risk after 3 months of treatment

93
Q

Pt with AF - 2.5

A

Leave Warfarin the same (2-3)

94
Q

Pt with prosthetic valve - 2.5-3.5

A

Leave Warfarin the same (2-3)

95
Q

Someone with a prosthetic valve

A

Between 3.0 and 4.0

96
Q

Pt with previous DVT 4

A

Decrease Warfarin

97
Q

Pt with previous DVT 1.5

A

Increase Warfarin

98
Q

INR 5-8 minor bleeding

A

Vitamin K

99
Q

Major bleeding:

A

prothrombin complex concentrate

100
Q

Patient has prolonged APTT, normal PT and normal bleeding time

A

Haemophilia A

101
Q

prolonged APTT, normal PT and prolonged bleeding time.

A

vWF

102
Q

increased INR, APTT alcoholic

A

vitamin K deficiency

103
Q

One question the woman had a clot but so did her father and sister  familial  very clotty

A

ATIII deficiency.

104
Q

for pregnant woman with seizures and schistocytes but

A

TTP because of fever & neuro symptoms etc… so not DIC (tricky Q).

105
Q

can get skin necrosis if given warfarin

A

Protein C problems

106
Q

10 year old with recurrent episodes of jaundice + mild anaemia - blood film shows NO central pallor, RBCs are spherical

A

hereditary spherocytosis

107
Q

10 year old afro-caribbean girl, history of chest crises and dactylitis, normal Hb with positive sickle solubility test

A

Sickle trait

108
Q

● 10 year old caucasian who had been on a holiday, presented with low platelets (thrombocytopenia) and profound anaemia (6g/dl + oliguria) - anaemic blood film showed ?bite cells, and schistocytes (MAHA)-

A

G6PD

109
Q

How would platelet defect would present?

A

Increased bleeding time

110
Q

What does heparin increase?

A

INR, bleeding time, APTT

111
Q

What would be increased in Haemophila?

A

APTT

112
Q

What would be increased in vW?

A

APTT and bleeding time

113
Q

If you see the reticulocytes what would you think?

A

Aplastic anemia

114
Q

Causes of microcytic anemia

A

FAST: Ironn, ACD, sideroblastic, Thalassemia

115
Q

incusions following splenectomy

A

Howell-Jolly Bodies

116
Q

Cabor rings are characterisitc feature of whaT?

A

Megaloblastic Anemia

117
Q

substittiution mutation which predisposes to DVT, the most common in the caucasia population

A

prothrombin G20210A

118
Q

frothy sputum following transfusion

A

fluid overload

119
Q

centrocytes and centroblast lymphoma

A

follicullar

120
Q

Hypocelluular bone marrow and macrocytosis

A

Macrocytosis results from the relase of the fetal haemoglobin in attempt to compnase for RBC

121
Q

Mechanism behind the anemia of chronic disease

A

IL-6 released from macrophages increases hepcidin, which retains iron in the macrophages,

122
Q

alcohol- what sort of anemia

A

non-megaloblastic macrocytic anemia , also sideroblastic

123
Q

Target cells can be found

A 
LITH
Liver disease 
Iron Deficency
Thalssaemia
Hyposplenism
124
Q

two weeks after viral ilness child develop a purpuric rash

A

ITP - self limiting ilness caused by preformed IgG binding to virus coated RBC (type II)

125
Q

What is underlying mechanism of the DIC?

A

malignancy, placent abruption, activate the clotting cascade leading to the secretion of the Tissue Factor
Also Plasmin is heavily involved

126
Q

Whchich cells contribute to granulomatous disease>

A

Monocytes

127
Q

What other causes of monocytosis do you know?

A

SLE, Brucelliosis, Typhoid, VZV, CMML

128
Q

Eosinophilia causes

A

Parasytic, asthma, autoimmune, Lymphomas (Hodkin and non-Hodkin). NSAID

129
Q

infection, cold day, jaundice, dark urine

A

Paroxymal Cold Haemoglobinurias

130
Q

defect in red cell membrane, leading to intravscular haemolysis, PNH (pancytopenia, NEw Thrombus, hemolytic anemia)

A

Flow cytometry would be diagnostic with this patient.

131
Q

prognostic factor melanoma

A

beta 2 microglobulin

132
Q

what is the main complication of massive transfusion?

A

thrombocytopenia

133
Q

/In what ways alcohol causes low platlets?

A

supresion of Bone Marrow

134
Q

the most common lymphoma, waxing and weaning lymphadenopathy

A

Follicular

135
Q

exploded popcorn kernel, peripheral lymphadenopathy without the B-symptoms

A

Nodular lymphocytic Hodkin

136
Q

Haptoglobin is increased or decreased in intravasculara haemolysis?

A

Decreased (marker of haemolytic anemia)

137
Q

Megacariocytes with excess blasts and hyperlobulated nuclei

A

MDS with 5q deletion

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