Haematology Flashcards
1
Q
patient had a high fever, high fever (>40), shock, rigors
A
Bacterial contamination of the unit
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).
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
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))
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
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)
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
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
9
Q
maculopapular rash, diarrhoea
A
GVHD
10
Q
severe anaphylaxis, laryngeal edema, wheeze, raised pulse
A
IgA deficiency
11
Q
dry cough, fever, dyspnoea low JVP, anti leukocyte antigens, acute SOB, low sats
A
TRALI
12
Q
same as TRALI but raised BP
A
TACO
13
Q
everything else excluded but high fever and hypotension-
A
bacterial infection of the unit
14
Q
mild symptoms (fever 2-h ago), raised pulse
A
Febrile non haemolytic:
15
Q
thalassemia patient who looks tanned and has diabetes
A
Transfusion haemosiderosis
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
17
Q
they have lots of transfusions so might have uncommon antibodies check antibodies in depth
A
Sickle cell
18
Q
Woman with anti D before C section - CMV neg
A
cross match
19
Q
Man with AAA repair (elective)
A
cross match
20
Q
Woman in emergency
A
O neg
21
Q
Immunocompromised
A
irradiated
22
Q
Previous severe allergic reaction
A
washed red cell and platelets
23
Q
A plastic anemia needs monthly transfusion irradiated and filtered
A
platelets if <10,000 and if bleeding, depleted
24
Q
non-cancerous growth in lymph nodes
A
HHV 8 Castleman’s disease
25
causes post-transplant lymphoproliferative disease where control of proliferation of latently infected B cells is lostIn HIV patients; oral hairy leukoplakia and lymphomas
Rituximab (anti-CD20 mAb) EBV
26
Complications: Giant cell pneumonia, encephalitis
Measles Give Human Normal Ig
27
affects paediatric post-BMT patients. Weekly PCR surveillance. Tx:
Adenovirus
| Reduce immunosuppression + Ribavirin
28
how to test whether it was autoimmune in origin
COOMBS test Haemolytic anaemia
29
Diagnosis of thalassaemia, sickle cell
Hb electrophoresis
30
Polycythaemia monitoring
Hct & Hb
31
Bone marrow response to haemolytic anaemia
Reticulocyte
32
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
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.
33
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,
Polyarteritis nodosa
34
EBV, mycoplasma, DAT positive which antibody is involved?
IgM Cold haemolytic anaemia:
35
DAT test plus jaundice, lymphoma on antibiotics
Warm IgG
36
MARCH:
MAHA, renal failure, CNS (headaches, hallucinations), haemogobinuria
37
Young man with fever, leucocytosis and a petechial rash after URTI
HSP
38
AK2, itching after a bath, myelodysplastic disorder
Polycythaemia vera:
39
>20% blasts, Auer rods, Down’s
AML
40
9;22, myeloid cell
CML
41
general malaise, weight loss, blurred vision, high IgM
Waldenstrom
42
should be able to recognize platelets going up with a pneumonia (to around 450 – patient was feeling feverish and unwell)
Infection/Reactive thrombocytosis
43
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
Essential Thrombocytopenia: platelet count > 600 * 109
tx: hydroxyurea, anagrelide
Can presents as both - bleeding and thrombosis
44
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
CML:
45
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
Hodgkin’s
46
Alk1 (liver, BM) t(2;5)
Anaplastic Large Cell Lymphoma
47
Caribbean and Japanese, HTLV-1 infection, aggressive
| Lymphocytosis,hypercalcemia, cloverleaf apperance of the attack cells
Adult T cell leukaemia/lymphoma
48
Associated with longstanding coeliac disease
Enteropathy-associated T cell lymphoma (EATL)
49
Associated with mycosis fungoides
Cutaneous T Cell Lymphoma
50
starry sky, EBV, jaw in African children
Burkitt’s
51
H pylori and Sjogren’s (parotid)
MALT
52
The most common cause of testicular mass in 40+,
| EBV associated and HHV, eldery men and B-symptoms
Diffuse Large B Cell:
53
CLL (Smear cells) into lymphoma, name this condition
Richter transformation ( Diffuse Large B Cell)
54
JC Virus would be present in which lymphoma?
–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.
55
BCR-‐ABL Translocation
CML (Philadephia Chromosome)
56
t(15;17)
seen in acute promyelocytic leukaemia (M3)
| fusion of PML and RAR-alpha genes
57
t(8;14
)seen in Burkitt's lymphoma
| MYC oncogene is translocated to an immunoglobulin gene
58
t(11;14)
| deregulation of the cyclin D1 (BCL-1) gene, lymphadenopathy and GI involvement in form of polyps
Mantle cell lymphoma
59
Patient with back pain, high IgG, plasma cells>20%
Multiple Myeloma
60
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→
Solitary plasmacytoma
61
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
Benign paraproteinaemia
62
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
MGUS
63
10% plasma cells (+ >30g/l) in BM but no CRAB / organ/tissue
Smouldering
64
IgM paraprotein (weight loss, fatigue, hyper viscosity syndrome, visual)
Waldestrom Hyperglobuinaemia
65
● 70-something year old, overweight patient with diabetes presents with chronic back pain and mildly raised creatinine. GFR was 55? Paraprotein at 12g/dl
Secondary?- Secondary Amyloidosis is associated with certain infections. The change in renal function is due to basement membrane thickening=Kimmelstiel nodules = Nephrotic syndrome
66
German woman with recurrent URTIs + UTIs w/ low neutrophils.
Cyclic neutropenia? ELA gene?
67
Philadelphia 9,22 BCR ABL present. Middle aged person 3% blasts Indolent. This is where Imatinib is the most effective
CML Chronic Pha <5% Imatinib
68
>10% blasts in bone marrow. Splenomegaly, lasting up for a year.
CML Accelerated phase.
69
● Philadelphia 9,22 BCR ABL present, TdT was expressed on cells - 22yr old, 70% blasts! No hepatosplenomegaly. No myelocytes or basophilia. STC treatment
CML in blast phase
70
Smear cells, elderly asymptomatic patients, generalised lymphadenopathy
CLL
71
High WBC + CD5 =
CLL
72
Tartate resistant acid phosphatase –
Hairy Cell Leukemia subtype of CLL
73
Patient with puritis + hepatsplenomegaly) raised haemoglobin following showering and Jak 2 Mutation:
PRV
74
elderly, massive splenomegaly, low platelets, red cells, normal white cells
Myelofibrosis (Massive splenomegaly: CML and fibrosis)
75
associated with DIC (hemmorrhage low platlets) , faggot cell, subtype of AML. ATRA (alpha –trans retinoic acid)
Acute promyelocytic leukaemia
76
Monoblstic, monocytes, Skin-gum infiltration plus hypokalemia
M4+M5
77
Pelger Huet cells hyposegmented neutrophil -
MDS
78
By definition all patients have <20% blasts
myelodysplastic disease
79
– 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.
refractory anaemia
80
the red blood cells, white blood cells and platelets are affected
refractory cytopenia
81
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
refractory anaemia with excess blasts (RAEB
82
What would you see on the iron studies with low iron??
low iron, low ferritin, high TBC, high Transferrin
83
Thalassaemia trait -
increased hbA2
84
1st episode DVT or PE, atrial fibrillation (2-3), caridomyopathy, symptomatic inherited thrombophilia, mural thrombus, cardioversion
2.5 if:
85
recurrent DVT or PE, mechanical prosthetic valve (2.5-3.5), coronary artery graft thrombosis, antiphospholipid syndrome
3.5
86
Anti Xa assay -
rivaroXaban, fondaparinuX (they have X’s in them)
87
low in liver disease and in DIC, high in pregnancy
Fibrinogen
88
breakdown product of fibrin
D dimers
89
Unfractionated heparin:
monitor APTT
90
Warfarin
PT
91
doesn’t need monitoring except late pregnancy and renal failure. Also aspirin.
LMWH (Clopidrogel):
92
When after the surgery patient comes back to the baseline risk of clotting?
DVT post surgery - will be back to baseline risk after 3 months of treatment
93
Pt with AF - 2.5
Leave Warfarin the same (2-3)
94
Pt with prosthetic valve - 2.5-3.5
Leave Warfarin the same (2-3)
95
Someone with a prosthetic valve
Between 3.0 and 4.0
96
Pt with previous DVT 4
Decrease Warfarin
97
Pt with previous DVT 1.5
Increase Warfarin
98
INR 5-8 minor bleeding
Vitamin K
99
Major bleeding:
prothrombin complex concentrate
100
Patient has prolonged APTT, normal PT and normal bleeding time
Haemophilia A
101
prolonged APTT, normal PT and prolonged bleeding time.
vWF
102
increased INR, APTT alcoholic
vitamin K deficiency
103
One question the woman had a clot but so did her father and sister familial very clotty
ATIII deficiency.
104
for pregnant woman with seizures and schistocytes but
TTP because of fever & neuro symptoms etc… so not DIC (tricky Q).
105
can get skin necrosis if given warfarin
Protein C problems
106
10 year old with recurrent episodes of jaundice + mild anaemia - blood film shows NO central pallor, RBCs are spherical
hereditary spherocytosis
107
10 year old afro-caribbean girl, history of chest crises and dactylitis, normal Hb with positive sickle solubility test
Sickle trait
108
● 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)-
G6PD
109
How would platelet defect would present?
Increased bleeding time
110
What does heparin increase?
INR, bleeding time, APTT
111
What would be increased in Haemophila?
APTT
112
What would be increased in vW?
APTT and bleeding time
113
If you see the reticulocytes what would you think?
Aplastic anemia
114
Causes of microcytic anemia
FAST: Ironn, ACD, sideroblastic, Thalassemia
115
incusions following splenectomy
Howell-Jolly Bodies
116
Cabor rings are characterisitc feature of whaT?
Megaloblastic Anemia
117
substittiution mutation which predisposes to DVT, the most common in the caucasia population
prothrombin G20210A
118
frothy sputum following transfusion
fluid overload
119
centrocytes and centroblast lymphoma
follicullar
120
Hypocelluular bone marrow and macrocytosis
Macrocytosis results from the relase of the fetal haemoglobin in attempt to compnase for RBC
121
Mechanism behind the anemia of chronic disease
IL-6 released from macrophages increases hepcidin, which retains iron in the macrophages,
122
alcohol- what sort of anemia
non-megaloblastic macrocytic anemia , also sideroblastic
123
Target cells can be found
```
LITH
Liver disease
Iron Deficency
Thalssaemia
Hyposplenism
```
124
two weeks after viral ilness child develop a purpuric rash
ITP - self limiting ilness caused by preformed IgG binding to virus coated RBC (type II)
125
What is underlying mechanism of the DIC?
malignancy, placent abruption, activate the clotting cascade leading to the secretion of the Tissue Factor
Also Plasmin is heavily involved
126
Whchich cells contribute to granulomatous disease>
Monocytes
127
What other causes of monocytosis do you know?
SLE, Brucelliosis, Typhoid, VZV, CMML
128
Eosinophilia causes
Parasytic, asthma, autoimmune, Lymphomas (Hodkin and non-Hodkin). NSAID
129
infection, cold day, jaundice, dark urine
Paroxymal Cold Haemoglobinurias
130
defect in red cell membrane, leading to intravscular haemolysis, PNH (pancytopenia, NEw Thrombus, hemolytic anemia)
Flow cytometry would be diagnostic with this patient.
131
prognostic factor melanoma
beta 2 microglobulin
132
what is the main complication of massive transfusion?
thrombocytopenia
133
/In what ways alcohol causes low platlets?
supresion of Bone Marrow
134
the most common lymphoma, waxing and weaning lymphadenopathy
Follicular
135
exploded popcorn kernel, peripheral lymphadenopathy without the B-symptoms
Nodular lymphocytic Hodkin
136
Haptoglobin is increased or decreased in intravasculara haemolysis?
Decreased (marker of haemolytic anemia)
137
Megacariocytes with excess blasts and hyperlobulated nuclei
MDS with 5q deletion
