Haematology Flashcards
84-year-old woman presents with pins and needles in hands and feet.
she says it feels as though she is ‘walking on cotton wool’.
what is the medical term for the symptom she has?
- paraesthesia
2. peripheral sensory neuropathy
An 84 year old woman has the following lab results back.
Her conjunctiva are lemon yellow Hb 63 (108-143) MCV 123 (82-99) WBC 3.2 (4-10) Plts 90 (140-400) Her film shows oval macrocytes and neutrophil hypersegmentation
what is the most likely diagnosis?
A. Iron deficiency anaemia
B. Megaloblastic anaemia
C. Acute leukaemia
D. Chronic anaemia secondary to diabetes
B. Megaloblastic anaemia
what blood test would you do to confirm a diagnosis of megaloblastic anaemia?
A. Plasma G-6-PD levels
B. Serum ferritin
C. Serum B12 and folate levels
D. Reticulocyte count, bilirubin and LDH
C. Serum B12 and folate levels
A megaloblast is a cell in which nuclear maturation is delayed compared with the cytoplasm. this occurs in B12 and folate deficiency as they are both required for DNA synthesis.
megaloblastic anaemia is a type of macrocytosis.
if a patient is thought to have pernicious anaemia, which of these tests would be diagnostic?
A. Antinuclear antibodies
B. Antiendomysial antibodies
C. Anti-intrinsic factor antibodies
D. Antiparietal cell antibodies
C. Anti-intrinsic factor antibodies
An 84 year old woman presents to you with pernicious anaemia. Her bloods show:
Hb 63, MCV 123, WCC 3.2, Plts 90
How would you treat her?
A. Oral vitamin B12
B. IM vitamin B12
C. Blood transfusion
D. Immunosuppression
B. IM vitamin B12
- you wouldn’t give the woman oral vitamin B12 because she wouldn’t be able to absorb it - no Intrinsic factor
- a blood transfusion can tip the patient into cardiac failure due to overtransfusion (maybe give 1 unit if the patient is compromised)
- immunosuppression is not required
with the following blood results for the 84 year old woman, what is the differential diagnosis?
Hb 63 (108-143) MCV 123 (82-99) WBC 3.2 (4-10) Plts 90 (140-400)
Her blood film then shows a blood film of hypogranular neutrophils with red cell anisocytosis
The lady’s B12 levels are normal
myelodysplasia
group of disorders that manifest as marrow failure with risk of life-threatening infection and bleeding.
- most are primary disorders but can also develop secondary to chemotherapy/radiotherapy. 1/3 will transform into a leukaemia
Tests:
- pancytopaenia
- decreased reticulocyte count
- increased marrow cellularity (ineffective haematopoiesis)
a 22 year old woman presents feeling tired, difficulty concentrating at work and is irritable with friends. she is breathless on exercise and denies any other symptoms:
she also looks pale.
Her bloods come back: Hb 84 (120 -160) MCV 77 (82-99) MCH 23 (27-32) WBC 5.7 (4-10) Plts 434 (140 – 400)
What is the term used to give a morphological description of this anaemia?
A. Hypochromic microcytic anaemia
B. Macrocytic anaemia
C. Normochromic, normocytic anaemia
D. Pancytopenia
A. hypochromic microcytic anaemia
this is important for the exam as this is a very common condition. the first laboratory test to investigate the cause would be to check a ferritin level.
What laboratory test would do first to investigate the cause of a hypochromic microcytic anaemia?
A. Ferritin
B. Haemoglobinopathy screen
C. Bone marrow aspirate
D. Serum Lgs
A. ferritin
a 22 yo woman presents with a ferritin of 6 micrograms/l. what is her diagnosis when this is what her history reads:
tired, difficulty concentrating at work and is irritable with friends. she is breathless on exercise and denies any other symptoms:
she also looks pale.
Her bloods come back: Hb 84 (120 -160) MCV 77 (82-99) MCH 23 (27-32) WBC 5.7 (4-10) Plts 434 (140 – 400)
iron deficiency anaemia.
given this history, the woman should NOT be referred for GI investigation as you discover that she is a vegetarian which is probably the cause of her iron deficiency
what symptoms would you ask a 22 year old woman who had iron deficiency anemia?
suggest 4 things
- bleeding menorrhagia
- pregnancy status?
- diet? (namely is she vegetarian
- check GI symptoms
how would you treat a 22 year old woman with iron deficiency anaemia?
Hb 84 (120 -160) MCV 77 (82-99) MCH 23 (27-32) WBC 5.7 (4-10) Plts 434 (140 – 400)
A. IV iron
B. Blood transfusions
C. Oral iron
D. Dietary iron
C. There is no reason from her history to suggest that she cannot absorb the iron orally.
- there is also no indication for IV
- her diet is difficult
a 78 yo retired surgeon presents feeling:
Tired Difficulty concentrating on crosswords Breathless on exercise Chest pain at rest Smoker No obvious epistaxis or bleeding
his blood tests show
Hb 84 (116-156) MCV 77 (82-99) MCH 23 (27-31) WBC 5.7 (4-10) Plts 623 (140 – 400)
should this patient be referred for GI investigations?
Yes. this patient should be referred.
the commonest cause in an elderly person for this kind of presentation is blood loss. particularly in males without obvious cause of blood loss.
there are no indications that his diet is poor.
a 78 yo retired surgeon presents feeling:
Tired Difficulty concentrating on crosswords Breathless on exercise Chest pain at rest Smoker No obvious epistaxis or bleeding
his blood tests show
Hb 84 (116-156) MCV 77 (82-99) MCH 23 (27-31) WBC 5.7 (4-10) Plts 623 (140 – 400)
How would you treat this patient?
A. IV Iron
B. Blood transfusion
C. Oral iron
D. Dietary advice
B. This person has chest pain at rest which indicates that there is some critical cardiac ischaemia which means he shouldn’t wait for IV/oral iron to work
describe the normal human haemoglobin (HbA) molecule in terms of alpha and beta genes and chains
HbA is composed of
- 2 alpha chains
- 2 beta chains
- 4 alpha genes
- 2 beta genes
The normal adult has
- Hb A 97% (alpha alpha beta beta)
- Hb A2 2% (alpha alpha delta delta)
- Hb F 1 % (alpha alpha gamma gamma)
antenatal and babies are screened for haemoglobinopathies
2 carriers of beta thalassaemia trait are partners and are planning a pregnancy.What is the chance that they will have a baby affected by beta thalassaemia major?
A. 1in 4
B. 1 in 2
C. 1 in 5
D. Unknown without know the specific mutation
A. Autosomal recessive inheritance in thalassaemia (and most haemoglobinopathies. there is a 1 in 4 chance of having thalassaemia. 1 in 2 chance of being a carrier and there in 1 in 4 chance of the child being normal.
Give other causes of hypochromic microcytic anaemia other than iron deficiency
- thalassaemia trait
- secondary anaemia/anaemia of chronic disease
- usually normochromic -normocytic normal or elevated ferritin
ineffective iron utilisation
a 34 year old waiter is tired with noticed yellow eyes
these are his blood tests:
Hb 73 (140-180) MCV 98 (82-99) MCH 32 (27-32) WCC 7.2 (4-10) Plts 480 (140-400)
hos blood film will show spherocytes. what pother investigations should be ordered?
A. A reticulocyte count B. Bilirubin, LDH C. Serum haptoglobin D. Coombs test/DAGT E. All of above
E. all of the above
a 34 year old waiter is tired with noticed yellow eyes
these are his blood tests:
Hb 73 (140-180) MCV 98 (82-99) MCH 32 (27-32) WCC 7.2 (4-10) Plts 480 (140-400)
hos blood film will show spherocytes. what pother investigations should be ordered?
if the Coombs test is positive, what is the diagnosis?
A. Autoimmune haemolysis
B. Hereditary spherocytosis
C. G6PD deficiency
D. Microangiopathic haemolysis
A. autoimmune haemolysis
if the DaFT was negative there may be an alternative.
ask the patient:
- previous episodes
- FH
- drugs
- viral
- infections
- hereditary spherocytosis
a 34 year old waiter presents with yellow eyes, chest pain SOB and fever
his labs show:
Hb 73 (140-180) MCV 98 (82-99) MCH 32 (27-32) WCC 7.2 (4-10) PLts 530 (140-400)
when the blood films are done they showed sickle cells. what other investigations are required.
A. A Reticulocyte count
B. Bilirubin, LDH
C. Haemoglobinopathy screen
D. All of the above
D. all of the above
a 34 year old waiter presents with yellow eyes, chest pain SOB and fever
his labs show:
Hb 73 (140-180) MCV 98 (82-99) MCH 32 (27-32) WCC 7.2 (4-10) PLts 530 (140-400)
the diagnosis is sickle cell disease HbSS. what is unlikely to be the cause of this man’s chest pain?
A. bony crisis
B. pneumonia
C. pulmonary embolism
D. splenic infarction
D. because early on in childhood, patients start to auto-infarct their spleen are are already vaccinated against infection
in painful sickle cell crisis, management should include:
A. analgesia
B. oxygen
C. fluids
D. all of the above
D. all of the above
the entire management for hbSS
- analgesia
- oxygen
- fluids
- antibiotics (if needed)
- thromboprophylaxis
- consider transfusion
lymphoma can often present with
- enlarged lymph nodes
- extranodal involvement
- bone marrow involvement
Describe 4 systemic (B) symptoms that may present with lymphoma
- weight loss
- fever
- night sweats
- pruritis
- fatigue
27 yo male presents with 1 month history of impaired vision and has lost 1/2 stone in weight. He is also SOB on minimal exertion
retinal infarcts present and investigation shows:
Hb 38g/L (120-140)
WCC 3.7 (4-11)
platelets (68 (150-400)
Bone marrow shows 90% B lymphocytes
what is the most likely diagnosis?
acute lymphoblastic leukaemia
treatment is with
- induction of chemo to obtain remission
- consolidation therapy
- CNS directed treatment
- maintenance treatment for 18 months
in other cases Stem cell transplantation can be tried but there is a high risk in this procedure.
what should be the treatment for a 27 year old male with acute lymphoblastic leukaemia?
- induction of chemo to start remission
- consolidation therapy
- CNS directed treatment
- maintenance treatment for 18 months
- stem cell transplantation (v risky)
name 3 poor risk factors for acute lymphoblastic anaemia
- increasing age
- increased white cell count
- immunophenotype (more primitive forms)
- cytogenetics/molecular genetics
a. t(9;22); t(4;11) - slow/poor response to treatment
what is the typical presentation with a patient with ALL - acute lymphoblastic anaemia?
1. bone marrow failure (with possible increased WCC_ 2. night sweats 3. bone pain 4. infection
treatment of ALL is with multi-agent intensive chemotherapy +/-0 allogeneic stem cell transplantation
how would you differentiate between iron deficiency anaemia (IDA) and sideroblastic anaemia despite they are both microcytic anaemias?
name one more common microcytic anaemia condition
- IDA will have low iron levels and decreased ferritin
sideroblastic anaemia will have high iron levels and high ferritin levels.
another kind of microcytic anaemia condition is thalassaemia
what type of factor deficiency is present in Haemophilia A and how does this differ from the deficiency in Haemophilia B?
Haemophilia A is affected by Factor VIII deficiency whereas Haemophilia B is affected by IX deficiency
suggest 2 treatments of iron overload
- iron chelators - oral deferiprone SE nause deafness cataracts and retinal damage and increased risk of yersinia
- large doses of ascorbic acid to increase the urinary excretion of iron
give 6 causes for thrombocytosis
bleeding infection chronic inflammation - collagen disorders malignancy trauma post surgery iron deficiency
thrombocytopenia is when the platelets are >450x10^9/L
what is the diagnostic criteria for myeloma?
- monoclonal protein band in serum or urine electrophoresis
- increased plasma cells found on bone marrow biopsy
- evidence from end-organ damage from myelome
- hypercalcaemia
- renal insufficiency
- anaemia
bone lesions: a skeletal survey is performed after diagnosis to detect bone disease, consisting of XR of chest; cervical, thoracic and lumbar spine; skull and pelvis
