Haematology

Question 1

When do you give platelet concentrations? (4)

Answer 1

• Bleeding due to thrombocytopenia such as after chemotherapy, bone marrow transplant and aplastic anaemia
• Mostly haematology patients with bone marrow failure (if platelets <10 x 109/L)
• Massive bleeding or acute DIC
• If very low platelets and patient needs surgery
• If for cardiac bypass and patient on anti-platelet drugs

Question 2

When do you not give platelet concentrations? (1)

Answer 2

• When the defect is in the secondary haemostasis

* Autoimmune Thrombocytopenia

Question 3

What is the mechanism of thrombocytopenia? (2)

Answer 3

• Enlarged spleen(pooling of platelets) and bone marrow disorder such as aplastic anaemia
• Destruction by autoantibody>spleen

Question 4

What are the presenting features of Beta Thalassaemia major? (3)

Answer 4

• Malaise, pale, fatigue, big abdomen on left (enlarged spleen), abnormal skull structure
Also failure to thrive and presenting in first year of life, and profound anaemia

Question 5

What does the blood film of someone with Beta Thal trait look like? (3)

Answer 5

Poikilocytosis (target cells)
Polychromasia
Increased red cell count
•	Hb may be normal
•	MCV low
•	MCH low
•	Red cell count increased                      
•	HbA2 increased [electrophoresis]

Question 6

What is the treatment for Beta Thal major and what are the risks and side effects? (3)

Answer 6

•	blood transfusion
•	iron chelator eg. deferoxamine
•	risks:
o	increased viral infection eg. Hep C from transfusion
o	iron overload