Haematology

Question 1

Key symptom of lymphoma

Answer 1

Drenching night sweats
Fatigue
Weight loss

Question 2

Main difference between Hodgkin/ Non-Hodgkin lymphoma?

Answer 2

NH - painless lymphadenopathy

H - alcohol induced pain in lymph nodes + MEDIASTINAL MASS (breathless, dyspnoea)

Question 3

What is follicular lymphoma?

What is it’s key characteristic?

Answer 3

Type of Non-Hodgkin lymphoma

Characterised by slowly growing lymph nodes

Question 4

What do blood tests show in a lymphoma

Answer 4

Errything raised

• Raised FBC, U+E, LFT, LDH, ACE level

Question 5

Key characteristic of chronic lymphocytic leukaemia that sets it apart from standard lymphoma?

Answer 5

Drenching night sweats
Fatigue
Weight loss
ABDOMINAL DISTENTION, ANAEMIA, THROMBOCYTOPENIA

Question 6

How to treat CLL?

Answer 6

Chemo-immunotherapy – Bendamustine + RITUXIMAB (toxic to B cells)

Question 7

In older people, what are the main 2 causes of iron deficiency?

Answer 7

GI Bleed

Blood loss

Question 8

What is the relationship between B12 and folate?

Answer 8

B12 needed to make folate

Question 9

Symptoms of B12/folate deficiency

Answer 9

Macrocytic anaemia
ANGULAR CHELITIS
Mild jaundice
Pancytopenia

Question 10

Key test results for haemolysis?

Answer 10

HIGH RETICULOCYTES (immature RBC)
LOW HAPTOGLOBINS (proteins that bind to free Hb)
Anaemia
High MCV 
Raised bilirubin

Question 11

Key symptoms for PCV?

Answer 11

GOUT 
TINNITUS
headache
red face 
Itching

Question 12

What gene causes PCV?

Answer 12

JAK2

Question 13

What is a key cause of thrombocytosis?

Answer 13

IRON DEFICIENCY 
Hyposplenism
Haemolysis
Surgery 
Cancer
Drugs (steroids/ TPO mimetic)

Question 14

What is a key marker of thrombocytosis?

Answer 14

FERRITIN

Question 15

What genes are involved in causing thrombocytosis?

Answer 15

JAK2

CALR

Question 16

Like lymphomas, what are the symptoms of myelofibrosis?

Answer 16

DRENCHING NIGHT SWEATS
Weight loss
Fatigue

Question 17

What does the blood film of myelofibrosis show?

Answer 17

TEAR DROP RBC

Question 18

How to treat myelofibrosis?

Answer 18

Bone marrow transplant

JAK2 inhibitors

Question 19

What chromosome causes chronic myeloid leukaemia?

Answer 19

PHILADELPHIA CHROMOSOME

9 & 22 merge together

Question 20

How to treat chronic myeloid leukaemia?

Answer 20

o low dose oral cytotoxic drugs (busulphan, hydroxycarbamide)
o interferon
o Gleveec/imatinib mesylate: a tyrosine kinase inhibitor (TKI)

Bone marrow transplant
Chemo

Question 21

What are the differences in chronic myeloid leukaemia and chronic lymphocytic leukaemia?

Answer 21

CML - myeloid cells are cancerous (macrophages/ granuloma cells). Causes ABDO PAIN, splenomegaly, anaemia, venous occlusion

CLL - lymphoid cells are cancerous (B cells). ABDO DISTENTION. Axillary lymphadenopathy, anaemic, decr platelets, splenomegaly, bone marrow failure, systemic symptoms

Question 22

Patient presents with drenching night sweats, fever and weight loss. What are your differentials?

What separates each one?

Answer 22

Myelofibrosis, Chronic Lymphocytic Leukaemia, lymphoma

Myelofibrosis - tear drop RBC, PANcytopenia

CLL - ABDOMINAL DISTENTION, ANAEMIA, THROMBOCYTOPENIA

Lymphoma - lymphadenopathy (usually painless, but in Hodgkin’s can hurt after drinking alcohol)