Haematology

Question 1

Hodgkin’s Lymphoma

What is the most common type?

Which ones have the best and worst prognosis?

Answer 1

Reed-Sternberg cells

Most common type (70%) - nodular sclerosing (good prognosis)

Best prognosis - lymphocyte predominant (~5%)

Worst prognosis - lymphocyte depleted (rare)

Question 2

Cryoprecipitate - what is it commonly used to replace?

Answer 2

Fibrinogen

Question 3

Indications for blood transfusion in iron-deficiency anaemia

Answer 3

1. Severely symptomatic and cannot tolerate or wait for the effect of iron-replacement (in iron deficiency anaemia the Hb usually rises 10g/L/week on oral iron replacement)
2. Have Hb <70g/L (some recommend using a higher cut-off of 100g/L in patients with ischaemic heart disease)

Question 4

Threshold for blood transfusion in: (NICE)
Patients without ACS
Patients with ACS

Answer 4

Without ACS - 70g/L (target post-transfusion: 70-90g/L)

With ACS - 80g/L (target post-transfusion: 80-100g/L)

Question 5

Von Willebrand Disease - management

Disease behaves like a platelet disorder - e.g. epistaxis, menorrhagia; haemoarthroses and muscle haematomas are rare

Answer 5

1. TXA for mild bleeding
2. Desmopressin - raises levels of vWF inducing release of vWF from endothelial cells (can reduce bleeding)
3. Factor VIII concentrate

Question 6

Haemophilia A and B

1. Mode of inheritance
2. What is the disorder due to? (for both A and B)
3. Blood test abnormality

Answer 6

1. X-linked recessive
2. A is caused by factor VIII deficiency; B (Christmas disease) is caused by factor IX deficiency
3. Prolonged APTT

Question 7

Key difference in bloods of patients with iron deficiency anaemia and anaemia of chronic disease (e.g. RA)?

Answer 7

LOW in IDA

HIGH in anaemia of chronic disease

Question 8

A 21-year-old male presents to the emergency department with a cough, fever and dyspnoea. On examination he is hypoxic. Pulmonary infiltrates are seen on chest x-ray. He has suffered with anaemia, jaundice and general weakness since the age of 3 months, as well as severe pain when exposed to cold conditions.

What is the most likely underlying condition?

Answer 8

Sickle cell disease

The patient described is having acute chest syndrome occurring in the context of sickle cell

Acute chest syndrome defined as: new pulmonary infiltrates on CXR alongside SOB, chest pain, cough or hypoxia. The patient also has vaso-occlusive crises (pain when exposed to the cold)

Question 9

Typical iron study in haemochromatosis (what would you find?)

Answer 9

1. Transferrin saturation >55% in men or >50% in women - considered to be the most useful marker
2. Raised ferritin (iron stores; not usually abnormal in early stages of accumulation) and iron
3. Low TIBC

Question 10

Mx of haemochromatosis

Answer 10

venesection - transferring should be kept below 50% and serum ferritin below 50ug/L

Question 11

Pyrexia of unknown origin and lymphadenopathy with raised WCC - ddx?

Answer 11

Lymphoma (may also be CLL, but more suggestive of lymphoma due to lymphadenopathy)

Ix: lymph node biopsy to give definitve dx

Question 12

Causes of ‘teardrop’ cells on histology film

Answer 12

Thalassaemia
Megaloblastic anaemia
Myelofibrosis

Question 13

Hypersegmented neutrophils on film - what does this indicate?

Answer 13

Usually found along side a megaloblastic anaemia - check B12/folate levels

Question 14

Blood film for intravascular haemolysis - what would you see?

Answer 14

Schistocytes

Question 15

Aplastic anaemia crisis due to infection in sickle cell disease - what is the most common cause?

Answer 15

Parvovirus B19 (erythema infectiosum) - reduces erythropoesis for about a week

Question 16

Staging system used for Hodgkin’s lymphoma

Answer 16

Ann Arbor staging system:

I - single node region
II - 2 or more regions; same side of diaphragm
III - involvement of lymph node regions on both sides of the diaphragm
IV - involvement of extra nodal sites