Haematology

Question 1

What does aminocytosis mean in regards to a blood film?

What does it indicate?

Answer 1

Variation in size of RBCs

Myelodysplastic syndrome and some forms of anaemia

Question 2

When might Target cells be seen on a blood film?

Answer 2

IDA

Post-splenectomy

Question 3

What are Heinz bodies caused by?

When might they be seen on a blood film?

Answer 3

Denatured globin

G6PD
Alpha-thalassaemia

Question 4

When might Howell-Jolly bodies be seen on a blood film?

Answer 4

Post-splenectomy

Severe anaemia

Question 5

When might Reticulocytes be seen on a blood film?

Answer 5

Haemolytic anaemia

Question 6

What are Schistocytes?

When might they be seen on a blood film?

Answer 6

Fragments of RBCs

Haemolytic uraemia syndrome
Disseminated intravascular coagulation
Thrombotic thrombocytopenia purpura

Metallic heart valves
Haemolytic anaemia

Question 7

What are Sideroblasts?

What does the presence of Sideroblasts indicate on a blood film?

Answer 7

immature RBCs that contain blobs of iron

Myelodysplastic syndrome

Question 8

What are Smudge cells?

What can they indicate if seen on a blood film?

Answer 8

Ruptured white blood cells

Chronic lymphocytic leukaemia

Question 9

What do Spherocytes indicate if present on a blood film?

Answer 9

Autoimmune haemolytic anaemia

Hereditary spherocytosis

Question 10

What are causes of microcytic anaemia?

Answer 10

Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia

Question 11

What are causes of normocytic anaemia

Answer 11

3 As and 2 Hs

Acute blood loss
Anaemia of Chronic Disease
Anaplastic anaemia

Haemolytic anaemia
Hypothyroidism

Question 12

What are the two types of macrocytic anaemia?

Answer 12

Megaloblastic

Normoblastic

Question 13

What causes megaloblastic anaemia?

Answer 13

Impaired DNA synthesis

Folate deficiency
B12 deficiency

Question 14

What are causes of normoblastic anaemia?

Answer 14

Alcohol 
Liver disease
Drugs - azathioprine
Hypothyroidism
Reticulocytosis

Question 15

What are the initial investigations required in a patient with suspected anaemia?

Answer 15

Hb
MCV
B12
Folate
Ferritin
Blood film

Question 16

What do low serum ferritin levels suggest?

Answer 16

IDA

Question 17

What do high serum ferritin levels suggest?

Answer 17

Inflammation - infection/cancer

Question 18

What can be used as a marker of how much transferrin is in the blood?

Answer 18

Total iron binding capacity

Question 19

What causes an increase in TIBC/transferrin levels?

Answer 19

Iron deficiency

Question 20

What causes a decrease in TIBC/transferrin levels?

Answer 20

Iron overload

Question 21

What gives an indication of the total amount of iron in the body?

Answer 21

Transferrin saturation

Question 22

What kind of sample gives the most accurate results when assessing a patients transferrin saturation?

Answer 22

Fasting sample

Question 23

What does a reduced transferrin saturation mean?

Answer 23

Reduced iron

Question 24

What does an increased transferrin saturation mean?

Answer 24

Increased iron

Question 25

What two things can increase the values of serum ferritin, serum iron, TIBC and Tf % giving the impression of iron overload?

Answer 25

Supplementation with iron | Acute liver damage

Question 26

What are the three ways that IDA can be corrected?

Answer 26

Blood transfusion Iron infusion Oral iron

Question 27

When should an iron infusion not be given?

Answer 27

During sepsis - iron feeds bacteria

Question 28

When is oral iron unsuitable?

Answer 28

If malabsorption is the cause of the IDA

Question 29

What are the causes of B12 deficiency?

Answer 29

Insufficient dietary intake | Pernicious anaemia

Question 30

What cells produce intrinsic factor?

Answer 30

Parietal cells

Question 31

What autoantibodies are involved in pernicious anaemia?

Answer 31

Intrinsic factor antibody | Gastric parietal cell antibody

Question 32

What type of symptoms can be caused by B12 deficiency?

Answer 32

``` Neurological symptoms Peripheral neuropathy with parathesia Loss of vibration sense or proprioception Visual changes Mood or cognitive changes ```

Question 33

How can dietary B12 deficiency be treated?

Answer 33

Oral replacement with cyanocobalamin

Question 34

How can pernicious anaemia be treated?

Answer 34

IM cyanocobalamin (3x weekly for 2 weeks then every 3 months)

Question 35

If there is a B12 and folate deficiency, what has to be treated first and why?

Answer 35

B12 deficiency first Treating patients with folate when they have a B12 deficiency can cause subacute combined degeneration of the cord

Question 36

What is the most common form of inherited haemolytic anaemia?

Answer 36

Hereditary spherocytosis

Question 37

How is hereditary spherocytosis inherited?

Answer 37

Autosomal dominant

Question 38

What signs may be suggestive of hereditary spherocytosis?

Answer 38

Jaundice Gallstones Splenomegaly Aplastic crisis in presence of parvovirus

Question 39

When might a patient with hereditary spherocytosis develop an aplastic crisis?

Answer 39

Parvovirus

Question 40

What are the features on FBC and blood film which are indicative of hereditary spherocytosis?

Answer 40

Spherocytes on blood film Raised mean corpuscular haemoglobin concentration Raised reticulocytes

Question 41

How is hereditary spherocytosis managed?

Answer 41

Folate supplements Splenectomy +/- cholecystectomy if gallstones

Question 42

What is the pattern of inheritance of G6PD deficiency?

Answer 42

X-linked recessive

Question 43

In what population is G6PD deficiency most common?

Answer 43

Mediterranean and African patients

Question 44

What can trigger G6PD crises?

Answer 44

Infections Medications Fava beans (broad beans)

Question 45

What are the signs of G6PD that you might see on a blood film?

Answer 45

Heinz Bodies Bite cells Blister cell

Question 46

How can G6PD deficiency present?

Answer 46

Jaundice (neonatal) Gallstones Anaemia Splenomegaly

Question 47

How can a diagnosis of G6PD deficiency be made?

Answer 47

G6PD enzyme assay

Question 48

What medications can trigger a G6PD?

Answer 48

``` Primaquine Ciprofloxacin Sulfonylureas Sulfasalazine Sulphonamide drugs ```