Haematology

Question 1

Types and causes of anaemia?

Answer 1

Micro
IDA, thalassaemia, AoCD

Normo
Blood loss, aplasia, renal failure, AoCD

Macro
Megaloblastic (Vit B12/fol), reticulocytosis, EtOH, hypothyroidism

Question 2

Causes of haemolytic anaemia?

Answer 2

Acquired

Immune (AIHA, penicillin, acute transfusion reaction)
Paroxysmal noturnal haemoglobinuria
MAHA
Infection
Burns

Hereditary

G6PD def
Hereditary sperocytosis
Sickle cell

Question 3

What would you find in the nails of someone with IDA?

Answer 3

Koilonychia

Question 4

Where is folate absorbed?

Answer 4

Proximal jejunum

Question 5

What is the underlying pathology of sickle cell disease?

Answer 5

Point mutation in beta globulin gene (glu -> val) resulting in sickle cells causing haemolysis and thrombosis

Question 6

When do the features of sickle cell first present?

Answer 6

3-6 months as HbF is taken over by HbA

Question 7

What are the features of sickle cell disease?

Answer 7

SICKLE

Splenomegaly (_>crisis)
Infarction
Crises (pulmonary, mesenteric, painful)
Kidney disease
Liver and lung disease
Erections
Dactylitis

Question 8

What are the complications of sickle cell?

Answer 8

Sequestration crisis
Splenic infarct
Infections
Aplastic crisis
Gallstones

Question 9

What is the management of acute and chronic sickle cell?

Answer 9

Acute
IV opioids (analgesia)
Hydrate
O2
Keep warm
Antibiotics e.g. cef

Question 10

What are the different transfusion reactions and their timings?

Answer 10

Haemolytic - minutes
Bacterial - <24hrs
Febrile non-haemolytic - <24hrs
Allergic - immediate
TRALI - <6hrs
Fluid overload - <6hrs
Delayed haemolytic - 1-7d
Fe overload - chronic
Post transfusion purpura - 7-10 days
GvHD - 4-30days

Question 11

What is the pathogenesis of multiple myeloma?

Answer 11

Clonal proliferation of plasma cells which are excreted by the kidney -> urinary Bence Jones proteins

Question 12

What are the symptoms of multiple myeloma?

Answer 12

CRAB

HyperCalcaemia
Renal failure
Anaemia
Bone disease

Question 13

How do you manage a patient with multiple myeloma?

Answer 13

Supportive
Analgesia for bone pain
Transfusions/EPO 
Hydration +- dialysis
Abc +- IVIG for infections 

Complications
Calcium - hydrate, furosemide, bisphosphonates
Cord compression - dex + MRI
Hyperviscosity - Plasmapheresis
AKI - rehydration

Specific
If fit then chemo + allogeneic BMT, if not then chemo only

Question 14

What are the features of amyloidosis?

Answer 14

Renal - nephrotic syndrome

Cardiac - restrictive disease, arrhythmias

Nerves - peripheral and autonomic neuropathy

GI - macroglossia, malabsorption, perforation, hepatomegaly

Vascular - periorbital purpura

Question 15

What are the 4 main complications to worry about with haematological malignancies?

Answer 15

Neutropaenic sepsis
Hyperviscosity syndrome
DIC
Tumour Lysis Syndrome

Question 16

What medication is used to protect against Tumour lysis syndrome?

Answer 16

Allopurinol

Question 17

What is the function of the spleen?

Answer 17

Phagocytoses old RBCs
Antibody production
Haematopoiesis
Sequestration of formed blood elements

Question 18

What are the causes of massive splenomegaly?

Answer 18

CML
Myelofibrosis
Malaria 
Leishmania
Gaucher's disease

Question 19

What are the causes of splenomegaly?

Answer 19

Haematological
Haemolysis - HS
Myeloprolliferative disease - CML, MF, PcV
Leukaemia/Lymphoma

Infective
EBV, CMV, hepatitis, HIV
TB, IE
Malaria, leishmania

Portal HTN
Cirrhosis
Budd Chiari

CTD

Sarcoid, Amyloid