Haematology

Question 1

What technique is used to diagnose CLL?

Answer 1

Flow cytometry showing a specific pattern of monoclonal B cell proliferation (CD19/5 co expressing, CD23 positive, light chain restricted B cell population) is diagnostic of CLL

Question 2

Type of anaemia caused by lead and blood film appearance?

Answer 2

Hypochromic microcytic anaemia with basophilic stippling on the film

Question 3

What are first line and second line treatments for Essential Thrombocytosis?

Answer 3

1. Hydroxycarbamide + Aspirin
2. Anagrelide
3. Interferon can be used during pregnancy

Question 4

What are features of chronic GVHD?

Answer 4

onset after day 80
oesophageal strictures
oesophageal webs, and
neutrophil infiltration on histology.

Question 5

What is the commonest heritable thrombophilia?

Answer 5

Factor V Leiden - a heterozygote state is seen in about 5% of the general Caucasian population.

Question 6

What does anisocytosis mean?

Answer 6

Variation in erythrocyte size

Question 7

What does poikilocytosis mean?

Answer 7

Variation in erythrocyte shape

Question 8

What are Howell-Jolly bodies?

Answer 8

Intracellular inclusion bodies consisting of remnants of DNA

Question 9

What coagulation abnormalities can be associated with sepsis?

Answer 9

APTT - elevated
PT - elevated
FDPs - elevated
D-dimers - elevated
Platelets - reduced
Fibrinogen - reduced
Protein C - reduced
Antithrombin - reduced.

Question 10

What are the elements of the pentad used to classically describe TTP?

Answer 10

MAHA
thrombocytopenia
neurological dysfunction
renal impairment, and
pyrexia

Question 11

How is TTP treated?

Answer 11

First line therapy is plasmapheresis with fresh frozen plasma as the plasma substitute (to replace the missing factor in TTP, called ADAMTS-13). Although fresh frozen plasma on its own and methylprednisolone, together with aspirin, are useful treatment options they should in no way replace institution of plasmapheresis as soon as possible, except in centres where plasma exchange is not available 24/7.

Question 12

What is an accurate prognostic marker in multiple myeloma?

Answer 12

Beta-2-microglobulin has been shown to be predictive of risk of progression of disease in myeloma, myelodysplastic syndrome, and chronic myeloid leukaemia.

In myeloma it is an accurate estimate of total disease load, with guidelines suggesting that a beta-2-microglobulin level of >3.5 mg/L is strongly associated with increased mortality and morbidity.

Question 13

Give 7 prognostic indicators in myeloma

Answer 13

Beta-2-microglobulin
Hypercalcaemia
Creatinine
Severity of anaemia
Viscosity
Lactate dehydrogenase level, and
Recurrent bacterial infections.

Question 14

Patients with sickle cell disease have a predisposition to develop osteomyelitis due to what bacterial species.?

Answer 14

Salmonella

Question 15

Patients with sickle cell disease have a predisposition to develop infections due to what types of bacteria.?

Answer 15

Encapsulated bacteria (pneumococci, meningococci)

Question 16

In TTP there is typically a classical pentad of:

Answer 16

MAHA
Severe thrombocytopenia
Neurological impairment
Renal impairment
Fever.

Question 17

The differential diagnoses of a MAHA with thrombocytopenia in pregnancy are as follows:

Answer 17

TTP
Disseminated intravascular coagulation (DIC)
Pre-eclampsia
Haemolytic uraemic syndrome (HUS)
HELLP - haemolysis elevated liver enzymes and low platelets

Question 18

What are the features of Thrombotic thrombocytopenic purpura (TTP)?

Answer 18

PENTAD

P - Pyrexia
E - Endothelial damage
N - Neurological abnormality
T - Thrombocytopenia
A - Anaemia (MAHA)
D - Damage to kidney