Haematology

Question 1

Causes of atypical lymphocytosis

Answer 1

1. Autoimmunity - addisons, IBD, RA
2. Hypersensitivity - DRESS, serum sickness
3. Infection - CMV/EBV, HIV, HTLV, influenza, pertussis, toxoplasmosis
4. Other
   - Cigarette smoking
   - Splenectomy
   - Thyrotoxicosis

Question 2

Medical management of low risk MDS

Particular situations including del(5q), transfusion dependent MDS with ring sideroblasts, and transfusion dependent hypoplastic MDS)

Answer 2

Depends on variety of factors

1. Active surveillance if only mild cytopenia
2. Erythropoiesis stimulating agents (especially if serum EPO level <200 mU/mL which is a reliable predictor of response)
3. Lenalidomide if isolated del(5q)
4. Luspatercept (binds to TGF beta and enhances late stage erythropoiesis) - in patients with transfusion dependent MDS with ringed sideroblasts
5. Cyclosporin in transfusion dependent hypoplastic MDS
6. Red cell transfusion with iron chelation

Question 3

Medical management of high risk MDS

Answer 3

Aimed at improving cytopenia and prevent evolution to AML and therefore prolong survival

1. Azacitidine (hypomethylating agents)
2. Venetoclax and azacitidine is effective in elderly patients with AML
3. Intensive chemotherapy - less used now given advent of azacitidine

Question 4

Features of IPSS-R for risk stratification in MDS

Answer 4

Haemoglobin level
Absolute neutrophil count
Platelets
Bone marrow blast (%)
Cytogenic category (very good to very poor)