Haematology

Question 1

DVT - length of treatment

Answer 1

provoked (e.g. recent surgery): 3 months

unprovoked: 6 months

Question 2

If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours, then what to do?

Answer 2

start a DOAC

Question 3

What should be avoided in patients on concurrent bone marrow suppression drugs (especially methotrexate)

Answer 3

Chloramphenicol

Question 4

G6PD deficiency: what to avoid

Answer 4

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis
Ciprofloxacin
anti-malaria; Primaquine

Question 5

Causes of vitamin B12 deficiency

Answer 5

pernicious anaemia: most common cause
post gastrectomy
vegan diet or a poor diet
disorders/surgery of terminal ileum (site of absorption)
Crohn’s: either diease activity or following ileocaecal resection
metformin (rare)

Question 6

Features of vitamin B12 deficiency

Answer 6

macrocytic anaemia
sore tongue and mouth
neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
neuropsychiatric symptoms: e.g. mood disturbances

Question 7

Management of vitamin B12 deficiency

Answer 7

if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord

Question 8

Von Willebrand’s disease features

Answer 8

most common inherited bleeding disorder

epistaxis and menorrhagia are common whilst haemoarthroses and muscle haematomas are rare

Question 9

Von Willebrand’s disease Investigation

Answer 9

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

Question 10

Von Willebrand’s disease Management

Answer 10

• tranexamic acid for mild bleeding
• desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
• factor VIII concentrate

Question 11

Neutropenic sepsis

Answer 11

defined as a neutrophil count of < 0.5 * 109

Question 12

Neutropenic sepsis: what to avoid

Answer 12

PR exam

Question 13

Sickle-cell crises: Aplastic crises, Cause

Answer 13

caused by infection with parvovirus

sudden fall in haemoglobin

Question 14

Drug causes of pancytopaenia

Answer 14

cytotoxics
antibiotics: trimethoprim, chloramphenicol
anti-rheumatoid: gold, penicillamine
carbimazole*
anti-epileptics: carbamazepine
sulphonylureas: tolbutamide

Question 15

Enlarged lymph nodes and itching

Answer 15

think of lymphoma

Question 16

Hodgkin’s lymphoma features

Answer 16

lymphadenopathy (75%) - painless, non-tender, asymmetrical
systemic (25%): weight loss, pruritus, night sweats, fever (Pel-Ebstein)
alcohol pain in HL
normocytic anaemia, eosinophilia
LDH raised

Question 17

Haemophilia

Answer 17

A - factor VIII deficiency - 90% of cases
B - factor IX deficiency

Blood tests
prolonged APTT
bleeding time, thrombin time, prothrombin time normal

Question 18

Antiphospholipid syndrome in pregnancy treatment

Answer 18

aspirin + LMWH

Question 19

Sickle-cell anaemia vaccination

Answer 19

Pneumococcal polysaccharide vaccine every 5 years

Question 20

to assess for myeloma in people aged 60 and over with persistent bone pain, particularly back pain, or unexplained fracture, what is the first test as per NICE.

Answer 20

FBC, calcium and plasma viscosity or ESR

Question 21

New guideline for DVT treatment

Answer 21

first line DOACs

at least 3 months, (usually 3-6 months)

Question 22

Drugs that could cause DVT

Answer 22

combined oral contraceptive pill: 3rd generation more than 2nd generation
hormone replacement therapy: the risk of VTE is higher in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations
raloxifene and tamoxifen
antipsychotics (especially olanzapine) have recently been shown to be a risk factor

Question 23

iron-deficiency anaemia

Answer 23

Total iron-binding capacity (TIBC) + transferrin levels are typically raised
transferrin saturation level is reduced

Question 24

Iron deficiency anaemia, when to stop treatment

Answer 24

After correcting iron deficiency anaemia, iron replacement should be continued for 3 months then stopped

Question 25

the most common inherited thrombophilia

Answer 25

Activated protein C resistance (Factor V Leiden)

Question 26

Hereditary spherocytosis; presentation

Answer 26

failure to thrive
jaundice, gallstones
splenomegaly
aplastic crisis precipitated by parvovirus infection
degree of haemolysis variable
MCHC elevated

Question 27

Benign ethnic neutropenia is commoner in which ethinic group?

Answer 27

Black African and Afro-Caribbean ethnicity. It is characterised by reduced absolute neutrophil counts in the absence of secondary causes

Question 28

Macrocytosis causes

Answer 28

B12 and folate deficiency

Question 29

raised GGT and MCV

Answer 29

alcohol

Question 30

high reticulocytes

Answer 30

haemolytic anaemia

Question 31

hypercalcaemia
renal failure
back pain

Answer 31

Myeloma