Haematology

Question 1

What is haematocrit?

Answer 1

Proportion of red cells in the blood

Question 2

Why do men have higher Hb than women?

Answer 2

Testosterone stimulates production of red cells

Question 3

What is the MCV useful for?

Answer 3

Determining the cause of anaemia

Question 4

Who is most likely to be B12 deficient?

Answer 4

Vegans

Question 5

What does hyper segmented neutrophils on blood film indicate?

Answer 5

Megaloblastic anaemia

Question 6

Name an autoimmune cause of macrocytic anaemia

Answer 6

Pernicious anaemia

Question 7

What is pernicious anaemia?

Answer 7

Autoantibodies to intrinsic factor

Question 8

What causes a microcytic anaemia?

Answer 8

Iron defiency anaemia

Beta thalassemia trait

Question 9

What causes a macrocytic anaemia?

Answer 9

B12 or folate deficiency

Question 10

How is pernicious anaemia treated?

Answer 10

IM B12

5 doses for 5 alternate days and then a dose every 3 months

Question 11

How is folate deficiency anaemia treated?

Answer 11

Oral folate replacement

Question 12

What must you exclude in cases of folate deficiency?

Answer 12

Malabsorption issues such as Crohns and coeliac

Question 13

List some blood markers of haemolysis

Answer 13

FBC
LFT - Bilirubin 
Lactate dehydrogenase 
Reticulocytes 
Direct antiglobulin test (DAT)

Question 14

What may be seen on blood film in autoimmune haemolysis?

Answer 14

Spherocytes

Question 15

What causes autoimmune haemolysis

Answer 15

CLL
Drugs
Idiopathic

Question 16

What is the management of autoimmune haemolysis

Answer 16

Transfusion - cross matching blood cells may be a problem if autoantibodies are present
Steroids
Immunosuppression - rituximab
IVIG

Question 17

What cells may be seen on blood film in sickle cell anaemia

Answer 17

Target cells
Sickle cells
Howell-Jolly bodies

Question 18

What are the complications of sickle cell disease

Answer 18

Hyposplenism
Bone pain - avascular necrosis
Chest infection
Gallstones

Question 19

What is the pathophysiology of hemochromatosis

Answer 19

Too much iron - excess absorption and then deposition in organs - multiorgan failure
Autosomal recessive condition

Question 20

Describe the management of haemochromatosis

Answer 20

regular venesection till <50. Monitor organ function, treat diabetes, replacement testosterone in males, family screening studies

Question 21

List causes of a neutrophilia

Answer 21

Bacterial infection
Inflammation - eg. MI/Polyarteritis nodosa
Myeloproliferative disorder
Drugs - eg. steroids
Disseminated malignancy
Stress - trauma, burns, haemorrhage, seizures

Question 22

List causes of a neutropenia

Answer 22

Viral infection
Drugs - chemo, cytotoxic agents, sulfonamides, carbimazole
Severe sepsis
Neutrophil antibodies - increased destruction - SLE, haemolytic anaemia
Hypersplenism - Feltys syndrome - RA, splenomegaly, neutropenia
Bone marrow failure - decreased production

Question 23

List the causes of a lymphocytosis

Answer 23

Acute viral infection
Chronic infection - TB, syphilis
Leukaemia and lymphoma - CLL

Question 24

List the causes of a lymphopenia

Answer 24

Steroid therapy
Post chemo
Post radiotherapy 
SLE
Uraemia 
Legionnaire's disease
HIV infection

Question 25

List some causes of an eosinophilia

Answer 25

``` Drug reactions Allergies - asthma and atopy Parasitic infection Skin disease - pemphigus, eczema, psoriasis, dermatitis herpetiformis Malignancy - lymphoma and eosinophilic leukaemia PAN and churg Straus Adrenal insufficiency Irradiation Loffler's syndrome ```

Question 26

Describe hypereosinophilic syndrome (HES)

Answer 26

Eosinophilia lasts for >6weeks resulting in end organ damage (endomyocardial fibrosis and restrictive cardiomyopathy, skin lesions, thromboembolic disease, lung disease, neuropathy and hepatosplenomegaly)

Question 27

What conditions result in increased monocytes (monocytosis)

Answer 27

Post- chemo/radiotherapy Malignant disease (M4 and M5 acute myeloid leukaemia and Hodgkin's disease) Myelodysplasia

Question 28

What conditions result in increased basophils (basophilia) ?

Answer 28

Myeloproliferative disease Viral infections IgE mediated hypersensitivity reactions - urticaria and hypothyroidism Inflammatory disorders - UC, RA