Haematology Crash Course

Question 1

Unexplained iron-deficiency anaemia

Answer 1

Causes a microcytic anaemia with low ferritin

Men and post-menopausal women - urgent gastroscopy and colonoscopy

Question 2

Microcytic anaemia causes

Answer 2

Iron deficiency
Chronic disease
Thalassaemia

Question 3

Recurrent nosebleeds and new red lesions on the skin and lips?
What investigations?

Answer 3

Full blood count - platelets!

Most likely diagnosis is…

Question 4

ITP is due to the formation of auto-antibodies against…

Answer 4

Platelet antigens
It is an acquired bleeding disorders due to low platelets
May be primary or secondary
Low platelets lead to petechiae, purpura and recurrent bleeding

Question 5

ITP vs TTP

Answer 5

Question 6

Most likely diagnosis?
- Hodgkin?
AML?
ALL?
CML?
CLL?

Answer 6

Chronic lymphocytic leukaemia

Malignant clonal disorders of B cells that causes high white cells and lymphadenopathy

Question 7

Malignant clonal disorders of B cells that causes high white cells and lymphadenopathy?

Answer 7

Chronic lymphocytic leukaemia
Commonest leukaemia - 60-80years old
Generally slow and indolent malignancy of unknown aetiology
Watch and wait

Question 8

Leukaemia overview

Answer 8

Question 9

ALL typically in

Answer 9

Children

Question 10

Treatment for CML

Answer 10

TKI (e.g. imatinib)

Question 11

AML vs CML

Question 12

Massive splenomegaly, lethargy and night sweats…

Answer 12

CML

Question 13

Bone marrow failure (adults?)

Answer 13

AML

Question 14

Answer 14

A

Question 15

Sickle cell disease

Answer 15

Autosomal recessive inherited

Sickle Hb is due to a point mutation in the beta-glob in gene

Question 16

Sickle Hb polymerises at … tension, which distorts its shape and causes ….

Answer 16

Sickle Hb polymerises at low O2 tension, which distorts its shape and causes vaso-occlusion

Question 17

Low Hb
High urea and creatinine
High K+ and calcium
High CRP
Para protein detected on protein electrophoresis
What next?

Answer 17

Bone marrow biopsy

Myeloma

Question 18

Multiple myeloma

Answer 18

Malignant disorder of plasma cells (mature b lymphocytes)
Characterised by excess secretion of a monoclonal antibody
CRAB (high calcium, renal impairment, anaemia, boney disease)

Question 19

Definitive diagnosis of multiple myeloma

Answer 19

Bone marrow biopsy

Question 20

Diagnostic criteria

MGUS, smouldering, myeloma

Answer 20

Question 21

High Hb + stroke

What investigation to confirm cause of stroke?

Answer 21

JAK2 mutation

Polycythaemia vera - myeloproliferative disorder characterised by an elevated red cell mass

Question 22

Polycytheamia Vera

Answer 22

Question 23

What is found in 98% of people with primary polycythaemia Vera?

Answer 23

JAK2

Question 24

Complications of polycythaemia

Answer 24

Question 25

What next?

Answer 25

Arrange an US doppler of the left leg

Question 26

DVT suspected

Answer 26

Deep veins of lower limb
Wells score - risk of DVT
If likely >2, straight to US within 4 hours
D diner if less than 1

Question 27

Answer 27

Vitamin B12/folate deficiency likely

Question 28

Macrocytic anaemia

Answer 28

Question 29

CLL
FL
MS
HL
Aplastic anaemia?

Answer 29

Hodgkin lymphoma

Question 30

Hodgkin lymphoma

Answer 30

Reed stern burg cells

Question 31

Aplastic anaemia

Answer 31

Abnormal EPO in bone marrow, reduced red cells

Question 32

Lymphoma

Answer 32

Hodgkin’s and non-hodgkins
Hodgkins - reed sternberg cells
Painless lymphadenopathy and B symptoms
Lymph node biopsy to diagnose!