Haematology & Oncology

Question 1

Unfractionated heparin (UFH) MOA

Answer 1

UFH enhances the activity of antithrombin, leading to the inhibition of coagulation factors IIa (thrombin) and Xa.

Question 2

Low molecular weight heparins (LMWHs) MOA

Answer 2

LMWHs exert their anticoagulant effect by targeting factor Xa

Question 3

Dabigatran MOA

Answer 3

Dabigatran is an inactive prodrug. It acts by reversibly inhibiting free thrombin, fibrin-bound thrombin, and thrombin-induced platelet aggregation.

Question 4

Apixaban, edoxaban and rivaroxaban MOA

Answer 4

These DOACs competitively inhibit both free and clot-bound factor Xa,

Question 4

DIC blood results

Platelet count
Fibrinogen
PT
D d-dimer
TT
Coag factors

Answer 4

Platelet count - low
Fibrinogen - low
PT - prolonged
D d-dimer - elevated
TT - prolonged
Coag factors - low

Question 5

INR 5-8 no bleeding

Answer 5

Withhold 1-2 doses of warfarin and reduced maintenance dose

Question 6

INR 5-8 w/ bleeding

Answer 6

IV Vit K (phytomenadione)
Stop warfarin and restart when INR <5

Question 7

INR >8 but no bleeding

Answer 7

Give oral Vit K (rpt if still high after 24hrs)
Stop warfarin and restart when INR <5

Question 8

INR >8 minor bleeding

Answer 8

Give IV Vit K (rpt if still high after 24hrs)
Stop warfarin and restart when INR <5

Question 9

Major bleeding on wafarin

Answer 9

IV Vit K & dried PT complex (or FFP if not available)
Stop warfarin

Question 10

Reversal agent for dabigatran?

Answer 10

Idaruccizumab

Question 11

What is andexanet alfa used for?

Answer 11

To reverse apixaban & rivaroxaban in pts with life threatening or uncontrolled bleeding, IF THE BLEED IS IN THE GI TRACT

Question 12

Heparin reversal agent

Answer 12

Protamine sulfate

Question 13

Which virus causes sickle cell aplastic crisis?

Answer 13

Parovirus B19

Question 14

Most common cause of osteomyelitis in children with sickle cell

Answer 14

Salmonella enterica

Question 15

Most common leukaemia in adults

Answer 15

CLL

Question 16

MSCC signs / symptoms

Answer 16

Severe or progressive lumbar back pain
Nocturnal pain interfering with sleep
Localised spinal tenderness
Radicular pain
Neurological symptoms

Question 17

MASCC Risk Index Score cut off for OP tx of neutropenic sepsis

Answer 17

21 or greater

Question 18

Most common causes of MSCC

Answer 18

prostate (1st), lung, breast and myeloma

Question 19

peripheral blood smear in iron deficiency anaemia

Answer 19

poikilocytosis (variation in shape) and anisocytosis (variation in size). Pencil cells are typical of iron deficiency anaemia.

Question 20

The most common virus transmitted by blood transfusion

Answer 20

parvovirus B19

Question 21

The most common bacterial organism associated with transfusion-transmitted bacterial infection

Answer 21

Yersinia enterocolitica

Question 22

Treatment for Transfusion-associated graft-vs-host disease

Answer 22

Supportive only

Question 23

Microcytic anaemia
(MCV < 80 fl)

(6)

Answer 23

Iron deficiency anaemia

Thalassaemia

Anaemia of chronic disease (can also be normocytic)

Sideroblastic anaemia (can also be normocytic)

Lead poisoning

Aluminium toxicity (affects some haemodialysis patients but now rare)

Question 24

Normocytic anaemia
(MCV 80-100 fl)

(8)

Answer 24

Haemolysis
Acute haemorrhage
Bone marrow failure
Anaemia of chronic disease (can also be microcytic)
Mixed iron and folate deficiency
Pregnancy
Chronic renal failure
Sickle-cell disease

Question 25

Macrocytic anaemia
(MCV > 100 fl)

(9)

Answer 25

B12 deficiency
Folate deficiency
Hypothyroidism
Reticulocytosis
Liver disease
Alcohol abuse
Myeloproliferative disease
Myelodysplastic disease
Drugs e.g. methotrexate, hydroxyurea, azathioprine

Question 26

Bacterial infection is more common with what blood products

Answer 26

Platelet transfusion (as platelets are stored at room temperature)
Previously frozen components thawed by immersion in a water bath
Red cell components stored for several weeks

Question 27

Most common type of transfusion reaction

Answer 27

Febrile transfusion reactions are the commonest type of transfusion reaction, occurring in approximately 1 in 8 transfusions.

Question 28

Glanzmann’s thrombasthenia

Answer 28

is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.

Question 29

Distinguish iron-deficiency anaemia from anaemia of chronic disease

Answer 29

TIBC is typically increased, and serum ferritin is typically low

Question 30

Auer rods most commonly seen on blood films in which disease states?

Answer 30

They are most commonly seen in acute myeloid leukaemia but can also be seen in high-grade myelodysplastic syndromes and myeloproliferative disorders.

Question 31

Sickle-cell disease is caused by a point mutation in what?

Answer 31

The beta-globin chain of haemoglobin

Question 32

Febrile transfusion reaction is caused by?

Answer 32

Usually caused by cytokines from leukocytes in transfused red cell or platelet components.

Question 33

Acute haemolytic reaction is caused by?

Answer 33

Often ABO incompatibility due to administration error.

Question 34

Allergic reaction in the context of a blood transfusion is caused by?

Answer 34

Usually caused by foreign plasma proteins but may be due to anti-IgA.

Question 35

Transfusion Related Acute Lung Injury is caused by?

Answer 35

Step 1: underlying illness -> complement activation -> pulmonary sequestration of neutrophils
Step 2: transfusion -> neutrophil activation -> endothelial cell damage and capillary leak syndrome

Question 36

Graft vs host disease in the context of blood transfusions

Answer 36

Viable T lymphocytes in blood components are transfused, engraft and react against the recipient’s tissues and the recipient is unable to reject the donor lymphocytes because of immunodeficiency, severe immunosuppression, or shared HLA antigens.

Question 37

Multiple myeloma is a malignant neoplasm of

Answer 37

Plasma cells