haematology questions Flashcards
A 32-year-old woman at 20 weeks gestation presented with shortness of breath and left leg swelling. Examination revealed tenderness along the left femoral vein.
What is the next best step in the diagnostic workup?
Compression duplex
women with suspected pulmonary embolism (PE) who also have symptoms and signs of deep vein thrombosis (DVT) should have a compression duplex ultrasound.
when someone with sickle cell comes in with an infection and anaemia secondary to this, what is a marker in the blood which helps determine if the body is responding to EPO and bone marrow production is increasing
Reticulocyte count
2 main features of Von Willebrand disease
Factor 8 deficiency
high APTT
prolonged bleeding time - longer time for platelets to aggregate
how to tell the difference between haemophilia A and B
both are issues with intrinsic pathway and cause muscle and joint bleeding due to FACTOR depletion
A will have a negative factor V111 assay
difference in presentation between platelet depletion and factor depletion
platelet -> skin bleed
factor -> muscle and joint bleed
which type of lymphoma presents with a mediastinal mass
Hodgkins
what is the difference between low grade vs high grade cancer
depends on how fast the cells proliferate
low grade is more chronic and the cells will proliferate slower
high grade is more of an acute presentation
key ways to differentiate between the different leukemias
ALL is the most common leukaemia in children and is associated with Down syndrome
CLL is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells
CML has three phases, including a long chronic phase, and is associated with the Philadelphia chromosome
AML may result in a transformation from a myeloproliferative disorder and is associated with Auer rods
which cancer is at a high risk of tumour lysis syndrome
fast growing ones such as diffuse large b cell lymphoma
features of DIC
low platelet
low fibrinogen
elevated D dimer
which type of bilirubin is raised in haemolytic anaemia
unconjugated bilirubin
treatment for ITP
as it is autoimmune they can have regular prednisolone
which medication leads to an increased level of warfarin
ciprofloxacin
which condition is the most common inherited coaugulopathy
VWD, more seen in women with menorrhagia
see low VWF and low factor 8
long APPT so long overall bleeding
most common inherited thrombophilia
Factor V Leiden
leading to a variant of Factor V that is resistant to inactivation by activated protein C (APC).
if someone has a transfusion reaction then what should you do
In mild reactions, the transfusion does not need to be stopped, and symptomatic treatment, such as paracetamol, can be administered.
medication given to prevent sickle cell crisis
Hydroxycarbamide
One of the ways it works is by increasing levels of foetal haemoglobin, a type of haemoglobin which is resistant to sickling
if someone has started treatment for chemo recently and they become unwell what is the main condition that needs to be ruled out
neutropenic sepsis
The management for this will involve initiating the sepsis 6, getting a full blood count and admitting the patient to the hospital. The most appropriate setting for this patient to be treated in is the hospital as this is a medical emergency and they will likely require urgent intravenous antibiotics.
what factors does warfarin have an affect on
1972
10 9 7 2
G6PD is which inheritance pattern
x linked recessive
what type of haemolytic anemia do schistocytes confirm
that it is microangiopathic due to the fibrin strands damaging the red blood cells
how to tell the difference between haemophilia A,B vs VWD
in the heamophillias this is x linked and so the history will say something to dow with the issue is on the mums side with her brother and uncle
what is usually the triad of oncological complications in haematological malignancies
- neutropenic sepsis
- SVC
- TLS
maybe hypercalcemia if myeloma
if a condition is x linked recessive what is the chance that the mother will give to son
50%
someone has spleen removed what is the prophylaxis
- yearly influenza
- every 5 years have pneumococcal
have a one off HiB, MenC - have penicillin V - phenocymethylpenicillin
what do teardrop cells on a blood film show
extra medullary haematopoesis
neffective haematopoiesis results in extramedullary haematopoesis, which results in
Frontal bossing (hair-on-end appearance on Skull XR)
Maxillary overgrowth and prominent frontal/parietal bones (hypertrophy of ineffective marrow) - “Chipmunk facies”
Hepatosplenomegaly
if someone presents with any unusual lymphadenopathy what is the first line investigation
chest xray, it might show something more sinister. Often next of a full body CT
In male ALL what is important to check
Need to check testes, the lymphocytes are small and can pass into the testes and cause swelling. Need to ask about any changes in the testicles.
They can also pass the BBB
which malignancies would you give GcSf (granulocyte colony stimulating factor)
a protein that stimulates the bone marrow to produce more white blood cells,
AML - NO
ALL - YES
what is leukemia is leukostasis more common in and how is it treated
AML -
cytoreductive agent needed via hydroxyurea
leukopheresis - to remove some of the excess myeloblasts
difference between ALL and AML
- ALL - has testicular involvement
- ALL - can cross BBB and cause meningeal leukemia
- ALL - more common to see hepatosplenomegaly
- ALL - if it is T cell, it affects the thymus and can compress on the surrounding structures like the oesophagus (dysphagia), trachea (dyspnea) and the SVC
man difference between acute and chronic leukaemia
in acute, they are producing the progenitor cells and are unable to differentiate
in the chronic they are well differentiated
treatment of pernicious anemia
low B12 due to reduced intrinsic factor
Hydroxocobalamin 1mg on alternate days for two weeks followed by lifelong injections every two months - these are injections of B12
if someone presents with DIC which leukaemia do they have
AML - subtype is APML
treatment for bleeding and raised INR from warfarin
IV vit K and prothrombin complex
aplastic crisis in sickle cell
this is when, there is a recent infection usually parvovirus and there is a drop in RBC, so they patient becomes tachyponeic and tachycardic AND no splenomegaly
what is the treatment for non Hodgkins lymphoma and what is the test that needs to be done prior to starting it
Patients starting rituximab should be screened for hepatitis B before starting treatment
anaphylaxis in blood transfusion
- hypotension
- tachycardia
- wheeze
acute haemolytic transfusion reaction
pyrexia, chest pain and abdominal pain
Non-haemolytic febrile transfusion reaction
chills and low-grade fever without haemodynamic instability, unlike this patient, who is not pyrexic and has hypotension. Compared to the patient in this scenario, these patients will also often appear well, b
Transfusion-associated circulatory overload (TACO)
typically presents in older patients with pre-existing heart failure and is characterised by features of cardiogenic pulmonary oedema
Transfusion-related acute lung injury (TRALI)
present with significant hypoxia and hypotension without evidence of angioedema,
which product of a blood transfusion is more likely to cause infection in an immunocompromised patient
platelet, they are the most likely to be contaminated by bacteria
which blood transfusion would most likely cause an infection
platelet transfusion
HBA2 on electroporesis is suggestive of which thalassemia
B trait
if someone presents with pancytopenia years after having chemo what could this be
meylodysplasia
the bone marrow has been destroyed from the chemo
if someone has TACO what is the treatment
STOP transfusion and offer a diuretic
