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haematology questions Flashcards

1
Q

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?

A

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.

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2
Q

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

A

Reticulocyte count

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3
Q

2 main features of Von Willebrand disease

A

Factor 8 deficiency
high APTT
prolonged bleeding time - longer time for platelets to aggregate

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4
Q

how to tell the difference between haemophilia A and B

A

both are issues with intrinsic pathway and cause muscle and joint bleeding due to FACTOR depletion
A will have a negative factor V111 assay

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5
Q

difference in presentation between platelet depletion and factor depletion

A

platelet -> skin bleed
factor -> muscle and joint bleed

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6
Q

which type of lymphoma presents with a mediastinal mass

A

Hodgkins

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7
Q

what is the difference between low grade vs high grade cancer

A

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

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8
Q

key ways to differentiate between the different leukemias

A

ALL is the most common leukaemia in children and is associated with Down syndrome (12:21)

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, associated with HUGE SPLENOMEGALY

AML may result in a transformation from a myeloproliferative disorder and is associated with Auer rods

Acute usually present with the low Hb, low plt, low wcc

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9
Q

which cancer is at a high risk of tumour lysis syndrome

A

fast growing ones such as diffuse large b cell lymphoma

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10
Q

features of DIC

A

low platelet
low fibrinogen
elevated D dimer

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11
Q

which type of bilirubin is raised in haemolytic anaemia

A

unconjugated bilirubin

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12
Q

treatment for ITP

A

as it is autoimmune they can have regular prednisolone

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13
Q

which medication leads to an increased level of warfarin

A

ciprofloxacin

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14
Q

which condition is the most common inherited coaugulopathy

A

VWD, more seen in women with menorrhagia
see low VWF and low factor 8
long APPT so long overall bleeding

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15
Q

most common inherited thrombophilia

A

Factor V Leiden
leading to a variant of Factor V that is resistant to inactivation by activated protein C (APC).

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16
Q

if someone has a transfusion reaction then what should you do

A

In mild reactions, the transfusion does not need to be stopped, and symptomatic treatment, such as paracetamol, can be administered.

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17
Q

medication given to prevent sickle cell crisis

A

Hydroxycarbamide
One of the ways it works is by increasing levels of foetal haemoglobin, a type of haemoglobin which is resistant to sickling

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18
Q

if someone has started treatment for chemo recently and they become unwell what is the main condition that needs to be ruled out

A

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.

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19
Q

what factors does warfarin have an affect on

A

1972
10 9 7 2

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20
Q

G6PD is which inheritance pattern

A

x linked recessive

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21
Q

what type of haemolytic anemia do schistocytes confirm

A

that it is microangiopathic due to the fibrin strands damaging the red blood cells

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22
Q

how to tell the difference between haemophilia A,B vs VWD

A

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

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23
Q

what is usually the triad of oncological complications in haematological malignancies

A
  • neutropenic sepsis
  • SVC
  • TLS

maybe hypercalcemia if myeloma

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24
Q

if a condition is x linked recessive what is the chance that the mother will give to son

A

50%

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25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
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
33
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
34
if someone presents with DIC which leukaemia do they have
AML - subtype is APML
35
treatment for bleeding and raised INR from warfarin
IV vit K and prothrombin complex
36
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
37
what is the treatment for non Hodgkins lymphoma and what is the test that needs to be done prior to starting it
chemo, radio immunotherapy -> Patients starting rituximab should be screened for hepatitis B before starting treatment hey work by helping the body's immune system recognize and attack cancer cells, either by directly targeting cancer cells or by enhancing the immune system's ability to do s
38
anaphylaxis in blood transfusion
- hypotension - tachycardia - wheeze
39
acute haemolytic transfusion reaction
fever and rigor pyrexia, chest pain and abdominal pain
40
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
41
Transfusion-associated circulatory overload (TACO)
typically presents in older patients with pre-existing heart failure and is characterised by features of cardiogenic pulmonary oedema
42
Transfusion-related acute lung injury (TRALI)
present with significant hypoxia and hypotension without evidence of angioedema,
43
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
44
45
which blood transfusion would most likely cause an infection
platelet transfusion
46
HBA2 on electroporesis is suggestive of which thalassemia
B trait
47
if someone presents with pancytopenia years after having chemo what could this be
meylodysplasia the bone marrow has been destroyed from the chemo
48
if someone has TACO what is the treatment
STOP transfusion and offer a diuretic
49
myeloma curable
no, put a cap on it, but it can have spikes of getting worse and can turn into plasma cell leukemia
50
what is the cancer which causes splenomegaly the most
CML due to the proliferation of abnormal myeloid cells, which infiltrate the spleen and lead to extramedullary hematopoiesi
51
if someone is having bad side effects from taking oral iron such as ferrous fumarate then what should the next steps be
change regime to every other day change ti ferrous glutamate and then IV iron
52
which defect in the heart makes an embolism more likely spread to the brain
ASD direct right-to-left shunt potential (especially under certain conditions), meaning that venous blood (which may carry things like small clots, air bubbles, or other emboli) can bypass the lungs and go straight to the systemic circulation — including the brain. This is called a paradoxical embolism.
53
allo vs auto
allo - patients body attacks donor - Cross match checks this. if there is an antibody - antigen reaction then it will show clumping of the cells auto - patients body attacks itself
54
which patients will have regular blood transfusions
- sickle cell - thalassemia
55
what is the specific white cell that is removed in irradiated blood products
T lymphocytes
56
what are the main investigations in a haemolysis screen
DAT: - bilirubin - LDH - reticulocytes - haptoglobin - will be reduced Blood film - in AIHA - often will see spherocytes - schistocytes in microangiopathic
57
when someone is bleeding loads, what position do you need to lie them in and what are some contraindications to this
- lie them FLAT this way it will help with venous return - unless they have an upper gI bleed otherwise it will compromise their airway
58
what should you be thinking if someone has a sudden drop of Hb
- bleeding - haemolysis can rule out by the hx
59
when would you avoid giving someone tranxemic acid
when they have haematuria as this can cause clot in the urethra
60
in AIHA how can we tell what the patients blood group is
must remove the autoantibody on the RBC as it is covering the natural antigens on the rbc must do absorption studies but this can take time
61
use for CMV -
- pregnancy - neonates - intrauterine transfusion
62
use of irradiated blood
- immunocompromised: - Recent bond marrow transplant - hodgkins -certain chemo - neonates
63
medication to give if allergic to blood transfusion
- chlorphenamine 10mg IV slowly
64
treat ABO incompatibility
- stop transfusion - IV saline - inform transfusion department - monitor urine - treat any fluid overload or DIC A
65
what condition is usually associated with polycythemia vera
gout, this is because the breakdown of lots of red blood cells leads to increased amount of uric acid can see splenomegaly as the spleen is trying to work overtime and reduce rbc
66
what do teardrop cells and a supppeerrr high platelet number suggest
primary myelofibrosis they will have MASSIVE splenomegaly as the the bone marrow is DRY so spleen is the only way to make blood cells clonal proliferation of abnormal hematopoietic stem cells, especially megakaryocytes (the precursors to platelets).
67
if someone has major bleeding due to a raised INR what do you give
IV vit K and then dried prothrombin complex
68
how does haemophilia often present in toddlers
failure to walk in toddlers due to bleeding into joints This leads to the displacement of normal joint structures,
69
triggers for vaso occlusive crisis
COLD trauma infection hypoxia It is associated with a drop In HB
70
how to differentiate between alpha and beta thalassemia
Beta will occur around 3-9 months suddenly, because all the fetal Hb is gone HbA2 Alpha will occur at birth (3/4) defective HbH
71
which cancer presents with MASSIVE splenomegaly
CML
72
if there is a prolonged PT time what factor will be affected
V11 Factor VII is the first coagulation factor activated in the extrinsic pathway and has the shortest half-life among all the factors in the coagulation cascade. Therefore, a deficiency of Factor VII is most likely to result in a prolonged PT.
73
MODE of biopsy for lymphoma
EXCISIONAL LYMPH BIOPSY - full architecture and then also refer to ENT
74
what level can platelets be to not worry about blood transfusion
if they are more than 50, then can carry our minor ops
75
if creatine is really really raised what diagnostic imaging can you do
US KUB and ontop if they are having chemo, then this may worry you about TLS
76
how does rituximab work
it is a monoclonal antibody used In NHL, and it targets CD20 receptors on B cells to target and kill them
77
KEY DIAGNOSTIC FACTORS FOR NEUTROPENIC SEPSIS
temp > 37.5 reent chemo within 6 weeks
78
what cancers are imatinib used for
CML, ALL TARGETED THERAPY Imatinib binds to the ATP-binding site of BCR-ABL and prevents its activation, thus blocking cell proliferation and promoting apoptosis.
78
what is a key thing to check in females undergoing chemo
FERTILITY - offer gnrh
79
myelodysplastic syndrome lead to what cancer
AML MDS - ineffective blood cell production. Peripheral Cytopenias: Anemia (fatigue, pallor) Neutropenia (infections) Thrombocytopenia (bleeding, bruising) 3. Dysplasia: Morphological abnormalities in: Red cells (e.g., ring sideroblasts) White cells (e.g., hypogranular neutrophils) Platelets (e.g., micromegakaryocytes)
80
polycythemia vera treatment
1. venesection 2. hydroxycarbamide
81
most appropriate first line investigation for myeloma
serum protein electrophoresis detect abnormal monoclonal immunoglobulin (M protein or paraprotein) in the blood.
82
what should people with haemophilia A be treated with in an acute major bleed
recombinant factor 8
83
treatment for MDS
1. support w blood transfusion, ego 2. haematopoietic Stem Cell Transplantation: 3.Hypomethylating Agents: Azacitidine
84
if someone with low grade non - Hodgkins lymphoma is asymptomatic for a long time, then they suddenly develop lots of symptoms what does this suggest
- can assume that maybe its turned into a high grade non Hodgkins lymphoma HIGH GRADE TRANSFORMATION (20% it will happen) you can treat the high grade but they will always have the background of the low grade
85
is hodgkins curative is non-hodgkins curative
yes depends : if low grade and asymptomatic usually watch and wait
86
how to diagnose CML from a blood test
flow cytometry
87
never say full body CT always say
PET - CT
88
difference between excisional lymph node biopsy vs core
both are fine, core is usually used if the lymph node is bigger than/ harder to get to first line is excisional lymph node biopsy
89
in myeloma which stem cell transplant do they receive
autologous stem cell transplant - their BM is making stem cells fine, just over producing plasma cells. So can grow their own blood and remove their plasma cells before giving it to them
90
what conditions require a allogeneic stem cell transplant
- ACUTE leukemias - Myelodysplastic syndromes - Aplastic anemia - Some genetic disorders (e.g., thalassemia, SCID)
91
what are the main cancer drugs you need to be aware of
Rituximab - monoclonal abx that targets CD20, used to treat NHL , CLL Imatinib - TKI, used to treat CML (BCR-ABL)
92
in a PET CT why does the brain, liver and bladder light up
brain - metabolically active liver - metabolising the dye bladder - excreting the dye

Y4 Cancer Care SA (21 decks)

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