Haematology Quiz Flashcards
How useful are percentages of white cells
Useless unless you use them to produce an absolute count.
What can cause the following incidental in an asymptomatic 83 year old man with no physical findings
Lymphocytes 26.6 (high)
Monocytes 0.5
Eosinophils 0.1
Basophils 0.1
Chronic lymphocytic leukaemia
FBC of a 58 year old man:
RBC 5.67 (high)
HB 18.3 (high)
HCT 0.543 (high)
Polycythaemia
What are the potential causes of polycythaemia (4)
Can be true or pseudo-polycythaemia.
Hypoxia from chronic lung disease or cyanotic heart disease.
Inappropriate erythropoietic secretion from a cyst or tumour
Intrinsic bone marrow disease
What can cause these results in a 67 year old woman.
Smoker and has coronary artery disease.
RBC 6.7 (high) Hb 18.2 (high) WCC 19.5 (high) Neutrophils 14 (high) Lymphocytes 2.7 Monocytes 0.8 Basophils 0.4 (high) Platelets 876 (high)
Polycythaemia
Thrombocytosis
Neutrophilia
Basophilia
Polycythaemia vera
What are the most likely abnormalities in a patient with polycyathaemia vera (6)
RBC, Hb PCV high
WBC, neutrophils and basophils high
Platelets high
How would you further investigate a patient suspected of having polycythaemia vera (3)
Analysis for JAK2 V617F mutation
Bone marrow aspiration and trephine biopsy
Serum erythropoietin
You might want to do other tests to exclude a secondary polycythaemia
WCC 37.5 (high)
Neutrophils 35 (high)
Lymphocytes 0.8 (low)
Monocytes 1.2 (high)
What does this blood film indicate:
Toxic granulation and vacuolation
Left shift
Rouleaux
(5)
Reactive neutrophilia
Most likely diagnosis in a 64 year old Spanish woman with splenomegaly. She is febrile and does not feel well.
WBC 26.3 (high) RBC 5.18 (high) Neutrophils 19.5 (high) Lymphocytes 4.2 (high) Monocytes 1.5 (high) Eosinophils 1.1. (high) Basophils 0.1
Chronic myeloid leukaemia
What can cause gangrene (2)
Abnormalities of the vessels
Abnormalities of the circulating blood
What test would you want to do in an elderly man presenting with bruising
Platelet count
What are some causes of bruising in a small child (3)
Non-accidental injury
Coagulation abnormality
Thrombocytopenia
What is the most likely cause of a hypochromic microcytic anaemia in a North African woman with an 18 month old baby
Iron deficiency anaemia
What haematological problem is associated with rheumatoid arthritis (5)
Anaemia of chronic disease
Iron deficiency anaemia resulting from use of aspirin or NSAIDs
Neutropenia or thrombocytopenia from drug toxicity
Felty syndromes
Increased ESR
A 10-year-old girl presented with a painful right knee that had started when she knocked her knee in a swimming pool
The next day she had become unwell with malaise, anorexia and fever
Her GP prescribed amoxicillin for ‘otitis media’
Next day her mother took her to an Accident and Emergency Department
She was afebrile
Her right knee was painful and swollen
X-ray of the knee showed patchy changes in density in the right medial tibial plateau
Blood tests showed
WBC 6.6 × 109/l
ESR 60 mm in 1 h (NR 0‒10)
C-reactive protein (CRP) 27 mg/l (NR 0‒10
Osteomyelitis
What are the differentials for a 10 year old girl with a painful knee following an injury the previous day (4)
Osteomyelitis
Septic arthritis
Haemorrhage into the joint following minor trauma
Non-accidental injury
What is slightly more common in children: ostemyelitis or septic arthritis
Osteomyelitis
A 1-year-old boy, an only child, presented to an Accident and Emergency department with a swollen right elbow following minor trauma
On clinical examination and radiology there was no evidence of bony injury
He was sent home
Three days later he was brought back with increased pain and swelling
Joint aspiration yielded haemorrhagic fluid
He was started on antibiotics and sent home
Four weeks later he was brought back as the effusion had not resolved
The joint was surgically explored (dark blood) and a biopsy was taken (‘synovitis’)
Post operatively the wound bled persistently
What is the most appropriate test?
Coagulation screen.
Haemophilia important differential
A 21-year-old woman presented with abdominal pain, bruising and altered level of consciousness
She had a low grade fever
Her platelet count was 15 × 109/l
Her bilirubin was increased and LDH was greatly increased
Her creatinine was marginally increased
Anaemia present: microangiopathic haemolytic anaemia.
Thrombotic thrombocytopenic purpura
What are the features of thrombotic thrombocytopenic purpura (5)
Microangiopathic haemolytic anaemia Thrombocytopenia Fever Neurological abnormalities Renal impairment
What is the underlying defect in thrombotic thrombocytopenic purpura
Deficiency of vin Willebrand factor (autoimmune deficiency)
What is the treatment for TTP
Plasma exchange
Do not give platelet transfusion
Corticosteroids do not play a role in treatment
A previously healthy 20-year-old man presented with fever, sore throat, malaise, dyspnoea and abdominal pain
Ten days before admission he had fallen on his left side and had attended Accident and Emergency with pain in the left chest wall
Chest X-ray had been normal but he was observed overnight
On this presentation, temperature 39.70C, BP 115/95, pulse rate 96 beats/minute, generalized lymphadenopathy, pharynx inflamed, mild hepatomegaly, spleen palpable 2 cm below left costal margin, abdomen tender
WBC 11.2 × 109/l, lymphocyte count 7.8 × 109/l, Hb 109 g/l, numerous atypical lymphocytes
What test would you do?
Screening test for infective mononucleosis.
Causes for concern: anaemia, tachycardia and abdominal pain and tenderness.
Suspicion: splenic damage and intraperitoneal haemorrhage - urgent imaging (abdominal US)
An urgent abdominal ultrasound showed splenomegaly and detachment of the inferolateral part of the spleen, 9 cm from the tip with subcapsular haematoma formation - emergency splenectomy.
What percentage of patients with infective mononucleosis undergo a splenectomy
50%
What are the risks of hyposplenism (3)
Overwhelming bacterial sepsis (particularly pneumococcal or haemophilus influenza)
Fatal malaria
Fatal capnocytophagia canimorsus infection
How are patients without spleens managed (4)
Vaccinate for pneumococcus, meningococcus, and haemophilus influenzae
vaccinate against influenza
Prescribe life-long penicillin
Advice the patient on: dog bites, travel to malaria zones, prompt treatment of infection.
Issue a splenectomy card and information sheet.
What are the peak ages for Hodgkin Lymphoma (2)
Adolescence
>50 years
How does Hodgkin’s lymphoma present (2)
Painless supradiaphragmatic lymphadenopathy
1/3rd may present with B symptoms
What are the lymphoma B symptoms (3)
Fever
Drenching night sweats
>10% loss of body weight in last 6 months
What are risk factors for Hodgkin lymphoma (3)
Increased risk in families fo affected patients
Association with HLA DPB1
Epstein-Barr virus found in >79% of over 50s
What biochemical marker is useful for prognosis and monitoring in Hodgkin’s lymphoma
ESR
What does treatment depend on in Hodgkin’s lymphoma (2)
Stage
Bulk
