Haematology (Week 4)

Question 1

Name three sites where haemopoietic stem cells occur

Answer 1

Bone marrow, umbilical cord blood and peripheral blood (after growth factor treatment)

Question 2

What does asymmetrical stem cell division achieve?

Answer 2

One stem cell and one differentiated cell is produced which maintains stem cell numbers

Question 3

Which feature of bone marrow stroma allows it to hold developing blood cells in place?

Answer 3

Stroma displays cell adhesion molecules which bind to developing cells to anchor them

Question 4

During a bone marrow biopsy, which site is the sample taken from?

Answer 4

From the back of the iliac crest under local anaesthetic

Question 5

Name the autoimmune anaemia condition which is of autosomal recessive inheritance?

Answer 5

Fanconi anaemia

Question 6

What are autologous stem cell transplants?

Answer 6

These use the patients own blood after growth factor therapy which allows stem cells to leave bone marrow and be harvested

Question 7

What is a syngeneic transplant?

Answer 7

A transplant between identical twins

Question 8

Under what conditions does Met haemoglobin form?

Answer 8

This occurs rarely when the haem portion of haemoglobin becomes oxidised

Question 9

Which molecule is iron bound to in the blood?

Answer 9

Transferrin (30% saturation)

Question 10

What are the two storage forms of iron in macrophages of the RES after red blood cell breakdown?

Answer 10

Haemosiderin and ferritin

Question 11

Roughly how many mg of iron does the RES store?

Answer 11

500mg

Question 12

In what circumstances may serum ferritin be normal despite anaemia being present?

Answer 12

In inflammatory conditions (e.g. rheumatoid arthritis) because ferritin is an acute phase protein

Question 13

What is the role of hepcidin and where is it produced?

Answer 13

Hepcidin reduces iron levels in the plasma by interactions with the membrane transporter ferroportin and is produced in the liver

Question 14

In situations of raised ESR (indicating inflammation), what feature can red blood cells exhibit?

Answer 14

Rouleaux (stack of coins)

Question 15

What type of anaemia can lead to vitamin B12 deficiency and how?

Answer 15

Pernicious anaemia
An AI condition affecting gastric parietal cells, meaning intrinsic factor is not produced so vitamin B12 cannot be bound and absorbed in the terminal ileum

Question 16

What is meant by ‘thalassaemia’?

Answer 16

The absence of normal global chains due to absent genes

Question 17

In cases of alpha thalassaemia, how many globin genes would need to be missing for a patient to suffer from HbH disease?

Answer 17

Three

Question 18

What is hydrops foetalis?

Answer 18

The absence of all four alpha globin chains, meaning foetal haemoglobin cannot be produced. This condition is incompatible with life.

Question 19

What adjunct therapy is needed in beta thalassaemia to prevent iron overload?

Answer 19

Iron chelation therapy with blood transfusions

Question 20

In haemolytic anaemias, the bone marrow cannot continue to compensate for cells that live for less than how many days?

Answer 20

20

Question 21

Which immunoglobulin molecule is involved in cold autoimmune haemolytic anaemia (AIHA)?

Answer 21

IgM

Question 22

Which immunoglobulin molecule is involved in drug induced warm autoimmune haemolytic anaemia (AIHA)?

Answer 22

IgG

Question 23

What is the difference in what the direct and indirect Coombs test looks for?

Answer 23

Direct: antibodies on RBC surface

Indirect: antibodies in plasma

Question 24

In haemolytic disease of the new born, what is the rhesus status of the mother and foetus?

Answer 24

Mother: rhesus negative
Foetus: rhesus positive

Question 25

What are the four classical types of Hodgkin’s lymphoma?

Answer 25

1. Nodular sclerosing
2. Mixed cellularity
3. Lymphocytes rich
4. Lymphocyte depleted

Question 26

Name three B symptoms that a lymphoma patient may present with

Answer 26

Night sweats
Unexplained fever
Weight loss

Question 27

What defines stage II lymphoma?

Answer 27

More than one affected lymph node group on the same side of the diaphragm

Question 28

Name 2 types of aggressive B-cell lymphoma

Answer 28

Diffuse large B-cell lymphoma and Burkitt’s lymphoma

Question 29

What the the mechanism of action of the cancer drug Rituximab?

Answer 29

A monoclonal antibody targeting CD20 antigens expressed on B-lymphocytes

Question 30

Name the 5 drugs involved in RCHOP chemotherapy

Answer 30

Rituximab 
Cyclophosphamide
Adriamycin 
Vincristine 
Prednisolone

Question 31

Name the four drugs involved in ABVD chemotherapy

Answer 31

Adriamycin
Bleomycin
Vinblastine
Darcarbazine

Question 32

What is the classical triad of myeloma?

Answer 32

1. Lytic bone lesions
2. Increased plasma cells in bone marrow
3. Clonal immunoglobulins/paraproteins

Question 33

What is the name given to asymptomatic myeloma in which a ‘watch and wait’ method is used?

Answer 33

Smouldering myeloma

Question 34

What does MGUS stand for?

Answer 34

Monoclonal gammopathy of undetermined significance

Question 35

Myelodysplastic syndromes are characterised by what kind of haemopoiesis?

Answer 35

Ineffective

Question 36

What type of diseases are characterised by haemopoiesis which is too effective?

Answer 36

Myeloproliferative diseases

Question 37

What happens to blood counts in acute leukaemia?

Answer 37

Blood counts fall due to compromise of normal marrow

Question 38

In acute lymphoblastic leukaemia (ALL), which chromosomal abnormality occurs?

Answer 38

9:22 translocation (Philadelphia chromosome)

Question 39

Describe the mechanism of action of Imatinib

Answer 39

Blocks Brc-Abl phosphorylation meaning the abnormal protein cannot be formed

Question 40

What are the vitamin K dependent clotting factors?

Answer 40

2, 7, 9 and 10