Haemotology

Question 1

How does thrombotic thromocytopenic purpura present?

Answer 1

AKI
Neurological features
Microangiopathic haemolytic anaemia
Low platelets
Fever

Question 2

What does direct anti globulin test for?

Answer 2

Autoimmune reaction in haemolytic anaemia

Question 3

What is a risk with high grade tumours?

Answer 3

Tumour lysis syndrome

Question 4

What should be given prior to chemotherapy for patients at risk of tumour lysis syndrome?

Answer 4

Rasburicase, a xanthine oxidase inhibitor

Question 6

Which type of chronic leukaemia is observation indicated for asymptomatic patients?

Answer 6

CLL as there is high risk of progression in CML

Question 7

What is second line for CML?

Answer 7

IF tyrosine kinase inhibitors fail, allergenic stem cell transplant with high dose induction chemotherapy

Question 8

How can hyperleukocytosis present?

Answer 8

Visual disturbance
Confusion
Priapism: persistent and painful erections
Deafness

Question 9

What is the NICE guidance for suspected leuemia?

Answer 9

Within 48 hour blood test for adult presenting with:

Pallor
Persistent fatigue
Unexplained fever
Unexplained persistent or recurrent infection
Generalized lymphadenopathy
Unexplained bruising
Unexplained bleeding
Unexplained petechiae
Hepatosplenomegaly

Question 10

What is used as induction in CML?

Answer 10

Hydroxycarbamide

Question 11

What are the side effects of tyrosine kinase inhibtiors?

Answer 11

Nausea
Thrombocytopenia
Neutropenia
Fluid retention

Question 12

Which cell count increases with Haemolysis?

Answer 12

Reticulocytes

Question 13

What is the treatment of minor bleeds in haemophilia A?

Answer 13

Desmopressin

Question 14

What is the treatment of major bleeds in haemophilia A?

Answer 14

Recombinant factor VIII

Question 15

What is tranexamic acid?

Answer 15

Antifibrinolytic, useful for bleeding wound but should be avoided in muscle haematoma

Question 16

What is a DAT test?

Answer 16

Direct anti globulin test for autoimmune haemolysis

Question 17

Which endocrine conditions can case macrycytic anaemia?

Answer 17

Hypothyroidism
Liver disease
Alcohol
Pregnancy

Question 18

Which drugs can cause folate deficiency?

Answer 18

Hydroxycarbamide
Azathriopine

Question 19

What is the cause of microcytic anaemia with high serum iron, high ferritin and high transferrin?

Answer 19

Sideroblastic anaemia

Question 21

What does the osmotic fragility test for?

Answer 21

Hereditary spherocytosis which presents in childhood with jaundice, anaemia, and splenomegaly

Question 22

What is the most common cause of DIC?

Answer 22

Sepsis with gram negative bacteria like Neisseria meningitis

Question 23

What is angular cheilitis?

Answer 23

Angular cheilitis is sores around the mouth, associated with B2 and B12 deficiency.

Question 24

What is atrophic glossitis?

Answer 24

Atrophic glossitis is the absence of papilla on the tongue due to iron deficiency

Question 25

How does G6PD deficiency appear on blood film?

Answer 25

Heinz bodies and bite cells

Question 26

What causes Heinz bodies and bite cells with normocytic anaemia?

Answer 26

GP6D dehydrogenase deficiency

Question 27

What causes low oxygen saturations with normal PaO2 and low SaO2?

Answer 27

METHAEMOGLOBINAEMIA due to abnormal haemoglobin -> there will be failure to improve with oxygen supplementation

Question 28

What causes pancytopenia with 10% blast cells?

Answer 28

Myelodysplasia

Question 29

What causes pancytopenia with over 20% blast cells?

Answer 29

Acute myeloid leukaemia

Question 30

What is Haemophilia c Caused by?

Answer 30

Factor XI deficiency

Question 31

What generally causes massive splenomegaly?

Answer 31

Myelofibrosis Myelodysplasia CML

Question 32

Which leuekmia causes massive splenomegaly?

Answer 32

Chronic myeloid leukaemia

Question 33

How is the intrinsic pathway activated?

Answer 33

Blood is exposed to collagen and Hangerman factor XII is converted to Factor XIIa

Question 34

Which medication causes folate deficiency? /

Answer 34

Methotrexate -> DHF reductase inhibitor It can cause diarrhoea and stomatitis and mucosal ulcers and pneumonitis

Question 35

Which groups is methotrexate contraindicated?

Answer 35

Hepatic or renal impairment Peptic ulceration Pregnancy Breast feeding

Question 37

How are WBCs altered in B12 deficiency?

Answer 37

Hypersegmented polymorphonuclear cells on blood film -> this will occur with glossitis and peripheral neuropathy

Answer 38

Low fibrinogen High D-diner

Question 39

What are the investigations findings for DIC?

Answer 39

Low fibrinogen High D-dimer

Question 40

What is the findings for iron deficiency anaemia?

Answer 40

Low haemoglobin Low MCV

Question 41

What is myelocytosis?

Answer 41

Increased number of plasma cells seen in CML and AML

Question 42

What is the most common cause of iron deficiency in a young man with no clear cause?

Answer 42

Thalassaemia

Question 43

What does agglutination indicate for blood type?

Answer 43

Affects the specific blood type. E.g agglutation with anti-A indicates A blood type