Hematology

Question 1

What is the dosage of elemental iron required to treat IDA in adults?

Answer 1

120 mg/d for 3 months
Continue therapy for 3 months after anemia is corrected

Question 2

Why does RA and other autoimmune dx result in anemia?

Answer 2

Inflammatory cytokines (eg. IL-6) stimulate hepcidin production and release

Question 3

What conditions require parenteral replacement of iron?

Answer 3

Celiac dx
IBD
Gastrectomy
Gastrojejunostomy
Bariatric sx
Other small bowel sx

Question 4

What is the bloodtest for pernicious anemia?

Answer 4

Instrinsic factor autoantibodies

Question 5

What are vitamin B12 treatment guidelines?

Answer 5

IM hydroxocobalamin:
No neurological symptoms – 3 times weekly for two weeks
Neurological symptoms – alternate days until there is no further improvement in symptoms

Question 6

How is combined vitamin B12 and folate deficiency treated?

Answer 6

Must treat vitamin B12 deficiency first, otherwise can lead to demyelination of the spinal cord

Question 7

What are the causes of microcytic anemia?

Answer 7

Thalassemia
Anemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia

Question 8

What are the causes of normocytic anemia?

Answer 8

Anemia of chronic disease
Acute blood loss
Aplastic anemia - bone marrow damage leading to production of fewer blood cells
Hemolytic anemia
Hypothyroidism

Question 9

What are the causes of megaloblastic anemia?

Answer 9

Vitamin B12 deficiency
Folate deficiency
* Macrocytic anemia can be normoblastic or megaloblastic

Question 10

What are the various types of leukemia?

Answer 10

Acute myeloid leukaemia
Acute lymphoblastic leukaemia - most common in children and associated with Down syndrome
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia (usually affects adults > 60)

The excessive production of a single type of cell can suppress the other cell lines, causing the underproduction of different cell types. This can result in pancytopenia, which is a combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia).

Question 11

What are smear or smudge cells?

Answer 11

Ruptured white blood cells
(particularly associated with CLL)

Question 12

A high proportion of blast cells are associated with which type of leukemia?

Answer 12

AML

Question 13

What is a characteristic finding in AML?

Answer 13

Auer rods in the cytoplasm of blast cells

Question 14

What are the 2 types of lymphoma?

Answer 14

Hodgkin’s lymphoma (a specific disease)
Non-Hodgkin’s lymphoma (which includes all other types)

Question 15

What is the characteristic finding of Hodgkin lymphoma?

Answer 15

Reed-Sternberg cells

Question 16

What are the 4 key features of myeloma?

Answer 16

C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain

Question 17

When is thrombocytopenia a concern

Answer 17

Platelet counts below 10 x 109/L are at high risk for spontaneous bleeding. Particularly concerning are:
Intracranial hemorrhage
GI bleeding

Question 18

Explain the MOA of Rituximab and its uses.

Answer 18

Rituximab is a monoclonal antibody that targets the CD20 proteins on the surface of B cells. By attacking B cells and reducing their numbers, it reduces the production of the antibodies that are responsible for autoimmune disease. It treats many autoimmune conditions, from rheumatoid arthritis to ITP.