Hematology Flashcards
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic+ Raised HbA2 + basophilic stipling and target cells.Dx:
B thalasemia Trait.
B thalasemia Trait.
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic.
Basophilic stippling with occasional target cells
Electrophoresis result in B thalasemia trait ?
Raised HBA2.
Blood film/ type of cells in B thalasemia trait ?
Basophilic stipling and occasional target cells.
Diagnostic test of B thalasemia trait ?
Haemoglobin electrophoresis = Raised HBA2.
Which mutation in Polycythemia Rudra Vera ?
JAK 2 Mutation.
Pruritis after bath + epistaxis + recurrent infection + splenomegaly+
Stroke history
JAK 2 mutation + all 3 : hb , tlc, platelet: all increased. Think :
Polycythemia Rubra Vera.
Polycythemia rubra Vera can lead to which condition :
AML and Myelofibrosis.
C/o SOB+ Lethargy+ night sweats+ Bone pain + H/o Polycythemia Rubra Vera. Which cancer most likely /
Acute Myeloid leukemia.
Marked spherocytosis + DAT= negative. Dx:
Hereditary Spherocytosis.
Marked spherocytosis + DAT=Positive. Dx:
Autoimmune Hemolytic Anaemia.
( AIHA)
Diagnostic test in Hereditary Spherocytosis :
EMA binding test.
H/O Hereditary Spherocytosis + Now : viral infection—Presents with weakness and lethargy.
Hemolytic crisis secondary to hereditary Spherocytosis.
Rx: Folic acid + - Fluids, Supportive Rx
Rx for Hemolytic crisis secondary to H.Spherocytosis : Rx:
Folic acid.
What genotype is associated with a milder form of sickle cell ?
HBSc.
Which UTI meds can lead to pancytopenia ?
Trimoethoprim.
Most common symptom of Myelofibrosis :
Fatigue.
What type of cells in Myelofibrosis :
Tear drop cells.
What is increased in Myelofibrosis, indicating high turnover ?
Urea and LDH.
What is increased in early stage of Myelofibrosis ?
High WBC and High Platelet count.
What indicates Dry tap in Myelofibrosis ?
Unable to take bone marrow sample.
Elderly + Basophilia + Massive splenomegaly. Dx:
Chronic Myeloid Leukemia.
Mutation In CML ?
BCR- ABL ( Tyrosine Kinase pathway)
Rx in CML ?
Tyrosine Kinase Inhibitor ( Imatinib)
Poor prognosis in CLL :
Deletion of 17p13 region.
K/C/O Sickle cell + Throbbing pain in leg. Dx and Investigation to diagnose :
Dx: Vaso occlusive crisis.
Ix: No Ix required. Dx is clinical.
Transfusion—SOB+ Decrease in BP. Dx and Rx?
Transfusion related acute lung injury. ( TRALI)
Rx: IV fluids + oxygen + escalation of care.
20-30 year old + low in IgA, IgG, IgM+ Recurrent chest infection. Dx:
Common variable immunodeficiency syndrome.
Lethargy + Splenomegaly +JAK 2 + High Urea and LDH + WBC and Platelets : slightly Raised. Dx and blood film :
Myelofibrosis
Tear drop cells
Dapsone + Dyspnoea =
Methhaemoglobinaemia.
Neutropenic sepsis is caused by :
Staphylococcus epidermidis.
Staphylococcus epidermidis is gram ?
Gram Positive , coagulase negative.
mechanism of action of DDAVP in von Willebrand’s disease?
Induces release of von Willebrand’s factor from endothelial cells
Antibiotic which causes hemolysis in G6PD?
Ciprofloxacin, sulphamethaxole, co trimoxazole.
Acute myeloid leukaemia - poor prognosis:
Deletion of chromosome 5 or 7
TTP features and Rx:
Terrible Pentad : Fever + Neuro. + Anaemia+ Decrease in Platelets + AKI= Increase in Urea and Creat.
Rx: Plasma Exchange.
TTP deficiency of what:
Inhibition or deficiency of ADAM TS 13 = leads to failure to cleave VWF multimers.
In TTP, The deficiency of ADAM TS 13 leads to what :
Leads to failure to cleave VWF multimers.
Wiscot Aldrich syndrome, features and mnemonic :
WATER:
WA:Wiscot Aldrich, WASP gene mutation.
T: Thrombocytopenia: Decrease in platelets
E: Eczema
R: Recurrent pyogenic infection.
Both B and T cell deficiency :
Wash your B and Ts:
Wiscot
Ataxia Telangiectasia
SCID
Hyper IgM syndrome.
B cell deficiency :
ABC:
A: IgA deificiency
B : Brutons
C: Common variable immunodeficiency
Recurrent bruising + Recurrent infection + eczema + low platelet + anaemia
Wiscot Aldrich syndrome.
Most common type of lung cancer in non smokers:
Lung Adenocarcinoma.
Rabiscurase MOA:
Converts uric acid to allantoin.
Most common symptom of Superior vena cava obstruction :
Dyspnoea.
Hodkin’s Lymphoma poor prognosis
Fever
Weight loss
Night sweats
The universal donor of fresh frozen plasma is :
AB RhD negative blood
Myelofibrosis: High or Low LAP ?
High LAP score.
Haemophilia A , which factor ?
Factor 8 ( Aight)
Haemophiila B , which factor ?
Factor 9
Haemophilia clinical features ?
Haemarthroses.
Haematomas.
Prolonged Bleeding after surgery.
Anaphylactic reaction to bee sting, First line Ix:
Radio allergosorbent assay. ( RAST)
In Acute myeloid leukaemia. What is the single most important test in determining his prognosis?
Cytogenetics.
Cytogenetics detects chromosomal abnormalities—which has biggest effect on AML prognosis.
Cytogenetics detects what ?
C=C= Chromosomal Abnormalities.
Neutropenic sepsis Rx?
Filgrastim.
K/c/O cancer= Hodkins + Recent chemo+ C/o : Fever+ Neutrophils= < 0.5 10^9. Dx:
Neutropenic Sepsis.
Aetio of Neutropenic Sepsis:
Staph epidermidis.
Gm + cocci, Coagulase Negative.
In Hemolysis, Haptoglobin: Increase or Decrease ?
Haptoglobin decreases.
As Haptoglobin binds to free haemoglobin.
1 adrenaline
2 adrenaline
>2 adrenaline . Admit for how many hours ?
1 Adrenaline= Admit for 2 hours.
2 Adrenaline= Admit for 6 Hours.
>2 Adrenaline = Admit for 12 hours.
Aprepitant MOA:
Antiemetic which Binds to NK1 receptor( Chef wearing Apron , Nikon Camera)
Which products are used to avoid transfusion-associated graft versus host disease?
Irradiated Blood products.
Acute myeloid leukaemia - good prognosis:
good prognosis: t(15;17)
Woman with bone metastases- most likely to originate in the :
Breast
Isolated neutropenia in which ethnicity ?
Black Afro Caribbean.
Gallstones is common in which blood disorder ?
Hereditary Spherocytosis.
Philadelphia chromosome good or bad prognosis in ALL ?
Bad prognosis
VIT B12 absorption ?
Active transport in terminal ileum
Taxanes MOA:
Prevents micro tubules polymerisation.
T(9:22)
Philadelphia chromosome in CML.
Transmission of which type of infection is most likely to occur following a platelet transfusion?
Bacterial.
What is the single most important factor in determining whether cryoprecipitate should be given?
Low fibrinogen.
Pt on warfarin—Trauma—#ge—blood transfusion—which blood product to give additionally?
Prothrombin complex concentrate.
Best Prognosis in Hodkins:
Lymphocyte Rich ( Rich ppl have better bank accounts)
Worst Prognosis in Hodkins :
Lymphocyte Depleted ( Poor ppl have depleted bank accounts )
The oncologist recommends starting a medication which can specifically target this type of breast cancer in post-menopausal women only
Aromatase inhibitor- Azoles.
CKD is the most common cause of Which clotting factor deficiency ?
Anti thrombin 3.
Anterior mediastinal mass + symptoms of myasthenia = Dx and Ix of choice:
Thymoma.
Ix of choice : CT scan of chest.
Thymoma clinical features.:
Anterior mediastinal mass + symptoms of myasthenia = thymoma
Prostrate cancer—new onset back pain+ Peri anal numbness + leg weakness. Dx and Rx:
Neoplastic spinal cord compression.
Rx: high dose dexamethasone orally immediately.
Painless neck lump + B symptoms. Dx and Translocation:
Follicular Lymphoma.
Translocation: t( 14, 18)
Transfusion + now—fever chills rigors. Dx and Cause:
Dx: Transfusion related infection
Cause: platelets
Screening for Hereditary angioedema?
C4 levels
What is not involved in patho of hereditary angioedema?
Histamine.
Isolated thrombocytopenia +Increase in bleeding time. Easy bruising + Epistaxis. Dx and Rx?
ITP
Rx: oral prednisolone.
ITP Rx:
Oral prednisolone.
In ITP antibodies are against :
Glycoprotein 2b/3a complex.
Cells seen in DIC:
Schistocyte.
DIC mnemonic and features:
Damn I am clotting.
Decreased Fibrinogen + Increased D dimer.
Decreased Fibrinogen + Increased D dimer. Dx?
DIC
CML , LAP score , high or low ?
Low.
Family H/o + Abd pain + Neuro symptoms- hallucinations , agitation , change of mood + reduced sensation of foot +
Acute intermittent porphyria.
Dx of Acute intermittent porphyria :
Porphobilinogen.
Rx for Acute intermittent porphyria :
Heme.
Bombesin is a tumour marker in
Small cell lung cancer
Small cell lung cancer tumour marker:
Bombesin.
Tumour lysis syndrome. Rx:
Rasburicase + IV Fluids.
Tumour lysis syndrome mnemonic and electrolytes :
UKPc: Increase in urea, creat, phosphate,
Decrease in calcium.
H/o Breast cancer + Osteosarcoma. Most likely Dx:
Li Fraumeni syndrome.
Tumour marker in Li Fraumeni :
P53.
Difference bw TRALI and TACO:
No Hypotension in TRALI.
Post splenectomy which types of cells are seen ?
Howel Jolly bodies.
Which diabetic drugs causes hemolysis in G6PD?
Sulphonamides- Glimepiride.
Biguinide- Metformin.
Which bodies are seen in Leukamoid reaction:
Dohle bodies.
Leukamoid reaction features:
High LAP score
Dohle Bodies
Left shift of neutrophils.
which direction of shift of neutroohils in Leukamoid reaction ?
Left direction shift.
Heparin binds which clotting factor ?
Antithrombin 3.
Which one of the following causes of thrombophilia is associated with resistance to heparin?
Antithrombin 3 deficiency.
Which urine test in lead poisoning ?
Increase in urinary coproporphyrin.
Blood picture in lead poisoning
Microcytic anaemia plus basophilic stipling.
Pt started on warfarin+ Now develops necrotic skin condition : Dx
Protein c deficiency.
Protein c deficiency= Hypercoaguable state + warfarin= blood thinner= this imbalance leads to necrotic skin condition.
Thymoma assn :
Myasthenia gravis
Red cell aplasia.
Dermatomyositis
SIADH
Food allergy test:
Skin prick test.
JAK 2 + isolated increase in platelets. Dx:
Essential Thrombocytosis.
Rx: Hydroxyurea ( Hydroxycarbamide)
Essential thrombocytosis. Rx
Hydroxycarbamide.
Coeliacs causes which type of spleen issues ? And causes which type of cells to appear /
Hyposplenism.
Howell jolly bodies.
Diagnostic test in anaphylaxis
Serum tryptase.
Cyclophosphamide Adverse and its prevention :
Haemorhagic cystitis
Prevention: MESNA
H/o Sickle cell disease. Hb, WBC, Platelet : all three decreased. C/o fever cough myalgia. Dx:
Aplastic crisis
Raynauds + waldernstrom. Dx: which type ?
Type 1 cryoglobulinaemia.
Hepatitis c + Waldenstriom, which type ?
Type 3 cryoglobulinaemia.
_____is the empirical antibiotic of choice for neutropenic sepsis
Piperacillin with tazobactam (Tazocin)
Dyspnoea + Normal PO2+ Decreased SPO2. Dx:
Methhaemoglobinaemia.
Rx:IV methylthioninium chloride (methylene blue) if acquired
Rx of Methhaemoglobinaemia.
IV methylthioninium chloride (methylene blue) if acquired
PE+ Recurrent DVT- unprovoked. DX:
Activated protein c resistance( Factor 5 Leiden)
Which antibiotics causes Methhaemoglobinaemia ?
Sulphamethaxzole—Co-trimoxazole.
Which infection ass with MALT= gastric lymphoma
H.Pylori.
Cisplatin MOA:
Cross linking in DNA.
Methaemoglobinaemia Patho :
oxidation of Fe2+ in haemoglobin to Fe3+
Intravascular hemolysis mnemonic :
MRCGP
Mismatch blood transfusion
Red cell fragmentation- heart valves,TTP
G6PD
Paroxysmal nocturnal haemoglobinaemia.
Paroxysmal nocturnal haemoglobinaemia diagnostic investigation :
Cytometry- To detect low levels of CD55 and CD59.
Most common type of Hodkins lymphoma :
Nodular Sclerosing.
Acute intermittent porphyria is deficiency due to :
Porphobilinogen deaminase
Anaphylaxis - serum tryptase reach peak at :
Serum tryptase reach peak at one hour.
SVC obstruction Rx:
Dexamethasone.
Hodkins lymphoma- spread to other organs. Which stage ?
Stage 4
Which mutation is associated with prostate cancer in men?
BRACA 2
BRAC-2 in men mnemonic :
BP2:
Breast
Prostrate
Pancreas.
Hodkins = both sides of diaphragm , which stage ?
Stage 3
Abd pain + red coloured urine+ rapid weakness in legs. Dx :
Acute intermittent porphyria.
Sickle cell patients should be started____ to reduce the incidence of complications and acute crises
started on long term hydroxycarbamide/hydroxyurea.
most common primary tumour that metastasises to the bone in men :
Prostrate cancer.
Patients starting rituximab should be screened for__
Hepatitis B before starting treatment
Hereditary angioedema is caused by deficiency of___
C1 esterase inhibitor
Baseline haemoglobin of 110g/L: sudden drop of Hb—H/o Sickle cell. Dx:
Aplastic Crisis.
Sideroblastic anaemia causes and mnemonic :
MALT:
Myelodysplasia.
Alcohol.
Lead
Anti TB drugs.
Anti TB drugs causes which type of anaemia ?
Sideroblastic anaemia.
Which stain in Sideroblastic anaemia ?
Pearl’s stain.
Rx of Sideroblastic anaemia :
Pyridoxine.
Burkits lymphoma Translocation:
T(8,14)
Which gene in Burkits lymphoma?
C-Myc.
Which virus in Burkits lymphoma ?
Epstein Barr virus.
Biopsy findings in Burkits lymphoma ?
Starry sky appearance.
Growth in Jaw + Starry sky appearance. Dx:
Burkits lymphoma.
ESR value in polycythemia Rubra Vera :
Low
Rx for hairy cell leukemia:
Interferon alpha.
H/o h.spherocytosis + Episodic upper abdomen pain. Dx:
Billiary colic.
How is capecitabine Administered ?
Orally.
Which sex is a good prognosis in CLL ?
Female sex.
most common inherited bleeding disorder:
Von WIllebrand disease.
most useful marker of prognosis in myeloma?
B2 Microglobulin.
Which is not a treatment modality in ITP ?
Plasma exchange.
Alpha thalasemia on which chromosome ?
Chromosome 16.
Olanzapine, an atypical antipsychotic Ass with increased risk of :
VTE.
primary immunodeficiency is due to a defect in neutrophil function?
Chronic Granulomatous disease.
Common variable immunodeficiency Is due to defect in which primary immunodeficiency ?
B cell function.
Mnemonic- ABC
A- IgA deficiency
B- Brutons agammaglobulinaemia
C- common variable immunodeficiency anaemia
Ovarian cancer tumour marker :
CA 125.
Peritoneal cancer tumour marker :
CA 125.
Pancreatic cancer tumour marker
CA 19 9
Breast cancer tumour marker :
CA 15 3
H/o Polycythemia rubra + petechia + gingival bleeding+ DIC picture. Dx:
Acute Promyelocytic leukemia
Which of the following chemotherapy agents is most likelcy responsible for hypomagnesemia ?
cisplatin.
Aromatase inhibitors common side effects in post menopausal women ?
Osteoporosis
The presence of haemolysis with blister cells on the blood film is highly suggestive of____
G6PD deficiency
Blood smear of G6PD:
Heinz bodies
Bite cells
Blister cells.
Anti malarials causes hemolysis in :
G6PD
Translocation of Acute promyelocytic leukaemia :
t(15;17)
T(15;17)
Acute Promyelocytic leukaemia.
irinotecan MOA:
Inhibition of topoisomerase 1.
Methhaemoglobinaemia. Po2 and spo2 level :
Normal PO2 and low Spo2( low oxygen saturation)
Recurrent pancreatitis + Recurrent parotitis. Dx:
IgG4 disease.
which gene proliferation in follicular lymphoma ?
Increases BCL2 transcription
Hereditary angioedema mode of inheritance ?
Autosomal Dominant.
Doxorubicin Adverse:
Cardiomyopathy
Vincristine Adverse :
Peripheral neuropathy.
Imatinib MOA:
Tyrosine kinase inhibitors
Ototoxicity is caused by which Anti cancer drugs ?
Cisplatin.
Cisplatin adverse :
Hypomagnesemia
Ototoxicity
Peripheral neuropathy
Acute Promyelocytic leukemia Rx:
All-trans retinoic acid (ATRA)
Abdomen pain, diarrhoea and progressive weakness and pain in the limbs. She looks low in mood and tearful at times. You ask for a urine sample and leaves it standing near the window. 20 minutes later, you notice that the urine has become darker.
Acute intermittent porphyria
M protein > 30 g/l + monoclonal plasma cell infiltrate.
▪︎No CRAB features. Dx and Rx:
Smouldering Multiple Myeloma.
Rx: Observe and Monitor.
Cyclophosphamide - MOA:
Causes cross-linking in DNA
HTLV1 association :
Adult T cell leukemia
Do fungal infection cause eosinophilia ?
No
IgG paraprotein level in MGUS?
<30 g/L
4 year old + Splenomegaly + clinically anaemic+ H/o Sickle Cell :
Sequestration crisis.
IV drug user + hep C + Rheumatoid arthritis +Purpuric Rash + low C4. Dx:
Cryoglobulinaemia.
Megaloblastic Anaemia Rx
Intramuscular vitamin B12 + start oral folic acid when vitamin B12 levels are normal
Congenital cause of Methhaemoglobinaemia :
NADH methaemoglobin reductase deficiency
H/o H Spherocytosis—C/o- Lethargy. Hb low , Retic=low. Dx:
Parvo virus infection.
In Hemolytic anaemia, retic count is high. It’s Low here.
Most useful follow-up investigation(s) to detect disease recurrence in testicular cancer.
Alpha-fetoprotein + beta-HCG.
weight loss, anaemia, splenomegaly, + Leucocyte with all stage of maturation. Dx:
CML
T(11,14):
Mantle Cell Lymphoma.
What chemical mediator is mainly responsible for the tissue oedema seen in patients in hereditary angioedema?
Bradykinin.
Does penicillin cause G6PD?
No.
Treatment of hereditary angioedema?
Anabolic steroids.
Is dermatomyositis ass with Thymoma ?
yes
Is motor neuron disease ass with Thymoma ?
No.
Which two anaemias are seen in PNH ?
hemolytic anaemia and aplastic anaemia.
Which test is positive in PNH ?
Positive Ham test.
Is hemearthosis a feature of PNH ?
No. its seen in haemophilias.
Lead poisoning mnemonic and features:
LEADS
L- lead lines on gingival
E- encephalopathy
A- Abdomen colic
D- wrist drop- peripheral neuropathy.
Type of cell seen in lead poisoning:
Microcytic Anaemia + basophilic stipling.
(Iron deposition around mitochondria)
Mode of inheritance in Wiscot :
X linked recessive( water down)
SVC obstruction is caused by primary malignancy or metastatic malignancy ?
Primary malignancy.
Stoke + isolated increase in platelets. Dx and Mutation :
Dx: Essential thrombocytosis.
Mutation : JAK 2 mutation and CALR mutation
Mutations seen in essential thrombocytosis:
JAK 2 mutation and CALR
Which toxin leads to hepatocellular cancer ?
Aflatoxin
Elderly + Increase in Lymphocytes + which cancer ?
Chronic Lyphocytic Leukemia.
Investigation of choice in CLL :
Flow Cytometry/Immunophenotyping - detects Antibodies on the surface
Deletion of which chromosome in
Deletion of Long arm chromosome 13.
Unusual taste in mouth is a classical feature of :
LEAD poisoning.
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling
Lead poisoning.
itchiness in her mouth and at the back of her throat after consuming peaches on several occasions with some mild swelling which settles down over time + Seasonal Variation:
Oral allergy syndrome.
Which of the following has a role in monitoring disease activity in colorectal cancer?
CEA
Difference between H. Angioedema and anaphylaxis :
H.angioedema has painful macular rash.
Skin manifestation in anaphylaxis is : urticaria.
Methotrexate MOA:
inhibits dihydrofolate reductase and thymidylate synthesis
Urinary findings in Acute Intermittent Porphyria.
Increased urinary porphobilinogen between acute attacks
Imp Adverse of SERM:
DVT
DVT in pregnancy. Rx:
Low molecular Weight Heparin.
(Heparin helps in pregnancy )
Rituximab acts against :
CD 20 and B cells
What to screen before giving Rituximab?
Patients starting rituximab should be screened for hepatitis B before starting treatment
Is Haemochromatosis ass with Polycythemia?
No.
Is dehydration ass with Polycythemia ?
Yes
Common causes of polycythemia ?
Polycythemia Rubra Vera.
COPD.
Stress/ Dehydration.
Fibroids.
Hypernephroma.
If allergy to latex, then allergy to which food ?
Banana
Hypodiploidy : Good or Bad prognosis In ALL ?
Bad prognosis
Epistaxis + Bleeding Gum+ Bilobed large nuclear cells. Dx:
Acute myeloid leukemia.
K/C/O Sickle + Fever + Dyspnoea + low spo2 + CXR= opacification.
Dx: Acute chest syndrome
Rx: Oxygen, IV FLuids, Incentive spirometry.
CLL - treatment:
Fludarabine, Cyclophosphamide and Rituximab (FCR)
MGUS+ Organomegaly + No bone lesions. think :
Waldenstorm
Headache+ epistaxis + hepatospleomegaly + Pancytopenia + IgM peak. Dx:
Waldernsotrm.
Which peak in waldenstorm ?
IgM Peak
Blood picture in Waldensorm :
Pancytopenia
What type of blood cells in Waldenstorm ?
B lymphocytes + Plasma cells
DVT plus IgM peak. Dx?
Waldenstorm.
DVT= Hyperviscocity syndrome
CLL is due to :
Monoclonal Proliferation of B lymphocytes.
Complications developed in Waldenstorm :
Hyperviscocity complications ( Headache, DVT)
Cancer patients with VTE Rx:
Continue DOAC for 6 months.
Provoked VTE Rx:
DOAC for 3 Months
Unprovoked VTE Rx:
DOAC for 6 Months
Elderly + Absolute Lymphocytosis. Dx:
CLL
Type of cells in CLL :
Smudge cells.
Diagnostic test for CLL.
Flow Cytometry/ Immunophenotyping : to detect antibodies.
Warm autoimmune Hemolytic anaemia is ass with Ig?
IgG
It’s warm in G=Ghana( Outside Uk)
Cold autoimmune Hemolytic anaemia is ass with ig?
IgM
It’s miserable in Manchester.
Coombs test ( DAT test) in warm autoimmune Hemolytic ?
Coombs or DAAT : Positive.
Recurrent infection in CLL is due to :
hypogammaglobulinaemia
Which type of anaemia occurs in CLL as complication:
Warm autoimmune haemolytic anaemia
Common complication in warm autoimmune Hemolytic anaemia ?
Lymphoma.
Raynauds+ Spherocytosis. Dx and First line Ix?
Next line Ix: Direct antiglobulin test (DAT)
Dx: Autoimmune Hemolytic anaemia.
Mutation in Hereditary Spherocytosis :
Mutation in Spectrin and Ankyrin
Sickle cell mutation occurs where ?
Valine substitution for glutamic acid at 6th position of B chain.
EPO level in Polycythemia Rubra Vera ?
Low EPO level
Long term Complications of Splenectomy :
Infections.
Therefore all splenectomy patients are vaccinated
Best time to give vaccine for a splenectomy Patients :
One month before surgery
Painless cervical Lymph nodes. Most appropriate Ix to do :
Excision Biopsy of lymph node.
A full lymph node biopsy is required to to determine the exact subtype of lymphoma/
Risk factor for Lead poisoning :
Old house with poor maintenance
H/o chemotherapy and radiotherapy + Now : Anaemia + recurrent infection taking longer to heal + Frequent Nose bleeds. Dx:
Secondary AML.
Secondary AML.
H/o chemotherapy and radiotherapy + Now : Anaemia + recurrent infection taking longer to heal + Frequent Nose bleeds.
Recent Transplant + Now : Right Quadrant pain + Abnormal LFT + Jaundice. Dx:
Veno Occlusive Disease.
Veno occlusive disease secondary to Recent transplant :
Recent Transplant + Now : Right Quadrant pain + Abnormal LFT + Jaundice.
Imatinib common side effect :
Nausea
Biopsy —Reduction in Hematopoeitic cells and Fatty bone marrow.
Aplastic anaemia
Aplastic Anaemic Bone marrow biopsy ;
Reduction in Hematopoeitic cells and Fatty bone marrow.
Young + fatigue+ Bruising + Gum Bleeding + Frequent nose bleeds +
Blood Picture—DIC
Acute promyelocytic leukaemias
Acute promelyocytic Leukemia Blood picture :
DIc picture/ thrombocytopenia
+ Auer Rods + Promyelocytes
Extensive bruising + Petechiae on Limbs + Bleeding Gums+ Suffers severe PR bleed.
Hb—Low, Platetlets- very low
Severe ITP
Rx: IV immunoglobulins
Mild ITP Rx : Oral Prednisolone
Recent chemo—Now feeling very tired. Hb- low, platelet-low. Dx
Symptomatic anaemia
Rx: transfuse with packed red cells
Primary function of Heparin :
Blocks anti thrombin 3 —which further blocks Factor 2(broken 2 tooth) and factor 10 (broken tennis racket)
Bleeding time in Haemophilia :
Bleeding time in Haemophilia is normal.
Bleeding time depends on platelet function.
In haemophilia platelets are normal. Problem is in clotting factors—factor 8 and factor 9. Therefore clotting factor is increased ( Increase in aPTT)
Bleeding time in VBD :
Bleeding time is prolonged
APTT —prolonged.
PT—normal.
Bleeding time depends on platelet function. In VBD , problem is in platelet adhesion.
Alcoholic + enlarged spleen + Bruises + on going nosebleed. Which vitamin deficiency ?
Vitamin K deficiency
Enlarged spleen is due to ALD
Pregnant + Mild knock at elbow + Now bruises + blood is normal + Platelets—Low
No intervention required.
Platelet is normally low in pregnancy.
Physiological thrombocytopenia.
17 year old + Asymptomatic + Painless cervical lymph nodes + B/L mediastinal lymph nodes
Hodkin’s Lymphoma—typical symptoms
Mantle and Non Hodkin’s—Very rare presentation in young age group
Sarcoidosis—other symptoms are present.
Quinine—Now bruises and low platelet :
Drug induced Thrombocytopenia
Rx for Paroxysmal nocturnal Haemoglobin anemia :
Eculizumab.
Diabetes Insipidus is associated with which hemat condition ?
Sickle cell
MAHA is associated with :
TTP
HUS
SLE
HELPP
Feve, weight loss, anorexia + Macrocytic anaemia + Thrombocytopenia + Blood film—Dimorphic red cells + papenheimmer bodies + basophilic stippling. Dx:
Myelodysplasia.
Protamine sulphate is used for reversal of :
Heparin
Prothrombin complex concentrate is used for reversal of :
Warfarin
Which drug to use for reversal of action of Altepase ?
Traneximic acid
Traneximic acid is used for reversal of which drug ?
Altepase
Which drug to use for reversal of warfarin ? :
Prothrombin complex concentrate.
Which drug to use for reversal of heparin ?
Protamine Sulphate.
Best test to detect protein C deficiency ?
Copperhead snake venom assay.
Lower back pain + tired + Hypercalcemia + Plasma viscosity raised + ALP raised. Best test to assess prognosis :
Dx: multiple myeloma.
For prognosis : serum B2 microglobulin.
Plasma viscosity in Multile myeloma:
Raised , due to excess immunoglobulins.
Age group in non Hodkin’s and Hodkin’s :
Hodkin’s—55
No Hodkins—80
Lymph node involvement in Non Hodkin’s and Hodkin’s :
Hodkins: Cervical lymph node
Non Hodkins : supraclavicular lymph node
which test is positive in Non Hodkin’s :
Cold agglutinin test.
Which blood work is raised in Non Hodkin’s and not in Hodkin’s ?
LDH and white cell count is only raised in Non Hodkin’s
Blood picture in AML ?
Pancytopenia
Blood film in AML ?
Auer Rods
Bilobed nuclei.
70 year + fatigue + bleeding gums + pancytopenia + splenomegaly. Dx?
AML
Pancytopenia —feature of AML
Which level can be raised in Hodkins?
Raised ESR
Factor 5 Leiden is resistant or deficiency of protein c
resistant to protein c
Most common symptom in waldenstorm :
generalised muscle weakness, Not raynauds
Best test to diagnose methhaemoglobinaemia :
Co-oximetry—it can directly measure methhaemoglobin level.
most serious side efffects in waldenstorm is caused by :
Hyperviscocity syndrome
How to differentiate between primary and secondary polycythemia ?
Do JAK 2 mutation , as this mutation is present in 95 % of primary polycythemia.
Prophylactic Rx of VWD for an upcoming surgery :
Desmopressin and Tranexemic acid
Increase in Thrombin Time
Normal Reptilase time
Heparin in sample
Heparin in sample, Blood picture :
Increase in thrombin time
Normal Reptilase time.
Protein c activates :
Factor Va and V111a
Va—X (common pathway)
V111a—1X (Intrinsic pathway)
Most common pathogen transmitted via platelet transfusion ?
Staphylococcus
Bone marrow biopsy of myelofibrosis :
Bone marrow aspirate: dry tap
Bone marrow biopsy : Patchy reticular fibrosis with small areas of haemopoeitic cells.
Does sickle cell cause hyposplenism ?
Yes.
Sickle cell has risk of which infection ?
Encapsulated organism :
Streptococcus pneumoniae + Neisserria + Haemophilus influenza.
Which medication to give in Sickle cell as preventive ?
Give lifelong penicillin plus prophylactic antibiotics.
Recent transplantation + Fever vomitting + diarrhoea + skin rash. Dx?
Graft vs Host disease.
Graft vs Host disease.
Recent transplantation + Fever vomitting + diarrhoea + skin rash.
differentiate Graft vs Host disease and acute graft rejection
Acute graft rejection—24 hrs following transplant: ongoing pancytopenia.
Graft vs Host disease :
Recent transplantation + Fever vomitting + diarrhoea + skin rash.
18 year old + tiredness and easy bruising. Auer rods. Dx and most important test to do here ?
Acute myeloid leukemia
Most imp test to do : Clotting screen to rule out DIC
Upper GI bleed symptoms :
Melena
Haematemesis
Lower GI bleed Symptoms :
Haematochazia
Diagnosis of Upper GI bleed ?
upper GI endoscopy
Diagnosis of lower GI bleed ?
Colonoscopy
Osmotic Fragility in Hereditary spherocytosis ?
Increased osmotic fragility
screen what ? During the blood transfusion in pregnant woman ?
Screen for Cytomegalovirus
Vitamin B12 is absorbed in :
Terminal ileum
Blood picture in Myelofibrosis?
Leukoerythorblastic picture with tear drop cells
two causes of spenomegaly in Hemat :
Myelofibrosis and CML
Differentiate Polycythemia Vera and secondary polycythemia ?
Polycythemia Vera: Decreased EPO
Secondary polycythemia : Increased EPO
Majority of Non Hodkin’s Lymphoma is of which type ?
B Lymphocyte type of Non Hodkin’s
Abdominal symptoms in which lymphoma ?
Non Hodkins
Which drug causes increased risk of catching opportunistic infection ?
Purine analogue ( Fludarabine)
Pt on fludarabine ( Purine analogue ) —Now , pt has progressive SOB + low spo2 + shadow at both Hila; Dx?
Purine analogue causes increased risk of opportunistic infections such as Pneumocystis jirovecii.
Transfusion related graft vs host disease. Because patients with fludarabine are T cell depleted.
Diagnosis of waldenstorm :
Serum Protein electrophoresis
B symptoms + Massive hepatosplenomegaly + Leucoerythroblastic picture + Raised LDH
Myelofibrosis.
When to give IV immunoglobulins in ITP ?
When platelet count < 30 * 10^9
What is globulin fraction ?
Total protein - Albumin.
When globulin fraction is significant—its paraprotein
greek man : Microcytic anaemia+ Low MCV and MCH. Serum ferittin is normal. Dx?
Greek + Serum ferittin is normal, so patient is not iron deficient.
Suspect Thallasemia.
Slight spike in temperature while transfusion + normal vitals. What to do next ?
Continue transfusion and give PCM
Which Ig peak in multiple myeloma?
IgG peak.
Which Ig peak in waldenstorm ?
IgM peak.
Plus Hyperviscocity syndrome.
Several supraclavicular lymph nodes. When to perform biopsy ?
Immediately
African + Hypercalcemia + Lymphadenopathy + Skin lesions. Dx ?
Adult T cell Leukemia
Ass with HTLCV1( human T cell lymphotropic virus 1)
Advantage of irradiated red cells :
Inactivates donor lymphocytes
Felty syndrome :
Rheumatoid arthritis + splenomegaly + Neutropenia.
Rheumatoid arthritis + splenomegaly + Neutropenia.
Felty syndrome
Most frequent complications which causes death in CLL ?
Infections.
Which anaemia is seen in coeliacs ?
Macrocytic anaemia.
Peripheral Blood of thallasemia :
Nucleated red cells
Worst prognosis in AML ?
Chromosome 7
Severe aplastic anaemia Rx ?
Haematopoetic stem cell transplantation.
Microcytic hypo chromic anaemia + Increased iron in stores
Increased iron in stores—Ring Sideroblasts
Dx: Sideroblastic Anaemia.
HRT on Bone and PE ?
Increased risk of PE ( Oestrogen is Thrommbotic )
Protects bone ( Prevents osteoclast activity )
Patient with Von Willebrand disease awaiting a dental procedure. Which prophylaxis to be done ?
Give DDVAP.
Pregnant woman : drop in Hb and Increase in MCV in couple of months. Which deficiency?
Megaloblastic Anaemia—due to : Folic acid deficiency.
Increased demand of folic acid during pregnancy.
Why not b12: it takes years to become b12 deficient.
Why does recurrent infection occur in CLL ?
Due to immunoglobulin deficiency
Role of DDVAP in Haemophilia ?
Releases pre formed Von willebrand factor—which complexes with factor 8—Prolongs factor 8 survival.
ITP + Autoimmune haemolytic anaemia :
Evans Syndrome.
Evans Syndrome.
ITP + Autoimmune haemolytic anaemia
Which type of anaemia in Multiple Myeloma ?
Normocytic Normochromic Anaemia.
What is characteristically raised in Multiple Myeloma ?
Raised ESR.
Stroke + DVT symptoms. Diagnosis and Diagnostic Test:
Dx: Patent foramen ovale.
Ix : Echocardiography.
Lyric lesions in vertebrae + back pain + Raised viscosity + Normocytic normochromic Anaemia.
Multiple Myeloma.
Is bleeding a complication of Polycythemia rubra vera ?
Yes—Due to low platelets.
Most common side effect of Heparin Induced Thrombocytopenia ?
Deep vein thrombosis.
Low platelet counts, but these are hyperactive and causes paradoxical thrombosis leading to DVT
Feature of hypothyroidism related anaemia :
Macrocytic anaemia without megaloblastic change in bone marrow.
Fat embolism causes which skin manifestation ?
Multiple petechiae in axilla and armpits.
Elderly + Tiredness + Neutrophilia + anaemia+ Splenomegaly
CML
In DIC , which blood product replacement ?
If prolonged PT and aPTT and bleeding—Fresh frozen plasma.
If fibrinogen is low : cryoprecipitate.
If platelet is low : Platelet transfusion
If significant anaemia : Packed red cells
Warfarin OD blood picture :
Warfarin inhibits vitamin K dependant clotting factors.
Which leads to : Affecting extrinsic pathway:
PT—Prolonged.
INR —Prolonged
APTT— normal or slightly increased(as its intrinsic pathway)
Fibrinogen—Normal
Platelet—Normal.
Recurrent DVT + Hb and platelet are low + Hemosiderin in urine analysis. Dx:
PNH
Dx by : cytometry or Immunophenotyping
PT in APLA ?
Normal
APTT in APLA ?
Prolonged.
Post op bleed—Low Hb + very low platelet + raised INR + presence of promyelocytes.
Acute promyelocytic Leukemias leading to coagulopathy as evidenced by low platelets and raised INR.
Give Platelets infusion as the first line.
Fresh frozen plasma—Not first line.
Give if ongoing bleed even after platelet infusion.
Admitted for PE , now developed DVT. Why ?
Developed DVT due to Heparin induced thrombocytopenia.
Which antibodies are responsible for developing HIT ?
Anti PF4 antibodies.
CLL is associate with which condition ?
Autoimmune haemolytic anaemia.
AIHA—Hemolytic anaemia + Raised Bilirubin and LDH
K/C/O CLL + Anaemia + raised bilirubin
C/0 Breathlessness + fatigue + Splenomegaly.
Which test to do find the cause of anaemia ?
Do Direct Globulin test ( Coomb’s test).
CLL is associated with Autoimmune haemolytic anaemia.
AIHA—Hemolytic anaemia + Raised Bilirubin and LDH
Target for immunotherapy in lymphoma ?
CD 20
Patient on fludarabine is at what risk?
Graft vs host disease—as those patients with fludarabine lack T cells.
Opportunistic infection.
How to know if it’s secondary APLA ?
Presence of SLE ( Raised ESR)
A 25-year-old pregnant woman with a history of postpartum hemorrhage has a prolonged APTT that normalizes with 50:50 mixing and a low Factor VIII level (12%). Her bleeding time is normal.
Haemophilia A Carrier
💡 Explanation:
Low Factor VIII (12%) suggests Haemophilia A.
APTT normalizes with mixing, meaning it’s a factor deficiency (not an inhibitor)—acquired haemophilia has inhibitors—which prevents normalisation
.
Normal bleeding time rules out Von Willebrand Disease.
Carriers of Haemophilia A can have mild bleeding symptoms, such as postpartum hemorrhage.
A 22-year-old woman from the USA, with a history of splenectomy and taking 20 mg prednisolone, presents with purpuric rash, headache, and neck pain. What is the most likely indication for her prior splenectomy?
A) Beta-thalassemia trait
B) Gaucher’s disease
C) Hodgkin’s disease
D) Immune thrombocytopenic purpura
E) Sickle cell disease
D - Immune Thrombocytopenic Purpura (ITP) → Splenectomy used when steroids fail—increases risk of infection.
❌ A - Beta-thalassemia trait → No splenectomy needed.
❌ B - Gaucher’s disease → Splenectomy rare.
❌ C - Hodgkin’s disease → Not a primary indication.
❌ E - Sickle cell disease → Causes auto-splenectomy, not surgical.
DVT with score > 2: Rx:
Apixaban
A 38-year-old woman with Crohn’s disease presents with anemia. Labs show:
Hb: 83 g/L
MCV: 101 fL
Bilirubin: 39 µmol/L
Low B12 and folate levels
What is the most likely cause of her anemia?
A) NSAID-induced gastritis
B) Anemia of chronic disease
C) Pernicious anemia
D) Iron deficiency anemia
E) Terminal ileal disease
E) Terminal ileal disease – Crohn’s affects the terminal ileum, causing B12 malabsorption.
❌ A) NSAID-induced gastritis – Can cause blood loss but does not explain low B12/folate.
❌ B) Anemia of chronic disease – Would not cause low B12/folate.
❌ C) Pernicious anemia – Due to intrinsic factor loss, not Crohn’s.
❌ D) Iron deficiency anemia – Typically microcytic, not macrocytic.
An 80-year-old woman with chronic lymphocytic leukemia (CLL) ( STABLE since many years, no medication) presents with increasing fatigue. She is clinically anemic and mildly jaundiced, with a 2 cm splenomegaly. Blood tests show:
Hb: 63 g/L
MCV: 106 fL
Reticulocytes: 205 × 10⁹/L
WCC: 85 × 10⁹/L (lymphocytes 65.5 × 10⁹/L)
Platelets: 110 × 10⁹/L
What is the most likely cause of her anemia?
✅ Autoimmune Hemolytic Anemia (AIHA)
Macrocytic anemia (MCV 106 fL) with raised reticulocytes suggests active red cell destruction or blood loss.
Mild jaundice indicates hemolysis.
CLL is associated with AIHA, as well as autoimmune thrombocytopenia.
Reticulocytosis confirms appropriate bone marrow response.
CLL progression – No worsening lymphadenopathy or cytopenias.
❌ C. Iron deficiency – No microcytosis, no GI bleed history.
❌ D. Richter’s transformation – No B symptoms, no high-grade lymphoma signs.
❌ E. Acute folate deficiency – Folate deficiency doesn’t cause reticulocytosis.
Which type of anaemia in warm autoantibody Hemolytic anaemia ?
Macrocytic anaemia
A 28-year-old woman with von Willebrand’s disease (type 1) needs a tooth extraction. She has a history of menorrhagia and prolonged bleeding after a previous dental procedure.
How should her bleeding risk be managed?
Give desmopressin (DDAVP) a short time before the procedure
A 17-year-old girl from Nigeria recently immigrated to England and was referred for anemia. Examination reveals frontal bossing of the skull and chronic leg ulcers. Her Hb is 70 g/L and Howell–Jolly bodies are seen on the blood film.
What is the most likely diagnosis?
: Sickle Cell Disease
Common in African populations due to high prevalence of HbS mutation.
Frontal bossing occurs due to erythroid hyperplasia from chronic hemolysis.
Howell–Jolly bodies indicate functional asplenia/autosplenectomy, common in sickle cell disease due to repeated splenic infarctions.
Chronic leg ulcers result from poor microvascular circulation and ischemia.
Which blood thinner is safe in pregnancy ?
Low molecular weight heparin
Why anaemia in kidney disease ?
Less production of erythropoietin
Role of all transretinoic acid in APML :
differentiation of APML cells into Mature granulocyte and apoptosis of these cells.
: Why should NSAIDs be approved by a hematologist before use in a patient with von Willebrand’s disease (vWD)?
NSAIDs impair platelet function by inhibiting thromboxane A2, worsening the bleeding tendency in vWD.
vWD already causes defective platelet adhesion, so NSAIDs can further increase bleeding risk.
Alternative pain management (e.g., paracetamol, opioids) should be considered.
Hematologist approval is required before prescribing NSAIDs in vWD patients.
Known APLA + 2 DVT attacks. What treatment ?
Lifelong warfarin
A 63-year-old woman presents with biventricular failure, bilateral retinal hemorrhages (eye bleed), and macrocytic anemia (Hb: 55 g/L, MCV: 118 fL). What is the most appropriate next step in management?
Options:
A) Blood transfusion
B) Bone marrow aspirate examination
C) Intramuscular B12 administration
D) Intramuscular B12 with oral folate supplements
E) Observation
A) Blood transfusion (✅ Correct) → Needed for severe symptomatic anemia (Hb 55 g/L), especially with heart failure & retinal hemorrhages.
B) Bone marrow aspirate (❌ Incorrect) → Only considered if blood tests don’t reveal a cause; unnecessary at this stage.
C) Intramuscular B12 (❌ Incorrect) → B12 should only be started after confirming deficiency; urgent transfusion takes priority.
D) IM B12 + Folate (❌ Incorrect) → Same reason as C; hematinic deficiency needs confirmation first.
E) Observation (❌ Incorrect) → Not appropriate in a critically symptomatic patient with severe anemia.
A 38-year-old man presents with worsening tiredness, night sweats, cough, and pruritus. His full blood count shows eosinophilia of 1800/µL (40–400 per µL). Six months ago, his eosinophil count was 1500/µL. He has no known allergies, and multiple stool samples showed no evidence of parasites. What is the most appropriate treatment?
Options:
A) Ampicillin
B) Corticosteroids
C) Cyclophosphamide
D) Interferon-alpha
E) Methotrexate
Corticosteroids
The patient has persistent eosinophilia without a clear reactive cause (e.g., infection, allergy, or parasite).
He may have idiopathic hypereosinophilic syndrome, which requires immunosuppression with corticosteroids as first-line treatment.
A) Ampicillin: No evidence of infection.
C) Cyclophosphamide: Not first-line; steroids are preferred.
D) Interferon-alpha: Not a treatment for hypereosinophilic syndrome.
E) Methotrexate: Not relevant for eosinophilic syndromes.
Most likely test to detect invasive aspergillus :
Galactomanan test.
2 weeks postpartum — a painful, swollen left leg.
O/E — pale, cold, swollen to mid-thigh + no pulses below femoral artery + ↓ power below knee + ↓ fine touch sensation.
Bloods — ↑ lactate, ↓ bicarbonate.
Most likely diagnosis?
A) Arterial embolism
B) Left leg DVT
C) Pathological fracture of the left femur
D) Post-partum lymphoedema
E) Ruptured popliteal cyst
✅ A) Arterial embolism – The leg is pale, pulseless, painful, and has neurological deficits. Raised lactate suggests ischemia.
Rule Outs:
❌ B) Left leg DVT – Would not explain pulselessness or significant motor/sensory loss.
❌ C) Pathological fracture of the left femur – No history of trauma or malignancy, and does not explain absent pulses.
❌ D) Post-partum lymphoedema – Would cause swelling but not pulselessness or ischemia.
❌ E) Ruptured popliteal cyst – Causes swelling but does not explain lack of pulses or systemic acidosis.
19M, thalassaemia major—multiple transfusions. SOB, ↓ exercise tolerance, bilateral oedema. BP 105/80, HR 85. JVP↑, pitting oedema. Pericardial rub O/E. Ferritin 562 µg/L (N: 20–250).
Dx: pericarditis secondary to iron overload.
Rx: Chelation using desferrioxamine.
A 22-year-old woman presents with menorrhagia. Her mother and sister have similar issues, and her brother had prolonged bleeding after a tooth extraction. Her PTT is prolonged (42.3s), while PT and platelet count are normal. What is the most likely diagnosis?
VWD
Sometime PT is normal in VWD.
Haemophilia—only male suffer. Woman are carrier.
Rx for factor v leiden :
Oral anticoagulant.
WBC and platelets in Secondary polycythemia :
WBC and Platelets: Normal.
Only Hb increases.
EPO only stimulates Hb, not wbc and platelets.
Iron deficiency anaemia + Howell jolly bodies. Which diagnostic test?
IDA + Hyposplenism—think Coeliacs.
Diagnostic test: Anti TTG antibody.
Cause of TRALI :
Donor antibodies.
Splenomegaly + lymphocytosis/pancytopenia + larger than normal lymphocytes + Abdundant pale cytoplasm + hairy cell like projections
Hairy Cell Leukemia.
Describe Hairy cell in Hairy cell leukemia :
Larger than normal lymphocytes + Abundant cytoplasm + Hairy vell like projections.
X ray findings of multiple myeloma :
Multiple lytic lesions on X ray.
An 18-year-old woman presents with severe menorrhagia, microcytic anemia, and reactive thrombocytosis. No structural or hormonal cause is found. Her prothrombin time (PT) is normal. What is the most likely underlying disorder, and which investigation will confirm the diagnosis?
VWB Disease.
Ix for Dx: VW factor.
Rule Out Other Options:
Factor VIII:C level: Not the most reliable; hemophilia primarily affects males.
Bone marrow aspirate: Too invasive and unnecessary for diagnosing a coagulation disorder.
Serum ferritin: Only confirms iron deficiency, not the underlying bleeding disorder.
Activated partial thromboplastin time (APTT): Can be normal or elevated but is not diagnostic.
A 25-year-old, 33-week pregnant woman presents with hypertension, proteinuria, epigastric pain, bruising, and petechiae. BP: 145/90 mmHg, pulse: 85 bpm.
Abnormal Investigations:
Hb: 101 g/L (Low)
Platelets: 40 × 10⁹/L (Low)
ALT: 180 IU/L (High)
LDH: 780 IU/L (High)
Initial Management?
A) FFP transfusion
B) Liver ultrasound
C) Platelet transfusion
D) Red cell transfusion
E) Immediate caesarean
Likely HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) with severe thrombocytopenia, requiring platelet transfusion before urgent C-section.
FFP (A): For coagulopathy, not needed here.
Liver ultrasound (B): Delays treatment.
Red cell transfusion (D): Not needed (mild anemia).
Immediate caesarean (E): Needs platelet support first.
RET protoncogene cause which thyroid cancer ?
Medullary thyroid cancer
Rx of Hodkins stage 2a :
Chemotherapy followed by radiotherapy
Mycosis fungoides is :
T cell lymphoma.
Biopsy : Atypical CD4 + T cells infiltrating epidermis.
Target INR for APLA :
INR 2-3 lifelong
Haemophilia A and B Rx
Mild haemophilia A Rx: DDVAP.
Haemophilia B Rx: IV factor 9 concentrate.
H/o renal transplant + fever of unknown origin + Epstein Barr virus antibody positive + enlarged axillary lymph nodes+ Raised ESR + Anaemia:
Post transplant lymphoma
CMV occurs within few months.
It presents with fever and pneumonia and graft rejection.
Girl undergoes thrombophilia screen within one week Of stopping warfarin. Next step ?
Undergo thrombophilia screen 3 weeks later.
which thrombotic disease is associated with Nephrotic ?
Protein S deficiency
Non-Hodkin’s is associated with which chronic disease ?
HIV
which factor improves neutrophil count ?
G CSF( granulocyte - colony stimulating Factor)
Most common cause of aplastic crisis in G6PD ?
Parvo virus infection
Which heparin has higher incidence of HIT ?
Unfractionated heparin.
G6PD causes hemolysis due to :
Reduced levels of NADPH
