Heme

Question 1

TTP Pentad

Answer 1

Fever low plts renal failure MAHA, altered LOC (CNS abnormalities!!)

ADAMTS 13 <10%
Unexplained thrombocytopenia and MAHA

Comb neg

Question 2

Vancomycin can induce low plts

Answer 2

Yes

Question 3

Autoimmune hemolytic anemia

Which test and which treatment

Answer 3

DAT positive

Steroid

Question 4

Iron def Anemia and relationship with plts

Answer 4

Can lead to elevated plts

Question 5

Trousseau syndrome

Answer 5

Cancer related hyper coag state

Superficial thrombophlebitis and arterial thromboembolism

Triggered by tissue factor released from cancer

Question 6

Heparin induced thrombocytopenia and DVT what to do

Answer 6

Stop heparin start direct thrombin inhibitor
Eg angiomax (bivalirudin) Renal clearance
Eg argatroban liver clearance not available in Canada?

Question 7

Microcytic anemia with normal Red cell width distribution normal iron store(ferritin)

Answer 7

Thalassemia

Iron def have uneven cell width distribution

Question 8

HIT presentation

Answer 8

No MAHA
Days to weeks after heparin exposure
Low plts multiple organ dysfunction

Question 9

Coombs

Answer 9

Positive means immune process

Negative and hemolytic think mechanical

Question 10

Meds that induce thrombotic microangiopathy

Answer 10

Chemo
Quinine
Cyclosporine and tacrolimus

Question 11

Coombs neg hemolytic anemia

Answer 11

TTP

Paroxysmal Nocturnal hemoglobinuria

Question 12

Syndrome name for

Autoimmune hemolytic anemia and immune thrombocytopenia

Answer 12

Evans syndrome

Coombs positive

Question 13

Lack cell surface protein that inhibits complement attack therefore causing intravascular hemolysis and abdo pain hemoglobinuria
Dxy by flowcytometry no MAHA

Answer 13

PNH

Question 14

ADAMS13 too little can’t break down Von willerband causing MAHA
Insidious onset mostly

Answer 14

TTP

Question 15

CML vs leukaemia

Answer 15

CML - elevation of all myeloid line including basophils eosinophil, chronic phase if myeloblast is less than 10% and acute phase if >20%

Question 16

Neutropenia in HIV patient with some acute infection common cause ?

Answer 16

Drug related.
Ganacyclovir can lead to neutropenia!
CMV can cause neutropenia but if pt improving / treated with antiviral and still neutropenia then think drug!

Question 17

Erythromeyalgia pruritis after shower elevated Hb and LOW ERYTHOPOEITIN

Answer 17

PV

Note RCC and monoxide expo can raise erythropoietin level leading to secondary elevation of HB

Question 18

Leukoerythroblastosis with uncleated erythrocytes and tear drop (dacryo) cells occasional blasts. hepatisplenomegaley

Dx and Inx

Answer 18

Myeolfibrosis and BM Bx

Jak2 nut 50-60%

CML is DDx but usually not thrombocytopenia dacryocytes and nucleated erythrocytes- test with bcr-abl

Question 19

Myelofibrosis secondary causes

Answer 19

Bone marrow infiltration of other tumours , granulomas, autoimmune conditions

Question 20

Most common risk factor for budd chiari

Answer 20

Myeloproliferative neoplasm of which polycythemia Vera is the most common