Interactive Cases (Haematology)

Question 1

What do symptoms of anaemia depend on (3)

Answer 1

Age
Severity of anaemia
Speen of onset of anaemia

Question 2

What are some symptoms of anaemia (5)

Answer 2

Weakness/fatigue 
Shortness of breath 
Lethargy 
Palpitations 
Cardiac failure (SOBOE, orthopnoea, PND, swollen ankles)

Question 3

What are the general signs of anaemia (3)

Answer 3

Pale mucous membranes
Tachycardia
Cardiomegaly/CCF

Question 4

What are some specific signs of anaemia (3)

Answer 4

Koilonychia (spoon nails) = iron deficiency

Glossitis (inflamed tongue) = B12 defiency

Jaundice = haemolysis

Question 5

What are some causes of low MCV (3)

Answer 5

Iron deficiency
Thalassaemia
Anaemia of chronic disease (low or normal)

Question 6

What are some useful investigations in a patient with anaemia (5)

Answer 6

FBC (including WCC, Hb, MCV)
Reticulocyte count 
Haemolgobin electrophoresis 
Iron studies e.g. ferritin, transferrin saturation
Blood film

Question 7

What is a normal physiological response to anaemia

Answer 7

Reticulocytosis

Question 8

What are some causes of reticulocytosis (3)

Answer 8

Haemolysis
Haemorrhage
Haematinics

Question 9

When is anaemia present WITHOUT reticulocytosis (3)

Answer 9

Inadequate haematinics
Bone marrow failure (e.g. infiltration)
Acute major haemorrhage… reticulocyte response within 6 mouths which increases over 6-10 days.

Question 10

What will be seen on the blood film in iron deficiency (4)

Answer 10

Pencil cells
Anisocytosis
Poililocytosis
Hypochromic

Question 11

What are some sources of blood loss in iron deficiency anaemia (2)

Answer 11

Uterine - menstruation/ pregnancies

GI

Question 12

What can cause pancytopenia (e.g. low Hb, low WBC, low platelets) (5)

Answer 12

Aplastic anaemia 
Leukaemia 
Infiltration (e.g. lymphoma, carcinoma) 
Drugs (e.g. chemotherapy) 
B12/folate deficiency

Question 13

What are some useful investigations in pancytopenia (4)

Answer 13

Blood film
Vitamin B12 levels
Folic acid levels
Bone marrow

Question 14

What are the principles of management in AML (2)

Answer 14

Supportive

Disease Related management

Question 15

What are the principles of supportive care in AML (3)

Answer 15

Red cell transfusions
Platelet transfusions
Nurse in isolation - prompt antibiotics

Question 16

What will cause anaemia and thrombocytopenia (2)

Answer 16

Not making platelets

Premature destruction of platelets

Question 17

What are some causes of not making platelets (2)

Answer 17

Drugs (chemotherapy, thiazides)

Bone marrow disorders (leukaemia, aplastic, myelodysplasia, myeloma, infiltration with carcinoma)

Question 18

What are some causes of premature destruction of platelets (3)

Answer 18

ITP (auto-immune)
Disseminated intravascular coagulation
Heparin

Question 19

What are some investigations for thrombocytopenia (5)

Answer 19

Coagulation screen 
Blood film 
Bone marrow aspirate/trephine 
ANA/RAPA
HIV

Question 20

What will cause a low platelet and abnormal clotting (4)

Answer 20

DIC
Alcohol
Drugs
Leukaemia

Question 21

What investigations could you do with low platelets and abnormal clotting (5)

Answer 21

Blood film
D-dimer/FDPs
Fibrinogen 
Blood cultures/CSR/MSU (septic screen) 
LFTs

Question 22

What is the management for DIC (4)

Answer 22

Liase with the haematology team and the haem lab
Antibiotics
Blood products….Red cells, platelets, cryoprecipitate, FFP
Regular blood tests to assess response to products