MCQ haem/ immuneology/ allergy Flashcards
risk of replacing folate before b12?
subacute combined degeneration
most common inherited bleeding disorer?
VWD: deficiency of abnormal function of VWF (responsible for platelet plug forming and factor 8)
nose bleeds, menhorragia, raised APTT, blood group O woman. tx?
VWD. test family.
Ix: VWF antigen assay detects quantitative deficiency. there is also qualitative
TX: desmopressin (temporarily increases factor 8/ vwf)(intranasal/ parerntal), TXa
drugs that cause low platelets?
CARDS Not Very High Quality
Carbemazepine
Abciximab
Rifampicin
Diuretics (furosemide)
Ssulphonamides
NSAIDs
Heparin
Quinine
Standard for detecting malaria?
fever pattern?
most serious cx?
thick and thin blood films, gram stain.
diurnal variation of fever
serious/ splenic rupture: P. falciparum
APTT measured?
intrinsic pathway - factors 12, 11, 9, 8,, 5, 2, 1, VWF. and the common pathway (factor 10 to 2 to fibrinogen to fibrin)
PT measures?
extrinsic pathway and common pathway, 1, 2, 5 ,7 10 and warfarin.
how do coagulation factor defects normally present?
large bruises, small bleed from cut, haematuria, bleeding after a day of truama/ surgery/ dental extraction, haemoarthrosis (in severe cases of haemophilia)
How are platelet/ vWF deficiencies liekly to present?
small bruises, lot sof bleeding form cuts, immediately bleeding post surgery/ dental work, nosebleeds and gI bleeds common
post transfusion: fever, chills, burnign at site of transfusion, red urine, pain, restless, chest tightness. cx?
acute haemolytic reaciton (ABO incompatibility/ direct antibodies in recipients blood)
post transfusion: 2 hrs after/ SOB, fever, chills, malaise
non haemolytic (due to cytokine production from leukocytes. delayed reaction could be days/ weeks later.
post transfusion: high fever, shock, no clear cx for infection?
bacterial contamination
TRALI is?
antibodies in donor’s blood attacking recipient, recipient releases mediators that cause pulmonary oedema
G6PD?
x linked causes haemolyitc crisis after exposure to fava beans, quinine, sulfa drugs, infections, heinz bodies, normocytic normochromic anaemia
pruritus, ehadache, sweating, ruddy complexion, splenomegaly, turning red in hot bath. HTN
dx criteria?
myeloproliferative neoplasm: Polycythaemia vera AF: dysfunction of JAK 1 and 2,
Dx: 2 major+1 minor or 2 minor and 1st major
major: HB 185+men/165+women / JAK2/ haematocrit 0.6+men/ 0.56 women
minor: EPO <normal, bone marrow changes
risk: vTE/ tx: control cardio rf
Down’s syndrom associated conditions?
hypothyroid, AD, duodenal atresia, t1dm, hirschprungs, acute leukaemia, LD, endocardial cusion defects, seizures
apparent polycythaemia?
increased haemtrocrit, normal red cell mass caused by reduced plasma volume. obese men, stress, diuretics, smoking, HTN, alchjol dehydration
secondary PCV?
caused by EPO production due to chronic hypoxia eg copd, CLD. renal disorders - inappropraite EPO, sleep apnoea, obesity,
microcytic cx?
TAILS (thallassaemia, anaemia of chronic disease, iron (ferritin <15, lead, sideroblastic).
thalassaemia - common in ethnic, MCV more reduced
Riskiest blood product?
platelets (@stored at room temp)
cough, sob, hypoxia, pulmonary infiltrates new on CXR.
B/G: anaemia, jaundice, vaso-occlusive crisis?
sickle cell crisis
cryoprecipitate contains?
factor 8, 13, vwf, fibrinogen,
VTE in cancer patients tx?
6 monts
coag disorder older women?
young boy?
VWF
Haemophilia A (x linked)
LN pain after drinking alcohol?
Hodgkins L
Hodgkins Lymphoma?
Reed sternberg cells
RF: EBV, SLE, RA,
ann arbour staging
bimodal age distribution
23 YO bowel obstruction, interssuseption, haematochezia, pigmented lesions on buccal mucosa with FH, GI polyps
peutz-jegher’s
Multiple myeloma fact file?
avoid prescribing?
ix?
plasma cells, 2nd most common (after NHL). AF: black men, maori, fH,
SX: unexplained back pain
risks: hyperviscosity, fractures, spinal comrpession, renal, infections, anaemia, bleeding
risk renal: avoid nsaids/ aminioglycosides
Ix: ESR high, Ca high, normochromic normocytic anaemia, serum electrophoresis, light chain, bence jones
MGUS dx?
Monocloncal protein <30 blood or <500 in urine (24 hrs), <10% plasma cells in bone marrow and no end organ damage
Waldenstorm’s macroglobulinaemia presentation?
diffuse large B cell lymphoma. old white men fatigue, anorexia, finding of monoclonal IGM or rapid growing large mass. bone lesions not a feature of this but can present like MM (hyperviscosity etc)
Non hodgkins Lymphoma?
burkitt’s - EBV/ HIV
Waldenstorms - large b cell, rapid mass old men
MALT - stomach , h.pylori
CML fact file?
what happens when known CML is acutely unwell with blast cells (progeniter cell) increased?
myeloprliferative disorder - granulocyte. philadelphia chromosome. 3 phases - chronic (normal), accelerated (unstable), blast stage (progenitor cells 20%+) is fatal.
tx: bone marrow transplant/ imatinab
sx: finding of raised WCC, tired WL, splenomegaly
Why are irridated products used in NHL?
irritated products are T cell deplete, reduces the risk of graft versus host disease
post transfusion, within 2 mins has abdo pain, fever, hypotension?
acute haemoyltic reacton confirm with coombs
purpura, platelets <80, nose bleed post URTI 5 weeks 2nd line?
ITP - give PO C/S, 2nd line - pooled human IVG
recurrent csx of priaprism?
DX?
HB?
sickle cell disease - dx nby hb electrophoresis
HBSS - homozygous, HBAS - sickle cell trait
prophylaxis for TLS? U+Es in tLS?
allopurinol
High potassium, high phosphate, and low calcium
tx for patients with B thalassemia major since childhood?
how do they present?
regular blood transfusions with desferrioxime
presents in the first year of life with failure to thrive and hepatosplenomegaly
microcytic anaemia
HbA2 & HbF raised
HbA absent
fatigue, raised HBA2, microcytic anaemia with very low MVC?
thalassemia trait
HL poor prognisis indicators?
Key points?
weight loss > 10% in last 6 months
fever > 38ºC
night sweats
HL: reed sternberg cells, pain after drinking alcohol
