Medicine - Haematology

Question 1

What tests should you order when querying IDA in a sick vs healthy patient?

Answer 1

No illness: Ferritin

Illness: TIBC, TF, iron

Why? Ferritin is an acute phase protein

Question 2

What markers will be raised in iron deficiency anaemia?

Answer 2

LDH, haptoglobins, uBR

Question 3

Differentiate the class of immunoglobulin associated with warm vs cold AIHA?

Answer 3

Warm: IgG

Cold: IgM

Question 4

How is warm AIHA managed?

Answer 4

Steroids, splenectomy

Question 5

Recall some causes of warm AIHA

Answer 5

Lymphoma
CLL
Drug allergy
SLE

Question 6

Recall some causes of cold AIHA

Answer 6

Myclopasma pneumoniae
EBV
CMV

Question 7

What abnormality would be seen on blood film in warm AIHA?

Answer 7

Spherocytes

Question 8

What test is used to identify paroxysmal nocturnal haemoglobinuria?

Answer 8

Ham’s test

Question 9

If warm AIHA and hereditory spherocytosis both have spherocytes, what test can be used to differentiate them?

Answer 9

Coomb’s/DAT test
Positive in AIHA
Neg in HS

Question 10

Recall 3 possible causes of MAHA

Answer 10

HUS
TTP
Adenocarcinoma

Question 11

Recall 3 electrolyte abnormalities seen in tumour lysis syndrome

Answer 11

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

Question 12

How should tumour lysis syndrome be managed?

Answer 12

Allopurinol
IV if high risk
PO if low risk

Question 13

What Hb level indicates packed RBC transfusion?

Answer 13

No ACS: <70g/L

ACS: <80g/L

Question 14

Recall 4 contraindications for platelet transfusion

Answer 14

Chronic BM failure
Heparin-induced thrombocytopaenia
ITP
TTP

Question 15

Which inherited thrombophilia increases the relative risk of DVT the most?

Answer 15

Antithrombin III deficiency

Question 16

What is the prevalence of Factor V Leiden?

Answer 16

5%

Question 17

What is the most common inherited bleeding disorder?

Answer 17

Von Willebrand

Question 18

What is the aetiology (broadly) of heparin-induced thrombocytopaenia?

Answer 18

Antibodies form against heparin and platelet factor 4 –> platelet activation via various mechanisms –> PROTHROMBOTIC state (even though it’s a thrombocytopaenia)

Question 19

Which blood group antigens are most likely to cause a delayed transfusion reaction?

Answer 19

Duffy

Kidd

Question 20

What % of the population are Rh pos?

Answer 20

85%

Question 21

What sort of transfusion reaction does Rhesus incompatability cause?

Answer 21

Delayed haemolytic

Question 22

Recall the storage conditions for RBCs, platelets and FFP

Answer 22

RBCs: 4C for 35 days
Platelets: 22C for 7 days
FFP: frozen

Question 23

How long does FFP need to thaw?

Answer 23

20-30 mins

Question 24

How long can RBCs be out of the fridge?

Answer 24

4 hours

Question 25

Most of the heritable haem disease information

Answer 25

is in the path decks

Question 26

Recall the parameters of each class of blood loss (depending on % volume lost)

Answer 26

Type 1: 0-15% lost, HR <100, BP normal, cap refill normal

Type 2: 15-30% lost, tachycardic, BP normal, cap refil >2s

Type 3: 30-40% lost, + tachycardic, BP reduced, cap refil >2s

Type 4: >40% lost, ++ tachycardic, BP reduced, cap refil undetectable, anuric

Question 27

What investigation is required to confirm the diagnosis of ITP?

Answer 27

Blood film

Question 28

What is the risk of replacing folate without B12 in a patient who is both B12 and folate deficient?

Answer 28

Subacute combined degeneration of the cord

Question 29

What are the 4 key electrolyte derangements in tumour lysis syndrome?

Answer 29

Hyperkalaemia, hyperuricaemia, hyperuricaemia

Hypocalcaemia

Question 30

How should tumour lysis syndrome be managed?

Answer 30

Rasburicase (allopurinol = prophylaxis)