Passmed - Haem

Question 1

Blood film + clinical signs/sx in

G6PD

Pyruvate kinase deficiency

Hereditary spherocytosis

Pyrimidine 5’ nuclotidase

Answer 1

G6PD
Bite cells
Blister cells 
triangle fragments 
keratocytes

Jaundice
Dark urine (indicated haemoglobinuria) 
Anaemia is typical of G6PD deficiency

Pyruvate kinase deficiency
causes mainly extravascular haemolysis thus would not cause dark urine (haemoglobinuria).
The blood film would reveal echinocytes

Hereditary spherocytosis would not cause dark urine and would exhibit spherocytes on the blood film.

Pyrimidine 5’ nucleotidase deficiency is a rare autosomal dominant enzyme disorder leading to basophilic stippling on the blood film.

Question 2

Bloodfilm in

Hyposplenism

Iron-deficiency anaemia

Myelofibrosis

Intravascular haemolysis

Megaloblastic anaemia

Answer 2

Hyposplenism e.g. post-splenectomy, coeliac disease (occurs in around 30% of coeliac patients)
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

Iron-deficiency anaemia
target cells
‘pencil’ poikilocytes
if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

Myelofibrosis
‘tear-drop’ poikilocytes

Intravascular haemolysis
schistocytes

Megaloblastic anaemia
hypersegmented neutrophils

Question 3

Mild cellulitis mx

Severe cellulitis mx

Answer 3

Mild
PO fluclox

Severe
Cellulitis Mx = Co-amox / Cefuroxime / Clindamycin / Ceftriaxone

Question 4

Hereditary spherocytosis vs

G6PD

Answer 4

Hereditary spherocytosis = extra-vascular haemolysis (causes Splenomegaly)
G6PD = intra-vascular haemolysis (normal spleen, but low Haptoglobin)

+
HS = autosomal dominant (affects any gender, every generation)
G6PD = x-linked recessive (males are more affected, but transmission from mother)

Question 5

What will you see on an FBC if a patient is on steroids

Answer 5

neutrophilia

Question 6

ITP mx in adults

Answer 6

Prednisolone PO

Question 7

How to decide what kind of leukaemia it is

Answer 7

Step given by my lecturer (simple yet helpful)

1. Look at lymphocytes
2. Look at WBC
3. Others hint (blast cell/ bands)

Example

1. Low Lymphocytes -> the answer should be AML or CML
2. WBC > 100 -> Chronic causes so Consider CML (rule out AML)
3. Presence of bands cell -> confirm CML

• blast -> Acute
• bands -> Chronic

Question 8

What is the major constituent of cryoprecipitate

Answer 8

FVIII

CryoprecpitEIGHT

Question 9

Medications that can cause bone marrow failure

Answer 9

Chem
Abx (chloramphenicol) - causes aplastic anaemia
Thiazide
Carbimazole 
Clozapine