Past paper corrections hematology Flashcards
Child with anaemia, blood film shows spherocytes and DAT+(?)
autoimmune hemolytic anemia
Child with anaemia, blood film shows spherocytes and DAT+(?) What is the cause?
autoimmune hemolytic anemia
Woman has had 2 children, her blood type is A-. Which naturally occurring IgM antibody would be present? (Repeat)
Patient presenting with monocular blindness with extremely high neutrophils (140s) , basophils - what is the diagnosis?
Chronic myeloid leukemia!!
key signs:
-> spleenomegaly!!!
-> vision loss!!!
-> gouty arthritis!!!
What coagulation factor falls most rapidly after starting warfarin?
factor 7
Infants with sickle cell disease (HbSS) may have splenic sequestration. Why does this not occur before 3 months of age?
HbF
Venetoclax is a BCL2 inhibitor used in CLL. What cellular process does it affect?
apoptosis
75 year old woman has neutropenic sepsis secondary to myelodysplasia. Her blood count is lower than it was 6 weeks ago, with marked panyctopaenia.
Blood film shows numerous large cells of primitive appearance. What is the likely explanation?
Progression to AML
M in AML = myelodyplasia
What is the diagnosis, results showed increased IgG lambda but normal kappa lambda ratio, <30g/L -
MGUS!!! (As criteria is)
1.. <10% plasma cells
2. Monoclonal protein spike <30 g/L -> this is IMMUNOGLOBULINS/IgG
- no CRAB symptoms or organ damage
* No evidence of other B-cell proliferative disorder
Person with aortic stenosis. Has some blood transfusions for some reason, on the second unit of blood immediately develops SOB, 85% O2 Sats, JVP elevated by 3cm.
Transfusion related circulatory overload = symptoms of pulmonary edema/fluid overload. Signs of HF = Increased JVP. increased PCWP
What is raised when a cell undergoes haemolysis?-
potassium
Man with positive HTLV1 and other bloods and flower cells, what type of cancer? -
Adult T cell lymphoma
What drug would be given to a patient with CLL with p53 deletion?
ibrutinib
Patient with multiple myeloma, and lights chains >1000. Most likely kidney manifestation?
AL amyloidosis
What is the most common site for a thrombotic event?,
deep leg veins
Bleeding patient has prolonged APTT and PT, but normal platelet count and normal fibrinogen. What is the most suitable blood component for treatment?.
Fresh frozen plasma as anticoagulant reversal is needed. (cryoprecipitate is only used if fibrinogen is low.). Platelets if abnormal platelet count
At what temperature can platelet transfusions be stored?
22 Degrees celsius. Rbcs at 4 degrees.
Lady with macrocytic anemia. Became vegetarian 2 years ago. Most likely cause of patients symptoms?
alcohol
40 year old with confusion, and difficulty speaking. Had a fever and a headache and bleeding from the gums for 10 days. On examination, kidney function had deteriorated, had become oliguric. Blood film shows thrombocytopenia and shistyocytes, what is the most likely diagnosis?
TTP = triad (thrombocytopenia, MAHA, kidney injury) + fever + neurological symptoms
Contrast to HUS = triad + bloody diarrhea
Chronic myeloid leukemia
presentation?
mutation?
high WCC with neutrophila!! And basophilia!!
T(9,22). Philadelphia CreaML cheese.
Chronic lymphocytic leukemia
which mutation makes worse?
TP53
markers of myeloid cells seen in AML?
CD33, CD13, CD117 = myeloid cells.
mpo+ve
Beta thalassemia in a pregnant woman. Most important test to investigate if the future health of fetus is at risk?
chorionic villious sampling
21 year old with beta Thalessemia has been receiving blood transfusion for 6 years. No presents with congestive cardiac failure and gonadal failure. Most likely explanation?
iron overload
23 year old. Bilateral cervical lymphadenopathy, night sweats and pain on drinking alcohol -
hodkins lymphoma
Something about gamma globin chains?
learn hemophilias
A patient who is known to have chronic lymphocytic leukaemia presents with sudden worsening of fatigue and is found to have had a fall in Hb. His FBC results are reported below. His blood film shows lymphocytosis, smear cells, spherocytes and polychromatic macrocytes. Which is the most likely cause of
AIHA - CLL
In optimal circumstances, for a 70kg male, transfusion of 1unit RBC and 1 unit of platelet gives a predictable increment in the Hb and platelet count. Which statement is correct?
Expected increment, Haemaglobin 10 g/L and Platelets 35 x 10^9/L.
A 41 year old woman who is 20 weeks pregnant attends a routine antenatal appointment. She has a past medical hx of venous thromboembolic disease in a previous pregnancy. BMI 31. Mx?
low molecular weight heparin
Children with Down syndrome have an increased incidence of which type of blood cancer?
Acute leukaemia. Especially AML
A 55 year old man is being discharged from hospital on long term anticoagulation with Rivaroxaban a direct acting anticoagulant. Which is the correct approach for routine monitoring of his anticoagulation?
monitoring not required
Woman has chest pain, SOB, persistent swelling in neck. Large mass in supraclavicular fossa is biopsied - malignant cells with reactive fibrosis and high eosinophils [exact pictures below were included in question - bilobed nuclei ]. What is the likely diagnosis? -
hodgkin’s lymphoma! (dyspnoea and chest pain = mediastinal involvement)
Person had an unprovoked DVT, treated with LMWH for 6 months. What long-term DVT prophylaxis should they take? Aspirin, warfarin, DOAC, none needed
LMWH
used for DVT prophylaxis also
A 30 year old woman with known ITP gives birth to a healthy full term baby. Which is the correct haematological management of the newborn baby?
Check daily FBC for a minimum of five days.
if platelets less than 20, give IVIG to baby and gove intracranial ultrasound
note: early onset thrombocytopenia eg 1st trimester of pregnancy -> high likely hood of ITP
management = IV immunoglobulins, steroids eg azathioprine to increase platelet count
what is the leading cause of maternal mortality in the UK
venous thromboembolism
give one symptom that will make you add the suffix “B” to hodgkins disease
fever!
night sweats!
Man has fatigue and back pain. Blood results show - high creatinine, low IgG, low IgM, no paraprotein detected (via electrophoresis) , low serum kappa light chains, high lambda light chains, low kappa/lambda ratio. What is the likely diagnosis?.
Multiple myeloma!!
regardless of meeting the other criteria, patient has CRAB symptoms and therefore automatically has MM!!!
what is the usual prophylaxis for allograft rejection?
Basaliximab (anti-CD25)
alemtuzumab Anti CD52
anti thymocyte globulin
The wall of vessels expresses anti-thrombotic factors why is this?
Because it secrete Thrombomodulin - anticoagulant
which blood count finding is characteristic of acute lymphoblastic anaemia (ALL)
neutropenia
Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause?
post thrombotic syndrome
A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?
myelofibrosis
An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?
– Glucose-6-phosphate dehydrogenase deficiency
A man has multiple myeloma, and get amyloidosis. Which type of amyloidosis would it be?
amyloid light chain amyloidosis
Woman hurt her back lifting something in the garden. Pain persisted for a week. Some blood abnormalities (low Hb, high Ca, high urea/creatinine? …)
What is the best test?
serum protein electrophoresis
Transfusion level for platelets after trauma?
10 bn/litre (10 x 10^9 /L)
higher threshold of 20 in sepsis
For rbcs = 70g/L if asymptomatic, 80g/L if symptomatic
