Past Papers Haem Flashcards
blood transfusion, rash several hours later
Allergic reaction
Delayed HTR if Days later
RTA, 6 units blood
SOB, fever, tachycardia
TRALI
B thalassaemia, regular transfusions
Malaise and erectile dysfunction
Transfusion associated haemosiderosis
AAA repair
several days later fever, low Hb, jaundice
Delayed HTR
myelodysplastic syndrome (MDS)
minutes after transfusion
tachycardic, transfusion site pain, Hypotension
ABO incompatibility
or Immediate transfusion reaction
Blood transfusion several DAYS later Fever, Low Hb/signs of anaemia, Jaundice Extravascular haemolysis IgG mediated
Delayed HTR
acute transfusion reaction (mins)
risk higher in IgA deficiency
anaphylaxis
Transfusion reaction in minutes to hours bleeding, dark urine, no rash abdo pain, flush, vomiting host IgM-mediated (attack donor RBC)
ABO incompatibility (immediate HTR)
severest if group A to group O
Transfusion reaction
minutes to hours
no rash, shock and high fever
Commonly in platelet transfusion
Bacterial contamination
Hep B/C, HIV
Transfusion reaction
minutes to hours
Rise temp of ≤1ºC (MILD fever), rigors
commonest transfusion reaction
after pregnancy
WBC release cytokines, and prevented by leukodepletion
Febrile non-haemolytic transfusion reaction
NB ABO has drop in BP as RBC targeted, but febrile non-HTR there is NO drop in BP
Transfusion reaction in HOURS Pulmonary oedema/fluid overload HF: ↑JVP, ↑PCWP no fever
Transfusion-associated circulatory overload
Transfusion reaction
in HOURS <6 hrs
dry cough, SOB, fever, tachy
bilateral lung infiltrates/oedema
No HF (↑JVP) cause = dont anti-HLA Abs
Transfusion-related acute lung injury
TRALI
Diarrhoea, liver failure, skin desquamation and bone marrow failure DAYS later (>24hr)
Donor WBCs recognise recipient’s HLA as foreign and attack gut, liver, skin, BM
Prevent by irradiating blood components for immunosuppressed recipients
GvHD
SCD/thalassaemia blood transfusions
bronze skin, HF, short stature
Transfusion associated haemosiderosis
/ Fe overload
African lady
requests a sickle cell solubility test
low Hb, normal MCV?]
clouding of the tested blood
Sickle cell trait
African child
low Hb,normal MCV
Electrophoresis - high HbS and low HbF
SCD
Normal = HbA =~99.99%, HbF, HbA2 = ~0.01% each or none.
Haemolysis after antimalarials / malaria treatment
G6PD
spherocytes
polychromasia
reticulocytosis on blood film
hereditary spherocytosis
Coeliac disease
poor compliance with diet
macrocytosis
cause?
folate deficiency
high HbF
low Hb
B thalassaemia
high HbS, low HbF
SCD
sickle cell train 50% HbS
high IgG paraprotein (32- 40) g/dl
back pain
loss of sensation in legs
multiple myeloma
IgM paraprotein and visual disturbances
Lymphoplasmocytic lymphoma
(Waldenstrom’s macroglobinaemia)
NHL low-grade, get hyperviscosity Sx
German lady
asymptomatic
low neutrophils, but no abnormal cells on film
Chronic idiopathic neutropenia
injured playing sports
pancytopenia
immature myeloid cells on blood film
WCC normal.
AML
overweight, diabetes longstanding bone/back pain. paraprotein IgA ~8g/dl GFR 55mls/min/1.73m^2 FBC normal and albumin normal.
MGUS
- IgG/A <30
<10% clonal plasma cells
no CRAB
IgA 31
12% plasma clonal cells
no other Sx
Smouldering MM
IgG 51
clonal cells 9%
Constipation, GFR 50, low Hb, fracture
multiple myeloma
IgG/A must be >30
plasma cell % anything
CRAB Sx
IgG/A <30
<10% plasma cells in BM
no CRAB or organ damage
MGUS
no Tx needed
IgG/A>30g/l
>10% plasma cells in BM
borderline CRAB
smouldering MM
no Tx needed, higher transformation rate
normal Ca levels
2.2-2.6
IgG/A >30
clonal plasma cell % any
1+ CRAB Sx
Calcium 2.75, Renal Failure 177, Anaemia 100
Organ damage - hypogammaglobulinaemia, bone disease, cytopenia, hyperviscosity
MM
need Tx
most common cause of thrombocytopenia/low platelets in Pregnancy
Gestational thrombocytopenia
then pre-eclampsia
Causes DIC in pregnancy
Amniotic fluid embolism
placental abruption
Normal change in pregnancy
increased fibrinogen
Cause of Neonatal thrombocytopenia
neonatal alloimmune thrombocytopenia (NAIT). ?
minor illness (cold, fever) a week ago
now abnormal bruising
otherwise well
idiopathic thrombocytopenia
viral infection
Donath-Landsteiner Abs
Paroxysmal cold Hburia
morning dark urine
thrombosis
Budd-Chiari
Ham’s test
Paroxysmal nocturnal Hburia
Thrombocytopenia + Anaemia + Renal Failure + Child + Fever
HUS
Thrombocytopenia + Anaemia + Renal Failure + Adult + Fever
TTP
Ab to ADAMTS13 -> vwF strands cut up RBCs
normal physiological changes in pregnancy ALP fibrinogen systemic vascular resistance creatinine clearance
ALP increases
fibrinogen increases
SVR decreases
creatinine clearance increases
young adult
translocation(9:22)
cells are positive for TdT
ALL
Low serum iron, Low ferritin
high TIBC
IDA
Low serum iron, normal or high Ferritin
high/low TIBC
ACD
high TIBC - poorly nourished
low TIBC - well nourished
Dad and brother of dead individual disagree over having an autopsy. The Dad was the main carer but no mention of Standing order or special status assigned to dad by the dead individual. Can do autopsy?
autopsy can be done but to settle the disagreement it goes to a special court
Next of kin is identified for a woman who is estranged from her family, and found at home unresponsive with needles, and is a drug addict. When they get her to hospital she dies.
Refer to coroner (for advice) as cause of death is unknown
A man presents with history of heart disease, left ventricular hypertrophy, has a facial basal cell carcinoma and type 2 diabetes. Investigations from one year ago showed critical aortic stenosis.
How should you fill out the MCCD (Medical Certificate of Causes of Death)?
1a = aortic stenosis
1b must cause 1a
Ic must cause 1b
2 = other causes related to 1a e.g. T2DM and MI
