Past Papers Haem

Question 1

blood transfusion, rash several hours later

Answer 1

Allergic reaction

Delayed HTR if Days later

Question 2

RTA, 6 units blood

SOB, fever, tachycardia

Answer 2

TRALI

Question 3

B thalassaemia, regular transfusions

Malaise and erectile dysfunction

Answer 3

Transfusion associated haemosiderosis

Question 4

AAA repair

several days later fever, low Hb, jaundice

Answer 4

Delayed HTR

Question 5

myelodysplastic syndrome (MDS)
minutes after transfusion
tachycardic, transfusion site pain, Hypotension

Answer 5

ABO incompatibility

or Immediate transfusion reaction

Question 6

Blood transfusion
several DAYS later
Fever, Low Hb/signs of anaemia, Jaundice
Extravascular haemolysis
IgG mediated

Answer 6

Delayed HTR

Question 7

acute transfusion reaction (mins)

risk higher in IgA deficiency

Answer 7

anaphylaxis

Question 8

Transfusion reaction
in minutes to hours
bleeding, dark urine, no rash 
abdo pain, flush, vomiting
host IgM-mediated (attack donor RBC)

Answer 8

ABO incompatibility (immediate HTR)

severest if group A to group O

Question 9

Transfusion reaction
minutes to hours
no rash, shock and high fever
Commonly in platelet transfusion

Answer 9

Bacterial contamination

Hep B/C, HIV

Question 10

Transfusion reaction
minutes to hours
Rise temp of ≤1ºC (MILD fever), rigors

commonest transfusion reaction
after pregnancy

WBC release cytokines, and prevented by leukodepletion

Answer 10

Febrile non-haemolytic transfusion reaction

NB ABO has drop in BP as RBC targeted, but febrile non-HTR there is NO drop in BP

Question 11

Transfusion reaction 
in HOURS
Pulmonary oedema/fluid overload 
HF:  ↑JVP, ↑PCWP
no fever

Answer 11

Transfusion-associated circulatory overload

Question 12

Transfusion reaction
in HOURS <6 hrs

dry cough, SOB, fever, tachy
bilateral lung infiltrates/oedema

No HF (↑JVP)
cause = dont anti-HLA Abs

Answer 12

Transfusion-related acute lung injury

TRALI

Question 13

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

Answer 13

GvHD

Question 14

SCD/thalassaemia blood transfusions

bronze skin, HF, short stature

Answer 14

Transfusion associated haemosiderosis

/ Fe overload

Question 15

African lady
requests a sickle cell solubility test
low Hb, normal MCV?]
clouding of the tested blood

Answer 15

Sickle cell trait

Question 16

African child
low Hb,normal MCV
Electrophoresis - high HbS and low HbF

Answer 16

SCD

Normal = HbA =~99.99%, HbF, HbA2 = ~0.01% each or none.

Question 17

Haemolysis after antimalarials / malaria treatment

Answer 17

G6PD

Question 18

spherocytes
polychromasia
reticulocytosis on blood film

Answer 18

hereditary spherocytosis

Question 19

Coeliac disease
poor compliance with diet
macrocytosis
cause?

Answer 19

folate deficiency

Question 20

high HbF

low Hb

Answer 20

B thalassaemia

Question 21

high HbS, low HbF

Answer 21

SCD

sickle cell train 50% HbS

Question 22

high IgG paraprotein (32- 40) g/dl
back pain
loss of sensation in legs

Answer 22

multiple myeloma

Question 23

IgM paraprotein and visual disturbances

Answer 23

Lymphoplasmocytic lymphoma
(Waldenstrom’s macroglobinaemia)

NHL low-grade, get hyperviscosity Sx

Question 24

German lady
asymptomatic
low neutrophils, but no abnormal cells on film

Answer 24

Chronic idiopathic neutropenia

Question 25

injured playing sports pancytopenia immature myeloid cells on blood film WCC normal.

Answer 25

AML

Question 26

``` overweight, diabetes longstanding bone/back pain. paraprotein IgA ~8g/dl GFR 55mls/min/1.73m^2 FBC normal and albumin normal. ```

Answer 26

MGUS - IgG/A <30 <10% clonal plasma cells no CRAB

Question 27

IgA 31 12% plasma clonal cells no other Sx

Answer 27

Smouldering MM

Question 28

IgG 51 clonal cells 9% Constipation, GFR 50, low Hb, fracture

Answer 28

multiple myeloma IgG/A must be >30 plasma cell % anything CRAB Sx

Question 29

IgG/A <30 <10% plasma cells in BM no CRAB or organ damage

Answer 29

MGUS no Tx needed

Question 30

IgG/A>30g/l >10% plasma cells in BM borderline CRAB

Answer 30

smouldering MM no Tx needed, higher transformation rate

Question 31

normal Ca levels

Answer 31

2.2-2.6

Question 32

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

Answer 32

MM need Tx

Question 33

most common cause of thrombocytopenia/low platelets in Pregnancy

Answer 33

Gestational thrombocytopenia | then pre-eclampsia

Question 34

Causes DIC in pregnancy

Answer 34

Amniotic fluid embolism placental abruption

Question 35

Normal change in pregnancy

Answer 35

increased fibrinogen

Question 36

Cause of Neonatal thrombocytopenia

Answer 36

neonatal alloimmune thrombocytopenia (NAIT). ?

Question 37

minor illness (cold, fever) a week ago now abnormal bruising otherwise well

Answer 37

idiopathic thrombocytopenia

Question 38

viral infection | Donath-Landsteiner Abs

Answer 38

Paroxysmal cold Hburia

Question 39

morning dark urine thrombosis Budd-Chiari Ham's test

Answer 39

Paroxysmal nocturnal Hburia

Question 40

Thrombocytopenia + Anaemia + Renal Failure + Child + Fever

Answer 40

HUS

Question 41

Thrombocytopenia + Anaemia + Renal Failure + Adult + Fever

Answer 41

TTP | Ab to ADAMTS13 -> vwF strands cut up RBCs

Question 42

``` normal physiological changes in pregnancy ALP fibrinogen systemic vascular resistance creatinine clearance ```

Answer 42

ALP increases fibrinogen increases SVR decreases creatinine clearance increases

Question 43

young adult translocation(9:22) cells are positive for TdT

Answer 43

ALL

Question 44

Low serum iron, Low ferritin | high TIBC

Answer 44

IDA

Question 45

Low serum iron, normal or high Ferritin | high/low TIBC

Answer 45

ACD high TIBC - poorly nourished low TIBC - well nourished

Question 46

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?

Answer 46

autopsy can be done but to settle the disagreement it goes to a special court

Question 47

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.

Answer 47

Refer to coroner (for advice) as cause of death is unknown

Question 48

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)?

Answer 48

1a = aortic stenosis 1b must cause 1a Ic must cause 1b 2 = other causes related to 1a e.g. T2DM and MI