Haem

Question 1

Blood results of Beta thalassaemia trait Vs Beta thalassaemia major

Answer 1

• trait presents with disproportionate MCV to anaemia - i.e MCV will be very low whilst Hb is only mildy low.
• major presents with low MCV AND severe anaemia [v low Hb] [similar pattern is seen in alpha thalassaemia]

Question 2

1st line imaging for suspected multiple myeloma

Answer 2

whole body MRI to assess for bony involvement.

Question 3

multiple myeloma CFs

Answer 3

Question 4

multiple myeloma Dx criteria

Answer 4

Both criteria must be met:
1. Clonal bone marrow plasma cells* ≥10% or biopsy-proven plasmacytoma.
2. One or more myeloma-defining events

• [S] ≥60% plasma cells in marrow
• [LI] Involved:uninvolved light chain ratio ≥100 (provided the involved light chain is >100 mg/l)
• [M] 2 or more focal lesions on MRI (>5 mm in size)
• [C] Hypercalcaemia: (>2·75 mmol/l or >0·25 mmol/l higher than upper limit of normal)
• [R] Renal insufficiency: (serum creatinine >177 µmol/l or creatinine clearance <40 ml/min)
• [A] Anaemia: Hb <100 g/l or 20 g/l below lower limit of normal
• [B] 1 or more lytic bone lesion on X-ray, CT or PET/CT (>5 mm in size)

Question 5

CLL summary

Answer 5

Question 6

CML summary

Answer 6

Question 7

ALL summary

Answer 7

Question 8

AML summary

Answer 8

Question 9

reversal agent for DOACs

Answer 9

• dabigatran = Idarucizumab
• apixaban + rivaroxiban = Andexanet alfa
• edoxaban = nothing licenced

Question 10

superior vena cava obstruction:
1. - Mc associated with
1. - CFs
1. - Mx

Answer 10

1. lung cancer [MC] also lymphoma
2. dyspnoea [MC], facial, neck and arm swelling, pappiloedema, visual disturbance, headache[ worse in the morning] pulseless jugular venous distension.
3. IV dexamethasone - reduces inflammation to increase venous flow

Question 11

hyposplenism blood film

Answer 11

• target cells
• Howell-Jolly bodies
• Pappenheimer bodies
• siderotic granules
• acanthocytes

Question 12

DVT investigation: if the scan is negative, but the D-dimer is positive →

Answer 12

stop anticoagulation and repeat scan in 1 week

Question 13

how is vaso-occlusive crisis diagnosed in sickle cell

Answer 13

clinical Dx in pts with known hx of sickle cell

Question 14

types of Sickle-cell crises

Answer 14

thrombotic, ‘vaso-occlusive’, ‘painful crises’
acute chest syndrome
anaemic
aplastic
sequestration
infection

Question 15

key side effect of chemo

NOT complication

Answer 15

tumour lysis syndrome

• presents with diarrhoea, paraesthesia, decreased urine output due to AKI

U+E findings = PUKE Calcium

• Phosphate, Uric acid, potassium (K) Elevated
• Calcium low

Question 16

causes of microcytic anaemia

Answer 16

Question 17

causes of normocytic anaemia

Answer 17

Question 18

potential causes of neutrophilia

Answer 18

• bacterial infection
• meds - steroids + lithium esp.
• inflammation
• stress
• malignancy

Question 19

causes of macrocytic anaemia

Answer 19

Question 20

key complication of chemo

• when does it occur
• what causes it
• Mx

Answer 20

neutropenic sepsis

• MC occurs 7-14 days after chemotherapy
• defined as a neutrophil count of < 0.5 * 109 in a patient who is having anticancer treatment and has one of the following:
  
  • a temperature higher than 38ºC or
  • other signs or symptoms consistent with clinically significant sepsis

MC causative organism = Staphylococcus epidermidis

• prophylaxis = fluoroquinolone. given when neutropenia is anticipated

MX

• IMMEDIATE Abx - never wait for blood results
  
  • piperacillin with tazobactam (Tazocin)
• if patients are not responding after 4-6 days the Christie guidelines suggest ordering investigations for fungal infections

Question 21

causes of B12 deficiency

Answer 21

• diet changes - veganism
• nitroous oxide use
• pernicious anaemia - autoantibodies against parietal cells in the stomach, destroying the ability to produce intrinsic factor (IF), a protein necessary for B12 absorption in ileum

Question 22

neutropenic sepsis

• definition
• cause
• Ix
• Mx

Answer 22

Definition

• MC occurs 7-14 days after chemotherapy
• defined as a neutrophil count of < 0.5 * 109 in a patient who is having anticancer treatment and has one of the following:
  
  • a temperature higher than 38ºC or
  • other signs or symptoms consistent with clinically significant sepsis

Cause

MC causative organism = Staphylococcus epidermidis

Ix

• Bloods: FBC - neutropenia [always present regardless of WCC], low or normal WCC

MX

• IMMEDIATE Abx - never wait for blood results
  
  • piperacillin with tazobactam (Tazocin)
• prophylaxis = fluoroquinolone. given when neutropenia is anticipated

//
- if patients are not responding after 4-6 days the Christie guidelines suggest ordering investigations for fungal infections

Question 23

lymphoma staging

Answer 23

lugano staging

Question 24

DIC typical blood picture:

Answer 24

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products

Question 25

a 20 yr old sees you at the GP with 2 weeks of unexplained fatigue and petechiae on her arms and legs and hepatomegaly on examination. how do you proceed?

Answer 25

- urgent referral to haematology within hours because when either hepatosplenomegaly or unexplained petichiae are present, the patient should be referred for immediate assessment where blood tests will be performed more quickly than from general practice. - if the pt just had symptoms of new onset fatigue/ general sx of leukaemia [not listed above] then a 48 hour urgent blood test would be appropriate

Question 26

what sx would warrant an urgen 48 hour blood test to assess possible leukaemia

Answer 26

* Pallor * Persistent fatigue * Unexplained fever * Unexplained persistent infections * Generalised lymphadenopathy * Persistent or unexplained bone pain * Unexplained bruising * Unexplained bleeding

Question 27

TTP - sx - how bad is it

Answer 27

FATHeR - Fever - Altered mental state - Thrombocytopenia - Haemolyrtic anaemia - Reduced renal function BAD BAD

Question 28

ITP bloods

Answer 28

- low platelets - TTP

Question 29

non-pharmacological Mx/ advice for sickle cell pts

Answer 29

* Avoid dehydration/cold/exhaustion , * avoid alcohol (due to dehydrating effects), * avoid smoking (may cause acute sickle chest)

Question 30

Give one immediate treatment for the hyponatraemia, and an alternative oral medication that can achieve and maintain a normal sodium.

Answer 30

- Fluid restriction; - demeclocycline or tolvaptan