Haem: Interactive Cases

Question 1

List some general clinical signs of anaemia.

Answer 1

• Pale mucous membranes
• Tachycardia
• Cardiomegaly/CCF

Question 2

How should pre-operative iron deficiency anaemia be managed

Answer 2

IV iron

Question 3

why are patients with liver disease rarely haemorrhagic
what effect does this have on blood parameters

Answer 3

they also get protein C and protein S deficiency –> are more pro-thrombotic (even though prolonged PT and APTT)

For interventional procudures e.g. ascitic drains dont necessarily need to stabilise factors

Question 4

List some specific clinical signs of anaemia.

Answer 4

• Koilonychia
• Glossitis (B12 deficiency - B12 is needed for epithelial cell replacement)
• Jaundice (haemolysis)

Question 5

List some causes of microcytic anaemia.

Answer 5

• Iron deficiency
• Thalassemia
• Anaemia of chronic disease

Question 6

List some investigationsthat are used for anaemia.

Answer 6

• FBC
• Blood film
• Reticulocyte count
• Haemoglobin electrophoresis
• Iron studies

Question 7

List some physiological triggers for reticulocytosis.

Answer 7

• Haemolysis
• Haemorrhage
• Haematinics (agents that stimulate RBC production)

Question 8

List some conditions in which reticulocytes are absent.

Answer 8

• Inadequate haematinics
• Bone marrow failure
• Acute major haemorrhage (reticulocyte response takes at least 6 hours)

Question 9

What are the typical haemoglobin electrophoresis findings of thalassemia?

Answer 9

• High HbA2 and HbF

Question 10

List some blood film features of iron deficiency anaemia.

Answer 10

• Pencil cells
• Anisocytosis
• Poikilocytosis
• Hypochromic

Question 11

List some causes of pancytopaenia.

Answer 11

• Aplastic anaemia
• Leukaemia
• Infiltration (e.g. lymphoma, carcinoma)
• Drugs (e.g. chemotherapy)
• B12/folate deficiency

Question 12

List some investigations for pancytopaenia.

Answer 12

• Blood film
• Vitamin B12 and folate
• Bone marrow biopsy

Question 13

What is a defining feature of myeloid cells?

Answer 13

• Auer rods
• NOTE: the presence of Auer rods means that cytochemistry and immunophenotyping is not necessary

Question 14

Which type of major infection is classically seen in AML?

Answer 14

Gram-negative septicaemia

Question 15

What are the principles of management of AML?

Answer 15

• Supportive - red cell and platelet transfusions, isolation
• Chemotherapy

Question 16

List some causes of thrombocytopaenia.

Answer 16

• Defect in platelet production - drugs, bone marrow disorders (e.g. leukaemia, myelodysplasia)
• Increased platelet destruction - ITP, DIC, heparin-induced thrombocytopaenia

Question 17

List some investigations for thrombocytopaenia.

Answer 17

• Coagulation screen
• Blood film
• Bone marrow aspirate
• ANA/RAPA/anti-platelet antibodies (check for rheumatoid arthritis, SLE)
• HIV (common cause of isolated platelet destruction worldwide)

Question 18

List some causes of low platelets with abnormal clotting.

Answer 18

• DIC
• Alcohol
• Drugs
• Leukaemia

Question 19

List some investigations for suspected DIC.

Answer 19

• Blood film
• D-dimer
• Fibrinogen
• Septic screen
• LFTs

Question 20

How is DIC managed?

Answer 20

• Antibiotics
• Blood products
• Regular blood tests to assess response