Haematology Module 2

A 63 year old man has been newly diagnosed with multiple myeloma. Unfortunately, he is not a candidate for autologous stem-cell transplant. The hematologist plans to start him on a combination of Bortezomib, Melphalan, and Prednisone (BMP). Which of the following medication could be added to his treatment in order to lower the risk of disease progression?

A 71-year-old woman who is known to have multiple myeloma is admitted with confusion. Blood tests show the following:

Which one of the following is the most significant cause of the raised calcium level?

Which one of the following feature is least recognized in myeloma?

What is the most useful marker of prognosis in myeloma?

A 67-year-old woman is diagnosed with multiple myeloma. Which one of the following complications is she most likely to develop as a result of her primary diagnosis?

A 30-year-old man is investigated for enlarged, painless cervical lymph nodes. A biopsy is taken and a diagnosis of Hodgkin’s lymphoma is made. Which one of the following types of Hodgkin’s lymphoma carries the worst prognosis?

An 18-year-old man is noted to bleed excessively during an elective dental extraction. Following the procedure, examination reveals petechial skin haemorrhages. Blood results show:

Hb 123 g/l

Plt 255 (10⁹/l)

WBC 7.9 (10⁹/l)

PT 13.3 secs

APTT 39 secs

Factor VIII activity 87%

What is the most likely diagnosis?

Transfusion Associated Circulatory Overload (TACO) and Transfusion Related Acute Lung Injury (TRALI) are both rare complications that could occur during blood transfusion but carries a significant mortality risk. However, patient may present with similar signs and symptoms such as shortness of breath, increased respiratory rate and hypoxemia.

So which of the following features would be more in keeping with TACO rather than TRALI?

Which one of the following would most suggest a leukaemoid reaction rather than chronic myeloid leukaemia?

A patient presents with nephrotic syndrome, postural hypotension, raised INR and macroglossia.

What is the diagnosis?

Which of the following is NOT involved in fibrinolysis?

A 60 year old man is referred by a surgeon for assessment of a prolonged APTT that was detected at a pre-operative assessment for elective CABG.Past medical history includes RA and BPH.No past history of bleeding.

APTT 45secs (22-38secs)

PT 14 (13-17secs)

Thrombin clotting time 12secs (11-18 secs)

APTT mixing studies 34 secs

What should you advise the surgeon to do?

What is the role of DDAVP in patients with von Willebrands disease?

A 20 year old woman has steroid refractory immune thrombocytopenia(ITP) relapsing after splenectomy with a platelet count below 20.She is commenced on a thrombopoeitin receptor agonist(romiplostim or eltrombopag) and her platelets rise rapidly to 220.

Which of the following is the most likely reason for this?

Which of the following factors are NOT involved in the intrinsic pathway?

Which of the following medication is most likely to enhance the effect of warfarin?

In a woman with antiphospholipid syndrome and recurrent pregnancy loss, what is the most appropriate treatment that will increase the chance for her of having a successful pregnancy?

A patient is found to have persistently elevated antiphospholipid antibodies (aPL) but is otherwise asymptomatic with no previous history of thrombosis.No risk factors for thrombosis identified.

What medication should be used for prophylaxis against primary thrombosis?

A patient with SLE is found to have persistently elevated antiphospholipid antibodies (aPL) but is otherwise asymptomatic with no previous history of thrombosis.No other risk factors for thrombosis identified.

What medication should be used for prophylaxis against primary thrombosis?

What is the most common cause of familial thrombophilia?

In a patient with DVT, what is the most likely reason to continue with anti-coagulation beyond 6 months?

Which of the following coagulation abnormalities is resistant to the effect of Heparin?

A 60-year-old man presents to the emergency department with chest pain. He is hypotensive but otherwise no abnormalities are noted on examination apart from mild hypotension.

His full blood examination shows:

• haemoglobin 125 g/L [128-175]
• white cell count 10.2 x 10⁹/l [3.9-12.7] with normal white cell differential.
• platelets 180 x 10⁹/l [150-396]
• Coagulation investigations show:
• APTT 100 seconds [26-38]
• APTT 1:1 mix (patient: normal plasma) 52 seconds
• prothrombin time-international normalised ratio
• (PT-INR) 1.2 [1.0-1.3]
• thrombin clotting time (TCT) 200 seconds [<24]
• fibrinogen 4.5 g/L [2.0-4.0]
• reptilase time 18 seconds [<24]

What is the most likely diagnosis?

A 67 year old man undergoes aortic valve replacement and is commenced on warfarin in the post operative period. Five days after commencing warfarin he develops a painful burning rash over his buttocks with evidence of skin necrosis.

Which of the following disorder is he likely to have?

How is multiple myeloma diagnosed?

A 21-year-old woman presents with recent-onset of right leg swelling and pleuritic chest pain and is found to have iliofemoral thrombosis on Doppler ultrasound examination.

Results of a ventilation-perfusion lung scan indicate a high probability for pulmonary emboli.

She had been taking the oral contraceptive pill for the last three years but has now ceased. She is a non-smoker. There is no significant medical history and no known family history of venous thromboembolism.

A panel of thrombophilia screen is performed.

Which one of the following investigations for an underlying hypercoagulable state is most likely to be affected by the presence of the extensive thrombosis?

Besides its anti-coagulant effect, Warfarin also exerts anti-thrombotic effects via depletion of which of the following?

Which of the following is the commonest cause of activated protein C resistance?

A 50-year-old businessman presents to your office for an insurance examination. He smokes a pack of cigarettes a day, is moderately (20 lb) overweight, and has a history of hypertension treated with hydrochlorothiazide. Except for some job-related stresses, he feels well. Systems review is normal.

Findings on physical exam are as follows: BP, 155/90; P, 92; T, 37.0 C; wt, 195 lb.

Plethoric facies are noted, but examination of the heart, lungs, and abdomen is normal.

Laboratory results are as follows:

• Hb 185
• HCT 55
• WBC 6.8 x 10⁹/l with normal differential
• peripheral blood smear, normal
• Na+, 140
• K+, 3.2
• Cr, 1.5
• COHb, 4.2
• RBC volume 31 (upper limits of normal)
• plasma volume 36 (low normal)
• Pao2, 94
• Paco2, 42
• pH, 7.41
• HCO3, 24
• Hb P50, normal
• erythropoietin, 25.

Which of the following is the most likely diagnosis?

A 78-year-old man presents for evaluation of progressive headache, dizziness, and weakness of 6 months’ duration.

Hot showers cause generalized pruritus. The past medical history and systems review are otherwise normal. He had a normal health maintenance examination 5 years ago, including routine laboratory studies.

Physical examination shows the following: BP, 130/70; P, 70; T, 37.0 C; wt, 165 lb. The skin of the face is plethoric and dusky red. Heart and lungs are normal. A spleen tip is palpable 2 cm below the costal margin.

There is no lymphadenopathy. The rest of the examination is normal.

Laboratory results are as follows:

• Hb 195
• HCT 0.65
• WBC, 12.8 with normal differential
• platelets, 525 x 10⁹/l
• peripheral blood smear, increased basophils, myelocytes, and metamyelocytes
• Na+, 140
• K+, 4.0
• Cr, 1.0
• uric acid, 10.5
• Pao2, 94
• Paco2, 42
• pH, 7.41
• HCO3, 24
• erythropoietin 5

Which of the following is the most likely diagnosis?