Haematology Module 4

Which of the following is NOT part of the intrinsic pathway in the coagulation cascade?

A 16 year old girl receiving chemotherapy for acute myeloid leukaemia presents in the early hours of Sunday morning with fever, bruising, petechiae and oral mucosal bleeding. Her platelet count is 4 x 109/L [150-400] and her blood group is Group A Rh negative. Platelet transfusion is indicated.

The transfusion service does not have irradiated Group A Rh negative platelets available.

Which of the following products would be most appropriate to request as an alternative?

Clotting factor deficiencies are most likely to result in spontaneous hemorrhage into which tissue?

Which one of the following cytotoxic agents acts by inhibiting dihydrofolate reductase and thymidylate synthesis?

An 18 year old man is admitted to hospital after developing a haemarthrosis in his right knee whilst playing football in the garden. The following blood results are obtained:

What is the most likely diagnosis?

A 62-year-old male attends the Emergency Department with a severe nose bleed. He is known to have alcoholic cirrhosis. His investigations reveal:

• haemoglobin 10.9 g/dL (13.0-18.0)
• white cell count 5 x 109/L (4-11)
• platelet count 60 x 109/L ( 150-400)
• prothrombin time 17.5s (11.5-15.5)
• APPT 42s (30-40)
• fibrinogen 0.7 g/L (1.8-5.4)

What is the most appropriate blood product for this patient?

A surgical registrar rings you for an opinion regarding bridging anticoagulation therapy for a patient with atrial fibrillation (CHADS2 score of 2) who is about to undergo an elective bowel surgery tomorrow. The patient’s warfarin has been withheld for 5 days. What would you advise them to do?

Which one of the following is least likely to cause a warm autoimmune haemolytic anaemia?

A 33-year-old male patient with a history of recurrent nose bleeds, iron deficiency anaemia and dyspnoea is found to have a pulmonary AV malformation on pulmonary angiography. What is the likely underlying diagnosis?

A blood film is reported as follows:

Howell-Jolly bodies, target cells and occasional Pappenheimer bodies are seen.

What is the most likely underlying cause?

A 22-year-old man with sickle cell anaemia presents with pallor, lethargy and a headache. Blood results are as follows:

Infection with a parvovirus is suspected. What is the likely diagnosis?

Which one of the following is NOT a feature of paroxysmal nocturnal haemoglobinuria?

A 21-year-old man comes for review. He recently had an abdominal ultrasound for episodic right upper quadrant pain which demonstrated gallstones. A full blood count was also ordered which was reported as follows:

The patient also mentions that his father had a splenectomy at the age of 30 years.

Which one of the following tests is most likely to be diagnostic?

A 42-year-old female is noted to have a Hb of 178 g/L. Which one of the following is least likely to be the cause?

Which one of the following is a marker of bad prognosis in acute lymphoblastic leukaemia?

A 34-year-old man who is HIV positive is starting treatment for Burkitt’s lymphoma. His chemotherapy regime includes cyclophosphamide, vincristine, methotrexate and prednisolone. Around 24 hours after starting chemotherapy he becomes confused and complains of muscle cramps in his legs. Which one of the following is most likely to have occurred?

A 66-year-old woman with a history of chronic kidney disease stage disease 4 metastatic breast cancer is admitted with a swollen right calf. Investigations confirm a deep vein thrombosis and she is started on treatment dose dalteparin. As she has a significant degree of renal impairment it is decided to monitor her response to dalteparin. What is the most appropriate blood test to perform?

A 72-year-old woman is found to have a marked lymphocytosis associated with smudge cells on the blood film. A diagnosis of chronic lymphocytic leukaemia is suspected. Which one of the following is the investigation of choice?

A 15-year-old man is noted to bleed excessively during an elective dental extraction. Following the procedure, examination reveals petechial skin haemorrhages. Blood results show:

What is the most likely diagnosis?

A 52-year-old woman with a history of hypothyroidism presents with lethargy and a sore tongue. Blood tests are reported as follows:

Further tests are ordered:

What is the most appropriate management?

A patient with a history of recurrent thromboembolic events develops a deep vein thrombosis despite full anticoagulation with heparin. Which one of the following causes of thrombophilia is associated with resistance to heparin?

What is the mechanism of action of DDAVP in von Willebrand’s disease?

Which one of the following statements regarding the aetiology of venous thromboembolism (VTE) is correct?

A 72-year-old man is admitted with a deep vein thrombosis. He is normally fit and well but has recently lost weight. Blood tests reveal the following:

What is the most likely diagnosis?

Which of the following is a cause of extravascular haemolysis?

A 67-year-old man is diagnosed with myelofibrosis. What is the most common presenting symptom of myelofibrosis?

Which one of the following malignancies may be associated with Human T-cell lymphotropic virus type 1 (HTLV-1)?

Each one of the following may cause eosinophilia, except:

A 51-year-old female is referred to the haematology clinic with a haemoglobin of 192 g/l. She is a non-smoker. Her oxygen saturations on room air are 98% and she is noted to have mass in the left upper quadrant.

What is the most useful test to establish whether she has polycythaemia rubra vera?