You are on page 1of 6

• What blood test is not required in diagnosis of hemolytic anemia?

• What neutrophil count means danger? 100 is immediate and 1000 uwaga
• Lowest amount of platelet for surgery – 50.g/l
• How big is the plasma bag in ml 300
• What increases apt T ,
Dic, Lupus, fdp, heamopillia a an b , von willenbrand and prekalikren or kinogen
• Know the numbers for macrocytic (>98), microcytic (<78), and normocytic (78-98)
anemia
• What do you do if your patient is a postmenopausal women with irondeficiency? Give
iron supplement or check for blood disorder etc
• Bortezomib = proteoze inhibitor
• What is the function of adhesion molecules?
Inflammatory cell recruitment requires the concerted action of at least five major sets of
adhesion molecules: integrins, immunoglobulin-like molecules, selectins, carbohydrate
structures serving as selectin ligands, and certain ectoenzymes.
• What is cryoathesis(?)
• What causes increase in D-dimer? DIC. DVT, PE
• Treatment of DIC –
Treat underlying disease
Restoration of anticoagulant pathways
=AT concentrate – 2500-3000 IU/day for 72-96 h
=Protein C concentrate – 245 mg/kg/day for 96 h

Anticoagulants
Heparin (300-500 j./h) or LMW heparin (Fraxiparin 15000-30000 j./day; Clexan 20-
40 mg/day)
Recombinant TFPI
Inactivated VIIa
Recombinant NAPc2 (complex between TF/VIIa and the factor derived from
nematode anticoagulant protein-NAP)
Substitution therapy
Quite safe substitution
RBC transfusions
PLT transfusions
Fresh frozen plasma
(10-15 ml/kg/day)
“Can add fuel to the fire”
Cryoprecipitate
1 pack from 400 ml of plasma/10 kg of body weight/day
• Know the anemias well i.e. B12 deficiency vs iron deficiency etc

• Coombs test

The two Coombs tests are:

• Direct Coombs test (also known as direct antiglobulin test or DAT).


• Indirect Coombs test (also known as indirect antiglobulin test or IAT).
The direct Coombs test is used to detect red blood cells sensitized with igG alloantibody,
IgG autoantibody, and complement proteins. It detects antibodies bound to the surface of red
blood cells in vivo. The red blood cells (RBCs) are washed (removing the patient's own
plasma) and then incubated with antihuman globulin (also known as "Coombs reagent"). If
this produces agglutination of the RBCs, the direct Coombs test is positive.

The indirect Coombs test is used in prenatal testing of pregnant women, and in testing blood
prior to a blood transfusion. It detects antibodies against RBCs that are present unbound in the
patient's serum. In this case, serum is extracted from the blood, and the serum is incubated
with RBCs of known antigenicity. If agglutination occurs, the indirect Coombs test is
positive.[

• Type of transplant in CML; allogeneic stem cell transplant

• When does a neoplasm start; what level 1 cell, 2 cells, 100 cells etc

• How many cells are produced in the body per day? I trillion

• What classification equals “no symptons” in Ann Arbor. Ans: A

A or B: the absence of constitutional (B-type) symptoms is denoted by adding an "A"


to the stage; the presence is denoted by adding a "B" to the stage.

• What type of biopsy needed fom lymphomas = whole lymph node

• Hodgkins = ABVD therapy


• Rituximab = monoclonal antubodies, B-cell lymphomas
• Stem cell marker ;is cd 34 in acute leukaemia
• Know the treatment of ALL, AML, CLL, CML, Multiple myeloma, Hodgkin’s on
Non-Hodgkins – drugs
ALL treatment :

Induction chemo – cyclophosphamide, daunorubicin, vincristine, prednisone (


CHOP) -/+ asparaginase
CNS prophylaxis – intrathecal MTX -/+ either cranial irradiation or systemic
MTX

Post-remission therapy options:


Consolidation/intensification chemo followed by maintenance chemo
High dose chemo w/ allo or auto HSCT,

If relapse > chemo vs. Allogeneic or autogenic HSCT

Emergency therapy :
Imatinib for ph+ ALL. Monoclonal Abs against lymphoid antigens

AML Treatment:
Induction chemo—
“3+7” : Idarubicin/daunorubicin x 3d and cytarabine x 7d
CR ( complete remission ) –
Consolidation therapy: chemo or allo or auto
M3 subtype –
ATRA added to induction chemo. ( ATRA = all trance retinoic acid)
Supportive care
CLL Treatment:
Palliative – early stage disease followed without therapy
Treatment is indicated starting Rai Stages III/IV, Binet stage C, progressive
disease, AIHA or ITP refractory to steroids, recurrent infections.
Initial trt- fludarabine or chlorambucil =/- monoclonal Ab against CD20
( rituximab) or CD52 ( alemtuzumab)

Radiation for compression symptoms due to bulky lymphoid masses


Splenectomy for marked splenomegaly and refractory cytopenia
Supportive care : cortico for AIHA or ITP, IVIg for recurrent major infections

CML Treatment:
Allogeneic HSCT is the only known curative.
Imatinib ( bcr-abl tyrosine kinase) is first line medical therapy
Hydroxyurea +/- leukopheresis for rapid drop of WBC count and palliation of
symptoms
Accelerated blast phase > allo HSCT

Multiple Myeloma Treatment:


Treatment not indicated for smoldering or asymptomatic stage Idisease
Systemic chemo: alkaline agents ( melphalan) + prednisone. If allo is
considered avoide alkylating agents
High dose chemo and auto HSCT
Local radiation for solitary or extramedullary plasmacytoma
Hodgkin Treatment:
Stage I and II- 4-6 cycles of ABVD ( doxorubicin) then field radiation
Stage III and IV - 2 cycles of ABVD with radiation for bulky disease +/or
incomplete regression.
Relapsed disease – chemo or high dose chemo plus auto HSCT
Non Hodgkin Treatment:
Treatment ( not like Hodgkin) determined by histo classification
Indolet : symptom management. Options include radiation, single agent
chemo, combination chemo and rituximiab
Aggressive: goal is cure
Combination chemo with radiation for localized or bulkly disease
CHOP ( cyclophosphamide, doxorubicin
CNS prophylaxis + MTX........
Relapse – high dose chemo + auto HSCT
• Type O blood can be given to what blood type? Universal donor

Anemia of iron deficiency is:


Normocytic and Normochromic
Microcytic and hypochromic

Key element of formation of blood cells is:

A) Messenchymal stem cell


B) progenitor stem cell
C) Hematopoetic cells
D) myeloblast
E) precursor cells
Complete bloodcount WBC 0.6 x 10 e 9/l LYM 0.2
Gran 0.3 x 10 e9/l RBC; 1.93 x 10e 12/l mcv; 88fl
Diagnosis of:
A]Iron def
B]Aplastic anaemia
C]Chronic lymphocytic leukaemia
D]Acute myeloblastic leukaemia
E] Injury to hematopoiesis by chemotherapy of cancer

Number of red cells produced and utilissed during one day is


2 billion
1 trillion
0.2 trillion
1 quintillion
0.1 trillion

Molecules on the surface of lymphocytes frequently used as a target for the treatment of
lymphomas
CD3
CD4
CD34
CD8
CD20

Neoplasm disorders start at


A. billion cells
B. 0.2 trillion cells
C. 100 million
D. 1 million
E. 1 cell

Most important info provided to cells by an adhesion molecule


A. survive
B. mature
C. proliferate
D. to be more active
E. adhere

Proteinurea in asymptomatic person maybe caused by;


A. cmv
B. light chain disease
C. lymphoma
D. megaloblastic Anaemia
E. thrombocytopaenia

Which blood disorder is frequently discorvered by accisdentally performed CBC


A. CLM
B. Multiple myeloma
C. ALL
D. Mantle cell lymphoma
E. Amyloidosis
Normal granulocyte count?
No of blood cells a day

Drugs used in second line treatment of CLL


A. cytosine arabinoside
B. fludarabine
C. mephlan
D. cisplatin
E. irinokenan 0r sumit like that

Phlebotomy used in trt of


A. CML
B. Osteomyelofibrosis
C. No longer used
D. Polycytheamia vera
E. Secondary Polycythemia vera

Hematology

Category Test Low High Unit Comments


Red blood Higher in neonates, lower in
Haemoglobin (Hb) (male) 140 180 g/L
cells children.
Haemoglobin (Hb) Sex difference negligible until
115 160 g/L
(female) adulthood.
Haematocrit (Hct) (male) 0.38 0.52
Haematocrit (Hct)
0.35 0.47
(female)
Cells are larger in neonates,
Mean cell volume (MCV) 80 98 fL
though smaller in other children.
Mean cell haemoglobin
26 34 pg
(MCH)
Red cell count (male) 4.5 6.5 x1012/L
Red cell count (female) 3.8 5.8 x1012/L
Reticulocytes 10 100 x109/L
erythrocyte sedimentation Females tend to have a higher
n/a 20 mm/hr
rate (ESR) ESR. ESR increases with age.
White blood The Total white blood
4 11 x109/L Higher in neonates and infants.
cells cells
45-74%. Also known as
Neutrophil granulocytes 2 7.5 x109/L granulocytes (grans), polys,
PMNs, or segs.
Lymphocytes 1.3 4 x109/L 16-45%
Monocytes 0.2 0.8 x109/L 4.0-10%
Eosinophil granulocytes 0.04 0.4x109/L 0.0-7.0%
Basophil granulocytes 0.01 0.1x109/L 0.0-2.0%
Coagulation Platelets are part of the
Platelets 150 400 x109/L
formation of blood clots
PT reference varies between
Prothrombin time (PT)[11] 11 13.5 s laboratory kits - INR is
standardised
The INR is a corrected ratio of a
INR 0.9 1.2
patients PT to normal
Activated partial
thromboplastin time 29 41 s
(APTT)
Thrombin clotting time
11 18 s
(TCT)
Fibrinogen 1.8 4 g/L
Bleeding time 2 9 minutes