(2)Study group haem practical

What is the most prominent abnormality in acute myeloid leukaemia (AML) on peripheral blood film?

Presence of numerous large blast cells.

What nuclear feature do blast cells in AML typically have?

High nuclear-to-cytoplasmic (N:C) ratio.

What chromatin pattern is seen in AML blasts?

Fine (delicate) chromatin.

What cytoplasmic feature is typical of AML blasts?

Scant, thin basophilic agranular cytoplasm.

What are the major differential diagnoses of blast cells on peripheral blood film?

AML, ALL, Myelodysplastic Syndrome (MDS), and leukemoid reaction.

What is the most likely diagnosis when numerous myeloid blasts are present?

Acute Myeloid Leukaemia (AML).

What does AML M0 represent in the FAB classification?

Minimally differentiated AML.

What does AML M1 represent?

AML without maturation.

What does AML M2 represent?

AML with maturation.

Which AML subtype is acute promyelocytic leukaemia?

AML M3.

Which chromosomal translocation is associated with AML M3?

t(15;17).

What does AML M4 represent?

Acute myelomonocytic leukaemia.

What does AML M4Eo represent?

Acute myelomonocytic leukaemia with eosinophilia.

What does AML M5 represent?

Acute monocytic leukaemia.

What does AML M6 represent?

Acute erythroid leukaemia.

What does AML M7 represent?

Acute megakaryoblastic leukaemia.

Which coagulation test is prolonged in Haemophilia A?

aPTT.

Which coagulation test is normal in Haemophilia A?

PT.

Which clotting factor is deficient in Haemophilia A?

Factor VIII.

Can Haemophilia A occur in females?

Yes, rarely (e.g., Turner syndrome).

What is the mainstay of treatment for Haemophilia A?

Factor VIII replacement therapy.

Which recombinant hormone can be used in mild Haemophilia A?

Desmopressin (DDAVP).

Which antifibrinolytic drug is useful in Haemophilia A?

Tranexamic acid.

What is the commonest joint complication of Haemophilia A?

Haemarthrosis.

What chronic joint complication results from recurrent haemarthroses?

Haemophilic arthropathy.

Name a life-threatening neurological complication of Haemophilia A.

Intracranial haemorrhage.

Which bleeding disorder is the main differential diagnosis of Haemophilia A?

Haemophilia B.

Which inherited bleeding disorder affects both factor VIII and platelet function?

Von Willebrand disease.

What are the laboratory features of Disseminated Intravascular Coagulation (DIC)?

Prolonged PT, prolonged aPTT, thrombocytopenia, low fibrinogen, elevated D-dimer, elevated FDPs, schistocytes, prolonged thrombin time.

Which clotting factor product is commonly used to treat DIC?

Fresh Frozen Plasma (FFP).

Which blood product is given in DIC for thrombocytopenia?

Platelet concentrates.

Which blood product provides fibrinogen in DIC?

Cryoprecipitate.

What is the major renal complication of DIC?

Acute kidney injury.

What respiratory complication can occur in DIC?

Acute Respiratory Distress Syndrome (ARDS).

Which peripheral blood smear finding supports DIC?

Schistocytes.

AML associated with DIC commonly presents with which blood film finding?

Blast cells.

Which cytochemical stain identifies myeloid lineage?

Myeloperoxidase (MPO).

Which stain highlights lipids in myeloid cells?

Sudan Black B.

Which stain is commonly positive in ALL?

Periodic Acid-Schiff (PAS).

Which stain is diagnostic for Hairy Cell Leukaemia?

Tartrate-resistant acid phosphatase (TRAP).

Which stain demonstrates iron stores?

Prussian Blue stain.

Which stain is positive in monocytes?

Non-specific esterase (NSE).

Which stain highlights granulocytic cells?

Chloroacetate esterase (CAE).

Which stain demonstrates bone marrow fibrosis?

Reticulin stain.

Which stain is routinely used for peripheral blood films?

Leishman stain.

Which stain is useful for malaria parasites?

Giemsa stain.

What are the phases of treatment for ALL?

Induction, consolidation, maintenance and CNS prophylaxis.

What are the phases of treatment for AML?

Induction therapy and consolidation therapy.

What is the initial management strategy for asymptomatic CLL?

Watch and wait.

What are the phases of CML management?

Chronic phase, accelerated phase, blast crisis and long-term TKI therapy.

Which morphological features support AML on blood film?

Numerous large blasts, high N:C ratio, prominent nucleoli, scant cytoplasm and minimal maturation.

How are AML blasts generally distinguished from ALL blasts?

AML blasts are larger with more cytoplasm, granules and may contain Auer rods.

How are ALL blasts typically described?

Smaller cells with high N:C ratio, scant cytoplasm and no granules.

Which FAB subtype of ALL has small uniform blasts?

L1.

What peripheral blood finding is characteristic of CML?

Leucocytosis with the full spectrum of myeloid cells.

Which mature cells predominate over blasts in CML?

Neutrophils and myelocytes.

Which additional circulating granulocyte is commonly increased in CML?

Basophils.

Which oral drug class is the standard treatment for CML?

Tyrosine kinase inhibitors (TKIs).

Which first-generation TKI is used for CML?

Imatinib.

Name two second-generation TKIs used for CML.

Dasatinib and Nilotinib.

Name two third-generation TKIs used for CML.

Ponatinib and Asciminib.

Which investigations confirm CML?

CBC, peripheral blood smear, bone marrow aspirate/biopsy and genetic/molecular testing.

What peripheral blood film feature strongly suggests megaloblastic anaemia?

Hypersegmented neutrophils with macro-ovalocytes.

Which vitamin deficiencies cause megaloblastic anaemia?

Vitamin B12 and folate deficiency.

What is the treatment for megaloblastic anaemia?

Vitamin B12 (cobalamin) and folic acid supplementation.