Some clinical hematology mcqs

Welcome to your Clinical hematology case based MCQs

1. A 70-year-old man trips on his doorstep. He develops massive bruising of his thigh and leg and heavy bleeding from a wound to the shin. He has a past medical history of myocardial infarction 20 years previously and idiopathic bile salt malabsorption, for which he is taking colestyramine. His FBC shows WBC 6.8 × 109/l, Hb 119 g/l, MCV 95 fl and platelet count 420 × 109/l. His blood film shows polychromasia. A coagulation screen shows PT >120 s (12–14), APTT 102 s (23–35), thrombin time 12 s (control 13 s) and fibrinogen concentration 3.5 g/l.The most likely explanation of the abnormal coagulation is:
2. A high platelet count (778 × 109/l) is an incidental finding in a 35-yearold woman. She is referred to haematology outpatients where she is seen 4 weeks later. There is no other relevant history and specifically nothing to suggest an infective or inflammatory disorder. Her spleen is felt on inspiration. On this occasion the platelet count is 670 × 109/l with a WBC of 11.2 × 109/l, Hb 148 g/l and MCV 97 fl. A manual differential count shows neutrophils of 9.0 × 109/l and basophils of 0.2 × 109/l. No neutrophil precursors or NRBC are seen. Erythrocyte sedimentation rate and C-reactive protein are normal. Analysis for JAK2 V617F is therefore done and is negative. The next thing you would do is:
3. A 17-year-old woman presents with microangiopathic haemolytic anaemia, hypertension, acute renal injury (creatinine 285 μmol/l) and a platelet count of 40 × 109/l. ADAMTS13 is found to be 55%. Atypical haemolytic uraemic syndrome (aHUS) is suspected. The most effective management is likely to be:
4. A 21-year-old man presents with episodic pallor, jaundice and dark urine following exercise. His FBC shows Hb 151 g/l, MCV 103 fl and MCHC 356 g/l (325-352). Reticulocytes are 5% and total and non-conjugated bilirubin are increased. Osmotic fragility is reduced and red cells show an increased sodium and reduced potassium concentration. A blood film shows occasional target cells and irregularly contracted cells. The most likely diagnosis is: