Pathology EMQ template.

Name:  Liam Jones

Theme: Haemolytic Anaemias (HA)

OPTION LIST

A	Burns	I	Malaria
B	Cold Autoimmune HA	J	March haemoglobinuria
C	Direct membrane damage (drugs)	K	Mechanical haemolysis
D	G6PD deficiency	L	Microangiopathic HA
E	Haemolytic transfusion reaction	M	Paroxysmal nocturnal haemoglobinuria
F	Hereditary spherocytosis	N	Sickle Cell disease
G	Hypersplenism	O	Thalassaemia
H	Immune (drug induced)	P	Warm Autoimmune HA

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 17 year old was diagnosed with Infectious Mononucleosis (EBV).  Confirmatory blood tests also revealed anaemia. Direct Coombs test was positive (but not “strongly positive”).  On more detailed analysis, IgM antibodies were eluted from red cells with C3d remaining.

2. A 4 year old African boy attends your clinic with recurrent pain in the hands.  While in the cold waiting room he suddenly grasps his chest in pain and starts breathing rapidly. Investigations reveal hypoxia and new chest X-ray changes that look like consolidation.

3. An 18 year old attending a routine check up at her new GP practice is noted to have mild splenomegaly and a leg ulcer.  Upon questioning she mentions that she had jaundice as a child, and that one of her parents (and grandparents) suffer from anaemia.  Blood results reveal slight anaemia with hyperchromic cells lacking central pallor.  Coombs test is negative.

4. A 58 year old man from South East Asia attends for a clinic feeling anaemic on return from holiday in Africa.  On direct questioning he admits that he did start taking the Primaquine and Quinine you prescribed until a couple of days ago.  Blood film revealed Heinz bodies and bite cells.

5. A 31 year old student nurse returns from her elective in Indonesia feeling generally unwell, with rigors and fever.  Clinical examination reveals slight splenomegaly and haematuria.

ANSWERS

1. B

2. N

3. F

4. D

5. I