ABSTRACT
A 22-year-old motorcyclist is involved in a road traffic accident, and is transfused two units of blood. Four hours later he develops acute shortness of breath and hypoxia, and despite attempts at ventilation deteriorates rapidly and goes into respiratory arrest. An autopsy shows evidence of massive pulmonary oedema with granulocyte aggregation within the pulmonary microvasculature. The most likely diagnosis is:
A Anaphylaxis B ABO incompatible blood transfusion C Fluid overload D Transfusion related acute lung injury E Air embolism
A 43-year-old woman is transfused three units of blood as an emergency following prolonged haematemesis. A few minutes later she becomes restless, and complains of chest pain. On examination she is pyrexial and tachycardic with a blood pressure of 95/60. There is bleeding at the site where her cannula is inserted, and urinalysis reveals haemoglobinuria. The most likely diagnosis is:
A Anaphylaxis B ABO incompatible blood transfusion C Myocardial infarction D Graft versus host disease E Bacterial contamination
An 83-year-old woman with myelodysplasia is found to have a haemoglobin of 6.2 on admission. She is transfused two units of blood, and is discharged 2 days later. Six days after her admission her carer calls the GP with concerns that she is feverish and her skin looks slightly yellow. She is readmitted to hospital where blood tests reveal the following: bilirubin 35, ALT 15 (N 5-35), ALP 82 (N 20-140), Hb 7.3 g/dL, platelets 264 × 109/L. The most likely diagnosis is:
A Febrile haemolytic transfusion reaction B Hepatitis B C Graft versus host disease D Post-transfusion purpura E Delayed haemolytic transfusion reaction
An 8-year-old boy is brought to his GP by his father, who reports that he has been feeling progressively more tired over the past few months. On examination the GP notices a slight yellowing of his sclera, and the presence of splenomegaly. His father recollects that he himself was told he had a problem with his blood cells as a child, but has never been affected by it. A peripheral blood film shows a raised reticulocyte count and spherocytes. He is likely to have a positive:
A Coombs test B Osmotic fragility test C G6PD test D Sickle cell screen E Schilling test
A 33-year-old Turkish man presents with extreme tiredness and shortness of breath after being started on a course of anti-malarial tablets. A full blood count reveals an Hb of 6.8. His Coombs test is negative. The cell type most likely to be found on his blood film is:
A Heinz bodies B Pencil cells C Target cells D Spherocytes E Sickle cells
A 25-year-old student is treated for infectious mononucleosis following a positive Paul Bunnell test. A blood film reveals target cells, Howell-Jolly bodies and atypical lymphocytes. Together, these suggest that he has features of:
A Bone marrow suppression B Hyposplenism C Disseminated intravascular coagulation D Haemolytic anaemia E Liver failure
A 4-year-old Afro-Caribbean boy has chest and abdominal pain. His blood tests reveal an Hb of 6.1 g/dL, with an MCV of 65. A blood film shows the presence of sickle cells. The most likely diagnosis is:
A Sickle cell trait B Sickle cell anaemia C Sickle cell/β-thalassaemia D Sickle cell/haemoglobin C E β-Thalassaemia
A 7-year-old child has known sickle cell disease. He presents with a 5-day history of fever, shortness of breath and extreme fatigue. His mother reports that his younger brother, who also has sickle cell disease, has been feeling unwell too recently. A blood test for the patient reveals a severe anaemia and low reticulocyte count. He has most likely developed:
A Splenic sequestration B Pneumococcal infection C Vaso-occlusive crisis D Folic acid deficiency E Parvovirus B19 infection
A 26-year-old pregnant woman is found to have an Hb of 9.5 g/dL on a routine blood test, with an MCV of 70. Serum electrophoresis reveals an Hb A2 of 3.9 per cent and Hb A of 96.1 per cent. Her ferritin levels are normal. The most likely diagnosis is:
A Iron deficiency anaemia B Cooley’s anaemia C β-Thalassaemia intermedia D β-Thalassaemia minor E α-Thalassaemia
A 24-year-old unemployed man presents to his GP with a 4-week history of flu-like symptoms and a persistent dry cough. On examination he has a maculopapular rash. A blood film reveals a haemolytic anaemia, and he is positive for cold agglutinins. The most likely organism implicated is:
A Streptococcus pneumoniae B Mycoplasma pneumoniae C Legionella pneumophilia D Chlamydophila psittaci E Borrelia burgdorferi
A 7-year-old boy is taken ill from school on a cold December day, with a presumed viral infection. On returning home that day, he beings to feel even more unwell with a very high fever, headache and abdominal pain. His father begins to worry that his skin has taken on a yellow tinge, and the boy says his urine is now a dark reddy-brown colour. He is taken to the GP and after several tests the presence of ‘Donath-Landsteiner antibodies’ is reported. This child is suffering from:
A Paroxysmal cold haemoglobinuria B Paroxysmal nocturnal haemoglobinuria C Sickle cell disease D Acute intermittent porphyria E Epstein-Barr virus
A 21-year-old student has recently been diagnosed with coeliac disease. She presents to her GP complaining of increased tiredness and shortness of breath on climbing stairs. Which of the following are most likely to be raised in this patient?
