In idiopathic thrombocytopenic purpura what are the autoantibodies most commonly directed at?
Correct Answer B:
ITP: Idiopathic thrombocytopenic purpura (ITP) is an immune mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb-IIIa or Ib complex.
ITP can be divided into acute and chronic forms:
Acute ITP:
Chronic ITP:
Evan's syndrome:
A 67-year-old man is investigated for dyspepsia. A gastroscopy reveals a suspicious lesion which is biopsied.
Which one of the following findings on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
Correct Answer E: Gastric adenocarcinoma - signet ring cells.
Gastric cancer: Epidemiology:
Associations:
Investigation:
A 34-year-old man who is known to have type 1 von Willebrand's disease asks for advice. He is due to have a tooth extracted at the dentist next week.
Which one of the following is the most appropriate management to reduce the risk of bleeding?
Correct Answer C: Blood products such as factor VIII concentrate should be avoided when possible to minimize the risk of transfusion acquired viral illnesses.
Von Willebrand's disease:
Von Willebrand's disease is the most common inherited bleeding disorder. The majority of cases are inherited in an autosomal dominant fashion* and characteristically behaves like a platelet disorder i.e. epistaxis and menorrhagia are common whilst haemoarthroses and muscle haematomas are rare.
Role of von Willebrand factor:
Types:
Management:
*Type 3 von Willebrand's disease (most severe form) is inherited as an autosomal recessive trait. Around 80% of patients have type 1 disease
A 54-year-old woman who has had a hysterectomy presents for advice about hormone replacement therapy.
Which one of the following would result from the use of a combined oestrogen-progestogen preparation compared to an oestrogen-only preparation?
Correct Answer C: HRT: adding a progestogen increases the risk of breast cancer.
This is the rationale behind giving women who've had a hysterectomy oestrogen-only treatment. The BNF states that the stroke risk is the same regardless of whether the HRT preparation contains progesterone.
Hormone replacement therapy: adverse effects:
Hormone replacement therapy (HRT) involves the use of a small dose of oestrogen (combined with a progestogen in women with a uterus) to help alleviate menopausal symptoms.
Side-effects:
Potential complications:
Breast cancer:
A 66-year-old woman is referred by her GP with anaemia. She has been feeling generally unwell for the past 3 weeks. Bloods on admission show:
Further tests were then ordered:
Which one of the following is the most likely underlying cause?
Correct Answer A: The blood results suggest warm autoimmune haemolytic anaemia (AIHA) which may be caused by non- Hodgkin's lymphoma. Mycoplasma pneumonia is associated with cold AIHA. The other three listed conditions are not commonly associated with AIHA.
Autoimmune haemolytic anaemia:
Autoimmune haemolytic anaemia (AIHA) may be divided in to 'warm' and 'cold' types, according to at what temperature the antibodies best cause haemolysis. It is most commonly idiopathic but may be secondary to a lymphoproliferative disorder, infection or drugs. AIHA is characterized by a positive direct antiglobulin test (Coombs' test).
Warm AIHA:
In warm AIHA the antibody (usually IgG) causes haemolysis best at body temperature and haemolysis tends to occur in extravascular sites, for example the spleen. Management options include steroids, immunosuppression and splenectomy.
Causes of warm AIHA:
Cold AIHA:
The antibody in cold AIHA is usually IgM and causes haemolysis best at 4 deg C. Haemolysis is mediated by complement and is more commonly intravascular. Features may include symptoms of Raynaud's and acrocynaosis. Patients respond less well to steroids.
Causes of cold AIHA:
*Systemic lupus erythematosus can rarely be associated with a mixed-type autoimmune haemolytic anaemia.
Click to expand