basics

Question 1

describe neutrophils

Answer 1

polymorphs (take various forms)
phagocyte invaders
attract other cells to site of injury/infection
increased in stress

Question 2

describe eosinophils

Answer 2

bi-lobed, red granules
hypersensitivity reactions
fight parasites
allergic conditions

Question 3

describe basophils

Answer 3

large deep purple
tissue mast cells
mediate hypersensitivity reactions
granules contain histamine

Question 4

describe monocytes

Answer 4

phagocytose invaders
liver longer than neutrophils

Question 5

describe lymphocytes

Answer 5

small with condensed nucleus and rim of cytoplasm
released in response to infection

Question 6

where is erythropoietin made?

Answer 6

kidneys

Question 7

what is erythropoietin released in response to and what does it stimulate?

Answer 7

hypoxia and RBC production

Question 8

where does red cell destruction occur?

Answer 8

liver and spleen
red cells taken up by macrophages

Question 9

what do the products of red cell destruction make?

Answer 9

globin chains = amino acids
haem = iron and bilirubin

Question 10

what will happen if a cell has no mitochondria?

Answer 10

no kreb’s cycle, relies on glucose metabolism

Question 11

what will happen if a cell has no nucleus?

Answer 11

can’t divide, can’t replace damaged proteins, limited lifespan

Question 12

what will happen if a cell is stuffed with Hb?

Answer 12

high osmotic pressure, needs to pump ions to stop swelling

Question 13

what is iron in its reduced form

Answer 13

Fe2+ -> Fe3+ = stopped by NADH (electron donor)

Question 14

what is needed for cells susceptible for oxidative stress?

Answer 14

glutathione, stops H2O2 forming, G6PG = rate limiting enzyme

Question 15

how is microcytic anaemia seen on blood results?

Answer 15

low Hb and low MCV

Question 16

what is microcytic anaemia due to?

Answer 16

haemoglobinisation problems

Question 17

what are the causes of microcytic anaemia?

Answer 17

TAILS
thalassaemia
anaemia of chronic disease
iron deficiency
lead poisoning
sideroblastic anaemia

Question 18

what is the most common cause of microcytic anaemia?

Answer 18

iron deficiency

Question 19

what is functional iron?

Answer 19

haemoglobin

Question 20

what is transported iron?

Answer 20

serum iron, transferrin

Question 21

what is iron stored as?

Answer 21

serum ferritin

Question 22

what inhibits iron transport?

Answer 22

hepcidin

Question 23

what is thalassaemia caused by?

Answer 23

fucked up globin chain

Question 24

what is iron deficiency anaemia, anaemia of chronic disease caused by?

Answer 24

fucked up iron part of the haemoglobin chain

Question 25

what is sideroblastic anaemia caused by?

Answer 25

fucked up part of protoporphyrin part of haemoglobin chain

Question 26

what are the 2 haemoglobinopathies?

Answer 26

thalassaemia and sickle cell

Question 27

what are the different types of haemoglobin?

Answer 27

haemoglobin A - HbA, HbA2, HbF 2 alpha chains 2 beta chains

Question 28

when does sickle cell occur?

Answer 28

when there's a mutation that alters haemoglobin structure

Question 29

what is the diagnostic sign of beta-thalassamia?

Answer 29

raised HbA2

Question 30

what are the clinical signs and symptoms of alpha thalassaemia?

Answer 30

trait - asymptomatic, possible low MCV full disease -moderate anaemia, very low MCV patient presents with jaundice, splenomegaly fetalis - not compatible with life

Question 31

what are the clinical signs and symptoms of beta thalassaemia?

Answer 31

babies - HbF falls - pale, failure to thrive

Question 32

what is the treatment for beta thalassaemia?

Answer 32

regular transfusions for live (side effect = iron overload) meds = desferrioxamine

Question 33

what is the pathophysiology of a sickle crisis?

Answer 33

in low O2 levels, HbS polymerises and distorts shape of red cell leading to vaso-occlusion = sickle crisis

Question 34

what investigations are used for sickle crisis?

Answer 34

FBC (Hb, RBC) blood film (target cells, teardrop cells) haemoglobin electrophoresis = beta thalassaemia (identifies HbS and if HbA2 raised)

Question 35

how do you treat a sickle crisis?

Answer 35

acute - analgesia, hydration, oxygen chronic - if hyposplenism = prophylactic penicillin, folic acid, hydroxycarbamide (hydroxyurea)

Question 36

what are the underlying causes of AOCD?

Answer 36

causes of inflammation, autoimmune, malignancy, disease

Question 37

how does AOCD present?

Answer 37

microcytic/normocytic anaemia chronic infection autoimmune conditions HIGH SERUM FERRITIN

Question 38

how do you treat AOCD?

Answer 38

treat underlying cause recombinant EPO and iron supplements

Question 39

what are the blood findings of iron deficiency anaemia?

Answer 39

decreased functional iron (Hb) + reduced storage iron (low serum ferritin)

Question 40

what are the causes of IDA?

Answer 40

diet - vegetarian pregnancy blood loss - menorrhagia, GI bleeds (ulcers, tumours) NSAIDs, haematuria coeliac

Question 41

what does negative iron balance lead to?

Answer 41

iron deficient erythropoiesis - falling RBC MCV microcytic anaemia epithelial changes - skin, koilonychiaw

Question 42

what is management for IDA?

Answer 42

iron supplementation

Question 43

how does lead poisoning present?

Answer 43

cognitive defects peripheral neuropathy renal dysfunction neuro signs + microcytic anaemia = LEAD POISONING

Question 44

what is sideroblastic anaemia?

Answer 44

impaired haem synthesis as can't put iron and protoporphyrin together = IRON OVERLOAD

Question 45

how does acquired sideroblastic anaemia present and what are the causes?

Answer 45

macrocytic anaemia myelodysplastic syndromes, drugs and toxins

Question 46

how does congenital sideroblastic anaemia present and how is it passed on?

Answer 46

microcytic, hypochromic anaemia x-linked

Question 47

how does sideroblastic anaemia generally present?

Answer 47

weakness, fatigue, difficulty breathing iron overload -> hepatomegaly/splenomegaly, arrhythmias

Question 48

what investigations are used in sideroblastic anaemia and what will be seen on it?

Answer 48

blood film increased reticulocytes, stippled RBCs (basophilic stippling)

Question 49

what is the management for sideroblastic anaemia?

Answer 49

pyridoxine iron overload = deferoxamine

Question 50

what is the initial investigation for macrocytic anaemia

Answer 50

blood smear