Basics

Question 1

What are some of the possible causes of low cell count?

Answer 1

Blood loss

Haemolytic anaemia

Bone marrow abnormalities

Chronic disease

Question 2

What are some of the causes of high cell count?

Answer 2

Infection

Malignancy

Steroids

Question 3

What terms are used to describe excess in haematology?

Answer 3

Cytosis or philia

Question 4

What term is used to describe shortage in haematology?

Answer 4

Penia

Question 5

Where does haematopoiesis occur in the embryo?

Answer 5

Yolk sac, then liver, then marrow

Spleen in the 3rd - 7th months

Question 6

In an adult, where is the common site for bone marrow aspiration and biopsy?

Answer 6

Posterior iliac crests

Question 7

What happens to the nucleus as red blood cells mature?

Answer 7

As the cell matures it loses its nucleus, once it leaves the bone marrow into the circulation it leaves the nucleus behind

Question 8

Which granulocyte is a polymorph with a segmented nucleus and has neutral staining granules?

Answer 8

Neutrophils

Question 9

Which granulocytes is usually bi-lobed and has bright orange/ red granules?

Answer 9

Eosinophils

Question 10

Which granulocytes has large deep purple granules which obscure the nucleus?

Answer 10

Basophils

Question 11

Which type of granulocyte is a circulating version of a tissue mast cell and mediates hypersensitivity reactions? This cell type has Fc receptors which bind IgE and granules which contain histamine.

Answer 11

Basophils

Question 12

Which cell type circulates for a week before entering tissues to become macrophages?

Answer 12

Monocytes

These phagocytose invaders and attract other cells

Question 13

Which cell type cognates responses to infection and ccan thus be considered the ‘brains’ of the immune system?

Answer 13

Lymphocytes

Question 14

What is Hb called when it is oxidised with Fe3+?

Answer 14

Methaemoglobin

Can’t carry oxygen in this state

Question 15

What does the RBC do for energy production?

Answer 15

Relies on glycolysis for energy production as it has no mitochondria

Question 16

Why do red blood cells have a limited lifespan?

Answer 16

They have no nucleus so can’t divide or replace damage

Question 17

What happens to the levels of erythropoietin in hypoxia?

Answer 17

Erythropoietin levels rise in hypoxia

Question 18

How is hypoxia sensed and what happens as a consequence?

Answer 18

Interstitial fibroblasts in the kidneys detect hypoxia in the blood flowing through the kidneys

This results in increased production of erythropoietin

Question 19

How does an increase in levels of erythropoietin levels in conditions of hypoxia act to increase red blood cell production?

Answer 19

Erythropoietin stimulates cell division red cell precursors and recruits more cells to the marrow

The result is erythroid hyperplasia (more machinery to produce RBCs)

Question 20

What are red blood cells called for the first few days after production?

Answer 20

Reticulocytes

Question 21

Worn out red blood cells are recycled into raw materials. What are these raw materials?

Answer 21

Iron, amino acids, bilirubin

Question 22

Where does red cell destruction usually occur?

Answer 22

Spleen

Question 23

How are aged red blood cells taken out of the circulation?

Answer 23

They are taken up by macrophages

Question 24

Describe how red blood cell contents are removed/ recycled

Answer 24

Globing chains are made into amino acid

Heme is broken down into iron and bilirubin

Bilirubin is taken to the liver, conjugated and then excreted in bile

Question 25

At the same p02, do HbF and myoglobin bind more or less oxygen than normal Hb?

Answer 25

At the same p02, both HbF and myoglobin can bind more 02

Question 26

What happens to the levels of 2,3 DPG in chronic anaemia?

Answer 26

2,3 DPG is increased in chronic anaemia

Question 27

How is most carbon dioxide transported?

Answer 27

Most carbon dioxide is transported as bicarbonate (60%) 10% is dissolved in solution 30% is bound directly to Hb as carbamino Hb

Question 28

Reactive oxygen species such as hydrogen peroxide are free radicals which have unpaired free electrons and can damage haemoglobin. How does glutathione counteract this?

Answer 28

Glutathione reacts with hydrogen peroxide to form water and oxidised glutathione product GSSG

Question 29

What does the Rapapoport Lubering shunt do?

Answer 29

Generates 2,3 DPG that shifts the oxygen dissociation curve to the right and allows more oxygen to be released

Question 30

What does the Embden-Myerhof pathway do?

Answer 30

Anaerobic glycolysis pathway Reverses Fe3+ to Fe2+

Question 31

How much iron is absorbed and lost per day?

Answer 31

1mg absorbed and 1mg lost

Question 32

Where does iron absorption mainly occur?

Answer 32

In the duodenum

Question 33

What things enhance or inhibit iron absorption?

Answer 33

Enhance iron absorption; - Ascorbic acid - Alcohol Inhibit iron absorption; - Tannins (e.g tea) - PPIs

Question 34

What is the role of ferroportin?

Answer 34

Facilitates iron export from cells Iron is then passed on to transferrin to be transported elsewhere

Question 35

What is the role of DMT (divalent metal transporter)?

Answer 35

Transports ferrous iron into the duodenal enterocyte

Question 36

What is the role of duodenal cytochrome B?

Answer 36

Reduces ferric iron (Fe3+) to ferrous form (Fe2+)

Question 37

What is the role of hepcidin?

Answer 37

It is the major negative regulator of iron uptake It binds to ferroportin and causes its degradation Produced in the liver in response to iron load and inflammation

Question 38

Different tests can be done to assess iron status. What is used to measure functional iron?

Answer 38

Haemoglobin concentration

Question 39

Different tests can be done to assess iron status. What is used to measure transport iron (iron supply to tissues)?

Answer 39

Transferrin saturation (saturation is normally 20-50%)

Question 40

Different tests can be done to assess iron status. What is used to measure storage iron?

Answer 40

Serum ferritin

Question 41

What is hereditary haemochromatosis?

Answer 41

An inherited condition involving decreased synthesis of hepcidin and thus iron loading

Question 42

Hereditary haemochromatosis can be caused by several different mutations but what is the most common?

Answer 42

Mutations in the HFE gene

Question 43

What would be the expected results of transferrin saturation and serum ferritin measurement in hereditary haemochromatosis?

Answer 43

Transferrin saturation >50% Serum ferritin >300ug in men/ 200ug in women

Question 44

How is hereditary haemochromatosis managed?

Answer 44

Weekly venesection Family screening

Question 45

Venesection is not a suitable treatment option for patients with secondary iron overload if they are already anaemic. What other management options can be considered?

Answer 45

Iron chelating agents - deferrioxamine- subcutaneous or IV Deferiprone/ deferasirox - oral gents