Blood

Question 1

Hemopoesis

Answer 1

Refer to picture.

Question 2

RBCs

Answer 2

Recombinant erythropoietin.
Problems = anaemia-hypoxia (hypo-regenerative vs. hyper-regenerative, reduced production vs. increased destruction, corpuscular vs. extra-corpuscular), polycythaemia-thrombosis (primary vs secondary).

Question 3

Anaemia

Answer 3

Corpuscular - membrane, haemoglobin, enzymes.
Extra-corpuscular - reduced production (iron, B2, chemotherapy), increased destruction (bleeding, haemolysis, autoimmune), redistribution (hypersplenism).

Question 4

Sickle cell disease

Answer 4

Haemoglobin abnormal - shape changes.
Acute chest syndrome.
Crizanlizumab - antibody drug bids to p-selectin - P-selectin increases the rate of adhesion of sickle red blood cells to blood vessels preventing then from going through smaller vessels and causing pain.

Question 5

WBCs

Answer 5

Generated in BM - mature in thymus.
Innate immunity - neutrophils, eosinophils, basophils, macrophages, mast cells. (Non-specific).
Adaptive immunity - T helper cell, B cells, DCs. (Specific).
Humoral immunity - secrete antibodies - plasma cells, memory B cells.
Cell mediated immunity - defence against infected cells, transplants and cancer - memory TH, memory TC, active TC cells.

Question 6

Lymphocyte maturation

Answer 6

Refer to picture.

Question 7

WBC abnormalities

Answer 7

Neutrophil leukocytosis.
Eosinophilia.
Basophilia.
Monocytosis.
Lymphocytosis.
Myeloid malignancies.
Lymphoid/plasma cell malignancies.

Question 8

GVHD/BITE/CAR-T

Answer 8

Look at the slides.

Question 9

Platelets

Answer 9

Derive from megakaryocytes by exocytosis.
Responsible for blood clotting.
Plasma membrane - cytoskeleton - dense tubular system - secretory granules (Alpha, dense, lysosome, peroxisome).

Question 10

Platelets functions

Answer 10

Initiation - endothelial injury, PLT shape, adhesion.
Propagation - granular release, PLT activation, aggrevation.
Stabilisation - primary PLT thrombus.

Question 11

Types of bleeding

Answer 11

PLT type - skin or mucosal bleeding, rash, WF disease, medication, liver disease, renal failure.
Haemophilia type - Hx of muscle/joint bleeding, large suffusing, haemophilia A/B/C.

Question 12

Pathogenetic classification of thrombocytopenia

Answer 12

Reduced production (less megakaryocytes) - congenital, acquired.
Increased destruction (more megakaryocytes) - immune,microangiopathic, consumptive.
Altered redistribution.
Pseudothrombocytpenia.

Question 13

Pathogenetic classification of thrombocytopathias

Answer 13

Congenital - adhesion, aggregation, secretion, procoagulant activity.
Acquired - medication related, underlying disease - renal failure, MDS, MPN, liver disease.

Question 14

Normal haemostasis

Answer 14

Healthy individual
- primary haemostasis - normal PLT count and function.
- normal procoagulants (PT, APTT) and anticoagulants.
- normal FBG level and structure - termination, fibrinolysis.

Question 15

Thrombocytosis

Answer 15

Clonal/malignant - MPN, MDS - increased risk of arterial or venous thrombosis, antiplatelet anticoagulant ion.
Reactive - bleeding/iron deficiency - infection/inflammation, hyposplenism - trauma - treating the underlying condition.

Question 16

Plasma

Answer 16

Water - up to 95% water.
Electrolytes.
O2 and CO2.
Proteins (6-8%) - albumin, globulins, hormones, transportation proteins, coagulation factors.

Question 17

PCC vs FFP

Answer 17

PCC - immediate effect, full correction, TE risk, less disease transmission, rare allergic reaction.
FFP - 1-2 hour effect - partial correction - disease transmission, alloimmunisation, hypervolemia, TRALI, increased infections.

Question 18

FFP use

Answer 18

Plasma should not be used for volume replacement.
If virally‐inactivated specific clotting factors are not available, pathogen‐reduced plasma may be used for factor replacement in congenital coagulation factor deficiency.
Massive transfusion protocol.
TTP.
Reconvalescent plasma, plasma as albumin, IVIG, cryoprecipitate, FBG source.