Blood and Bleeding Disorders

Question 1

What is haemotology?

Answer 1

involves the diagnosis and treatment of patients who have disorders of the blood and bone marrow

Question 2

what are the functions of blood? 4

Answer 2

transport
immune system
homeostasis
coagulation

Question 3

which cellular component of blood is vital for oxygen transport?

Answer 3

red blood cell / erythrocytes

Question 4

which cellular component of blood is vital in the immune system?

Answer 4

white blood cells / leukocytes

Question 5

which cellular component of blood is vital for clotting?

Answer 5

platelets

Question 6

blood is composed of what 2 things?

Answer 6

plasma
cells

Question 7

what does blood plasma contain? 6

Answer 7

proteins (clotting)
lipids
nutrients
hormones
electrolytes
water

Question 8

blood is composed of what cells? 3

Answer 8

red blood cells - erythrocytes
white blood cells - leukocytes
platelets (clotting)

Question 9

what is haematopoiesis?

Answer 9

production of the cellular components of blood

Question 10

where does haematopoiesis occur?

Answer 10

in the red bone marrow in flat bones in adults
(ribs, sternum, vertebrae, iliac crest)

Question 11

white blood cells - leucocytes are subdivided into what 5 categories?

Answer 11

lymphocytes
neutrophils
macrophages
eosinophils
basophils

Question 12

what are the 3 haematological investigations

Answer 12

bone marrow biopsy
full blood count
blood film

Question 13

what does a full blood count haematological investigation?

Answer 13

automated process that gives the number and size of cells in a blood sample

Question 14

platelet count is normally between?

Answer 14

150-400 x 10^9 per litre

Question 15

what is thrombocytopenia

Answer 15

platelet count <150

Question 16

what is thrombocythaemia

Answer 16

platelet count >400

Question 17

what’s another name for platelet?

Answer 17

thrombocyte

Question 18

this image illustrates what process?

Answer 18

taking a bone marrow sample (biopsy) from the iliac crest

Question 19

what is activated partial thromboplastin time? (APTT)

Answer 19

is the time (seconds) it takes for a patients plasma to clot after phospholipid, calcium and intrinsic pathway activator have been added to it.

Question 20

activated partial thromboplastin time APTT tests which pathways? 2

Answer 20

the function of the intrinsic and common coagulation pathways

Question 21

activated partial thromboplastin time detects deficiencies in? 5

Answer 21

factors
XII
XI
IX
VIII
factors in the common coagulation pathway

Question 22

what is prothrombin time PT?

Answer 22

time (seconds) that it takes for blood to clot after addition of the activating enzyme thromboplastin

Question 23

prothrombin time PT tests which pathways?

Answer 23

extrinsic and common coagulation pathway

Question 24

prolonged prothrombin time PT can indicate what?

Answer 24

deficiencies or inhibitors of one or more of factors II, V, VII, X and fibrinogen

Question 25

what is international normalised ratio?

Answer 25

reproducible version of prothrombin time patients prothrombin time divided by a standardised normal prothrombin time

Question 26

international ratio (INR) tests what?

Answer 26

the effect of warfarin on the blood

Question 27

in health a normal international ratio INR is?

Answer 27

1.1 or below

Question 28

coagulation depends on what? 2

Answer 28

platelet number and function coagulation cascade

Question 29

after vessel injury how does the platelet plug form and increase in size?

Answer 29

vasoconstriction reduces blood flow platelet aggregation activated platelets clump together, activating and attracting other platelets allowing the platelet plug to increase in size

Question 30

in the clotting cascade the intrinsic pathway is activated by?

Answer 30

internal damage to the vessel wall (exposure to endothelial collagen)

Question 31

in the clotting cascade the extrinsic pathway is activated by?

Answer 31

tissue factor / thromboplastin / factor III released by endothelial cells after external damage

Question 32

in the clotting cascade the intrinsic and extrinsic pathway merge to form?

Answer 32

common pathway

Question 33

in the clotting cascade results in? 3

Answer 33

conversion of fibrinogen to fibrin stabilisation of the fibrin clot formation of the blood clot

Question 34

what causes platelet problems?

Answer 34

deficiency production problem destruction

Question 35

how does liver disease affect blood coagulation

Answer 35

Site of production for all coagulation factors and precursor enzymes e.g. prothrombin

Question 36

the most common anti platelet drugs are? 3

Answer 36

Aspirin Clopidogrel Dipyridamole

Question 37

aspirin belongs to what drug group?

Answer 37

NSAIDs - non-steroid anti-inflammatory drugs

Question 38

the newer antiplatelet drugs are? 2

Answer 38

Ticregalor Prasugrel

Question 39

platelet aggregation problems are managed by? 2

Answer 39

treating underlying causes platelet transfusions

Question 40

coagulation cascade problems can be the result of what?

Answer 40

generalised deficiency specific deficiency

Question 41

the ? is the site of production for all the ? ? and their ? except for ? ? ?

Answer 41

liver coagulation factors inhibitors von Willebrand's factor

Question 42

example of a generalised deficiency that can cause coagulation cascade problems

Answer 42

generalised protein deficiency from liver disease or severe malnutrition

Question 43

what are the two types of specific deficiency associated with coagulation cascade problems?

Answer 43

congenital (inherited) drugs

Question 44

examples of specific congenital (inherited) deficiencies associated with coagulation cascade problems 2

Answer 44

haemophilia von Willebrand's disease

Question 45

examples of coagulation cascade problems associated with specific deficiencies drugs? 3

Answer 45

Warfarin and heparin direct oral anticoagulants - DOACs

Question 46

haemophilia is inherited in an ...?

Answer 46

X-linked recessive manner - males only

Question 47

what is deficient in haemophilia A?

Answer 47

coagulation factor VIII

Question 48

what is deficient in haemophilia B?

Answer 48

coagulation factor IX

Question 49

what happens in von Willebrands disease?

Answer 49

von Willebrand's coagulation factor is either reduced in quantity or functionality

Question 50

von Willebrand's disease is inherited in

Answer 50

a autosomal dominant manner male and female affected

Question 51

von Willebrand's disease affects

Answer 51

the function of platelets and factor VIII

Question 52

how is the risk from von Willebrand's disease managed? 2

Answer 52

trauma avoidance preparation for expected bleeding (operations)

Question 53

what is warfarin?

Answer 53

oral anticoagulant Inhibits the activation of vitamin K -> reduction in the body stored of vitamin K -> reduced production of activating clotting factors

Question 54

do the drugs DOACs or Warfarin require INR testing?

Answer 54

only warfarin as its unstable and reacts with other medications

Question 55

examples of DOACs (direct oral anticoagulants)

Answer 55

apixaban rivaroxaban edoxaban dabigatran

Question 56

the DOACs apixaban, rivaroxaban and edoxaban inhibit what?

Answer 56

factor Xa

Question 57

the DOAC dabigatran inhibits what?

Answer 57

thrombin

Question 58

what is heparin and low molecular weight heparins?

Answer 58

injectable anticoagulants used commonly in hospital after surgery to prevent blood clots - dialysis

Question 59

manifestations of coagulation problems

Answer 59

traumatic bleeding mucosal bleeding

Question 60

what is purpura?

Answer 60

discolouration of the skin or mucous membranes due to haemorrhage from small blood vessels

Question 61

what is this type of purpura called?

Answer 61

petichiae

Question 62

what is this type of purpura called?

Answer 62

ecchymoses