blood key points

Question 1

functions

Answer 1

transport of nutrients
removal of waste
transport of host defences

Question 2

composition

Answer 2

cells
plasma proteins - albumin and globulins
lipids
nutrients
water

Question 3

RCC

Answer 3

estimate number of rbc/l of blood

Question 4

HCT

Answer 4

% of rbc to total blood vol

cell/liquid ratio

Question 5

anaemia

Answer 5

low Hb

Question 6

polycythaemia

Answer 6

raised Hb

Question 7

platelet number

Answer 7

FBC

Question 8

platelet fct

Answer 8

bleeding time

Question 9

DIC

Answer 9

atherosclerosis - inflamed endothelium releases tissue factor - initiate clotting (also sepsis)
blood clots form throughout body, blocking small blood vessels
depletes platelets and CFs - excessive bleeding

Question 10

clotting stages

Answer 10

vasoconstriction
platelet plug
coagulation

Question 11

AT3

Answer 11

inhibits coagulation - neutralises enzymatic activity of thrombin

Question 12

proteins C and S

Answer 12

anticoagulants

inactivate Va and VIIIa

Question 13

thrombophilia

Answer 13

excessive tendency to clot - usually DVT

- life threatening due to PE

Question 14

thrombophilia - thrombo-promoting actions

Answer 14

smoking
immobility
pregnancy
surgery
OCP

Question 15

thrombophilia common reasons

Answer 15

AT3 deficiency
protein C or S deficiency
factor V leiden variant

Question 16

therapeutic coagulopathy

Answer 16

where coagulation cascade is manipulated by medicine to make clotting less likely
reduce platelet adhesion and function - usually prevent arterial thrombosis
reduce activity in coagulation cascade - usually prevent venous thrombosis

Question 17

porphyria

Answer 17

abnormality of haem metabolism - deficiencies in enzymes
can’t produce enough haem
2 main types - hepatic and erythropoietic

Question 18

clinically relevant porphyrias

Answer 18

variegate - Afrikaans descent
acute intermittent
hereditary coporphyria

Question 19

clinical effects of porphyria

Answer 19

photosensitive rash
neuropsychiatric disturbance in acute attacks
 - motor and sensory changes, seizures
 - autonomic disturbances
hypertension and tachycardia
may be fatal

Question 20

porphyria triggers

Answer 20

poorly understood
many drugs
pregnancy
acute infections
alcohol
fasting

Question 21

broad causes of anaemia

Answer 21

reduced production
increased losses
increased demand

Question 22

dental aspect of porphyria

Answer 22

drug administration - be vvvvvv cautious

Question 23

microcytic anaemia

Answer 23

Fe deficiency, thalassaemia

Question 24

macrocytic anaemia

Answer 24

B12/folate deficiency

reticulocytosis

Question 25

anaemia - reduced production

Answer 25

``` reduced normal red cells - marrow failure - aplastic anaemia normal red cells, reduced Hb - deficiency states - abnormal globin chains - chronic inflammatory disease ```

Question 26

iron absorption

Answer 26

duodenum

Question 27

diseases reducing iron absorption

Answer 27

achlorhydria - lack of stomach acid - no conversion of non-haem iron coeliac disease

Question 28

iron loss

Answer 28

``` gastric erosion and ulcers IBD: Crohns, UC bowel cancer haemorrhoids internal bleeding ```

Question 29

sources of vit B12

Answer 29

animal/fortified foods

Question 30

absorption of vit B12

Answer 30

terminal ileum | - combines with intrinsic factor

Question 31

fct of vit B12

Answer 31

DNA synthesis

Question 32

vit B12 deficiency

Answer 32

lack of intake - strict vegans lack of intrinsic factor - pernicious anaemia disease of terminal ileum e.g. crohns

Question 33

folic acid deficiency

Answer 33

lack of intake (odd diet) absorption failure - jejunal disease e.g. coeliac - usually seen codeficient with iron

Question 34

consequence of folic acid deficiency

Answer 34

can lead to neural tube defects in foetus - spina bifida

Question 35

anaemia - increased losses

Answer 35

``` RCC and HCT normal red cells - bleeding - chronic GI bleed, menstrual abnormal red cells - AI, hereditary - sickle, G6PD, spherocytosis ```

Question 36

anaemia - increased demand

Answer 36

pregnancy | malignant disease

Question 37

thalassaemia

Answer 37

normal haem production genetic mutation of globin chains - a and B

Question 38

clinical effects of thalassaemia

Answer 38

``` chronic anaemia marrow hyperplasia (skeletal deformities) splenomegaly cirrhosis (liver affected by extra Fe) gallstones ```

Question 39

management of thalassaemia

Answer 39

blood transfusions | prevent iron overload

Question 40

reticulocytosis

Answer 40

almost mature rbcs released early into circulation to replace losses will raise MCV

Question 41

sickle cell anaemia

Answer 41

less common than thalassaemia abnormal globin chains - a different genetic mutation to thalassaemia change shape in low O2 env - prevent rbc from passing through capillaries - stick and block capillaries - tissue ischaemia - pain and necrosis

Question 42

sickle cell trait

Answer 42

heterozygous one abnormal gene carrier

Question 43

anaemia diagnosis

Answer 43

Hb - degree of anaemia? RCC and HCT - cell or Hb formation deficiency? MCV - deficiency?

Question 44

anaemia investigations

Answer 44

``` history FBC FOB endoscopy/colonoscopy renal fct bone marrow examination ```

Question 45

anaemia tx

Answer 45

``` tx cause replace haematinics - FeSO4 200mg tds 3m - 1mg IM vitB12 x6 then 1mg/2m - 5mg folic acid daily transfusions - production failure erythropoietin - production failure - renal disease - made by kidneys, induces rbc formation ```

Question 46

anaemia dental aspects

Answer 46

GA - O2 capacity | haematinic deficiency - oral infections, ROU, BMS

Question 47

myelooid cells

Answer 47

``` erythrocytes megakaryocytes neutrophils basophils eosinophils monocytes ```

Question 48

lymphoid cells

Answer 48

B T NK

Question 49

leukaemia and lymphoma types

Answer 49

``` acute lymphoblastic leukaemia acute myeloid leukaemia chronic lymphocytic leukaemia HL NHL multiple myeloma chronic myeloid leukaemia myeloproliferative disorders ```

Question 50

clinical presentation of leukaemia

Answer 50

``` anaemia neutropenia thrombocytopenia lymphadenopathy splenomegaly/hepatomegaly ```

Question 51

acute lymphoblastic leukaemia

Answer 51

peak age 4yrs catabolic state - fever, sweats, malaise lymphadenopathy and tissue infiltration common

Question 52

acute myeloid leukaemia

Answer 52

more common elderly similar presentation clinically to ALL poor prognosis

Question 53

chronic lymphocytic leukaemia

Answer 53

elderly mostly asymptomatic and discovered on routine blood tests commonest leukaemia slow progression, may not require tx

Question 54

chronic myeloid leukaemia

Answer 54

increase in neutrophils and their precursors | lots have philadelphia chromosome

Question 55

is HL or NHL more common?

Answer 55

NHL

Question 56

HL

Answer 56

``` peak 15-40yrs mutation in DNA of B lymphocytes risk factors - weakened immune system e.g. HIV - immunosuppressant meds - (EBV) - had NHL Reed-Sternberg cells microscopically older peiple do less well ```

Question 57

symptoms of HL

Answer 57

``` painless cervical lymphadenopathy fever night sweats weight loss itching infection ```

Question 58

NHL

Answer 58

mutation in lymphocyte DNA - multiply uncontrollably B cell (85%) or T cell (15%) types any age - more indolent elderly aetiology - microbial factors strongly indicated: EBV, HTLV-1, h pylori - AI disease - SS, RA - immunosuppression - AIDS, post-transplant

Question 59

NHL presentation

Answer 59

lymphadenopathy extra-nodal disease more common - oropharyngeal involvement - Waldeyer's ring (noisy breathing and sore throat) symptoms of marrow failure constitutional symptoms less common

Question 60

NHL prognosis

Answer 60

poor

Question 61

multiple myeloma

Answer 61

malignant proliferation of plasma cells - release lots of paraprotein (an antibody) often elderly

Question 62

multiple myeloma features

Answer 62

monoclonal paraprotein in blood and urine lytic bone lesions - pain and fracture excess plasma cells in bone marrow - marrow failure

Question 63

multiple myeloma symptoms

Answer 63

infection bone pain renal failure amyloidosis

Question 64

multiple myeloma management

Answer 64

bisphosphonates

Question 65

myeloproliferative disorders

Answer 65

make lots more cells | blood becomes more viscous - harder to move around body

Question 66

tx of haematological malignancies concepts

Answer 66

``` induction remission maintenance and consolidation relapse - often repeat this cycle several times before a cure is reached ```