Blood system Flashcards
(38 cards)
What is meant by the term hemorrhagic diathesis?
Hemorrhagic diathesis is an umbrella term used to refer to the blood disorders that occur without any trauma. The term encompasses repeated bouts of bleeding caused by the following three:
- coagulopathy (something wrong with the coagulation system)
- thrombocytopathy (something wrong with the platelets)
- angiopathy (something wrong with the blood vessels)
Haemophilia is an X-linked blood clotting disorder that only affects males (in the majority of the cases). It is further categorised into groups, depending on which clotting factor is absent? What are these groups?
- Haemophilia group A = deficiency of factor VIII
- Haemophilia group B = deficiency of factor IX
- Haemophilia group C = deficiency of factor XI
What are the stages of bone marrow development in an embryo?
2nd month - bone marrow is found in clavicle
3rd month - bone marrow is found in flat bones ie. scapula, skull bones, ribs, sternum) + vertebrae
4th month - bone marrow is found in tubular/cylindrical bones
What are three of the most typical complaints associated with disorders of the blood system?
- bleeding
- pallor of mucous membranes
- ostealgia (pain in bones)
You see a patient who presents with haemorrhagic rashes, you are teaching a junior doctor how to describe the characteristics of such rashes. They suspect petechiae, purpura or ecchymoses. How can you differentiate between these options?
- petechiae = small red dots ca. 1-2 mm in size
- purpura = circular red spot ca. 2-5 mm in size
- ecchymoses = irregularly shaped spot, > 5 mm in size
When a patient presents with haemorrhagic rashes, in order to identify the type of rash, certain features must be elaborated on. What are they?
- location (symmetrical? asymmetrical? unilateral? bilateral?)
- size
- number (if possible to calculate)
- colour
A patient presents to the clinic with red spots, you suspect that the rashes are of haemorrhagic origin, however you are not 100% sure - how can you confirm your diagnosis?
You can differentiate between haemorrhagic rashes and rashes of other origin by applying pressure to the area. Haemorrhagic rashes do not blanch.
You suspect hypersplenism in a 5-year-old girl and you have been asked by your supervising consultant to palpate her spleen. What are the instructions in palpation of a spleen?
- patient should be in supine position
- their hands should not be covering their abdomen
- the left hand can be bend at the elbow joint and positioned near the neck
- the right hand can be on their side - right leg should bent at the knee joint (this is to relax the abdominal muscle)
- the doctor should be on the right side of the patient and their left hand should be placed at rib X
- the right hand should be on top of the left hand at ca. 90 degress ot the costal arches
- Ask the patient to take a deep breath in, this will lower the spleen
Usually the spleen is not palpable, however in the event that it does become enlarged, there are a few features we should take note of. What are they?
- does it have a pole form?
- where is the pole of the spleen located? How far is it below the costal arch?
- what is the consistency like?
- what is the surface like?
- is it mobile? This is pathological, since the spleen is usually immobile
- is there are pain in the spleen area?
A 30-year-old man presents to the clinic with pain in the abdominal region and you have narrowed down your differential diagnoses to mesenteric lymphadenitis and appendicitis. Your hunch is that the patient has appendicitis - how can you confirm or reject this?
Klein’s symptom is very important in the differentiation between mesenteric lymphadenitis and appenditicis. Klein’s symptoms refers to the movement of pain (with whatever side they’re lying on). In appendicitis, Klein’s symptom is -ve (in other words there is no pain).
What is the MCHC (mean cell haemoglobin concentration) and how is it calculated in the blood? What significance does it have?
The MCHC looks at the average [Hb] in each RBC. It is calculated by the following equation:
MCHC = (3 * [Hb] )/ #erythrocytes (first three digits)
You are examining the thoracic lymph nodes of a patient entering your clinic. What 4 tests can be carried out to determine any pathology of lymph nodes?
- Corani’s symptom
- Arkavin’s symptom
- Maslov’s symptom
- Filosofov’s symptom
The blood of a newborn is often different, histologically, from the blood of an adult. The infant may present with signs of poikilocytosis in their blood. What is poikilocytosis?
Poikilocytosis is the presence of differently shaped blood cells in the blood. Such blood cells may include:
- Burr (thorn) cells
- Spherical cells
- planar cells
Neutrophils are a type of WBC and are present in the blood in 4 different groups - what are these groups?
- myelocytes
- juvenile
- stab (band) - ca. 5 %
- segmented - 95 %
Blood is a very useful indicator of effective functioning of the blood. A person who presents to the clinic with pathological changes in their blood work may present with either a left-shift or right-shift in their blood work, what is the difference between the two?
- Left-shift leukocytosis refers to an increase in #immature neutrophils ie. myelocytes, juveile, stab(band) neutrophils
- Right-shift leukocytosis refers to an increase in mature neutrophils ie. segmented (this is very rare and indicates pathology of hematopoeisis in bone marrow)
Lymphopenia is the reduction in the #lymphocytes. In what pathological conditions does this occur?
A decrease in the total #lymphocytes is observed in:
- congenital immunodeficiency diseases
- lymphogranulomatosis
- AIDS (Acquired immunodeficiency syndrome)
- Increased radiation
- Severe sepsis
What is meant by erythrocyte sedimentation rate? What is it a measure of?
- Erythrocyte sedimentation rate measure how many blood cells sediment/fall to the bottom of a tub per unit time
- Erythrocyte sedimentation rate is an indirect measure of inflammation in the body
What are the standard values of ESR?
Neonate: 0-2 mm/hr
Breast-feeding age 2-4 mm/hr
Child/Adult = 4-10 mm/hour
What is a higher ESR indicative of?
- inflammation
- malignancy
- allergic reaction
What is the osmotic fragility test?
The osmotic fragility test is a measure of the resistance of erythrocytes to hypotonic solutions of NaCl of different concentrations.
What does Corani’s symptom indicate? How is this test carried out?
A positive Corani’s symptom indicates enlargement of the paratracheal and bifurcational lymph nodes.
Corani’s test is carried out by percussion along the spinous processes of the 7th/8th thoracic vertebra from bottom to top vertebra.
There should be a decrease in resonance as you go upward towards higher thoracic vertebra. In young children, decrease in resonance is heard at T2 vs older children at T4. If a decrease in resonance is heard below T2-T4, then there is pathology of the paratracheal lymph nodes.
What is Maslov’s symptom? How is this test carried out?
Maslov’s symptom (positive) indicates pathology of the bronchopulmonary lymph nodes.
This test is carried out by paravertebral percussion along T3-T4. The test is considered positive if resonance is decreased on both sides.
What is Arkavin’s symptom? What does it indicate?
A positive Arkavin’s symptom is a decrease in resonance along the anterior axillary lines from bottom to top.
It indicates enlargement of the bronchopulmonary lymph nodes.
How is Filosofov’s bowl test carried out? What does it indicate?
Filosofov’s test is carried out by deep percussion in the 1st and 2nd intercostal spaces from both sides in an outward to inward fashion. Normally, there should be a decrease in resonance onto the sternum, however if Filosofov’s symptom is considered positive, then the resonance will decrease up to the edge of the sternum, and not the sternum itself.
