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Flashcards in CSIM blood Deck (116):
1

4 signs / symptoms of anaemia?

fatigue
pale
chest pain
brittle nails

2

2 causes of microcytic anaemia?

bleeding -> iron deficency
thalassaemia

3

4 causes of macrocytic anaemia?

B12 deficiency
folate deficiency
alcohol
haemolysis

4

what kind an anaemia in haemolysis and why?

MACROCYTIC
lots of new RBCs are made which are immature therefore bigger

5

2 causes of normacytic anaemia?

chronic disease
bone marrow pathology

6

what must be excluded before anaemia of inflammatory cause can be diagnosed?

bone marrow pathology e.g. multiple myeloma

7

what Ix in suspected haemolysis? why

blood film - looking for spherocytes
DAT - for autoimmune haemolysis
LTFs - raised bilirubin
reticulocyte count
LDH - raised

8

what is a reticulocyte and how does it differ to a RBC?

immature RBC
BIGGER and has genetic material still in it

9

what do RBC look like in auto immune haemolysis and why?

TENNIS BALLS- spherocytes

proteins bind onto it and the spleen chucks them out

10

what does a DAT test tell you?

if haemolysis is auto immune

11

reasons for increased no. of platelets?

secondary (reactive) to infection/ inflammation
myoproliferative disorders e.g. myelofibrosis

12

caues of thrombocytopenia

decreased production:
haematinic deficit
acute leukaemia

increased consumption:
DIC
sepsis
ITP (idiopathic thrombocyopenia purpura)

13

what is ITP

idiopathic thrombocyopenia purpura

auto antibodies bind to platelets and destroyed by the spleen - thought to be due to background viral illnes

14

effect of smoking on Hb?

increase due to overcompensation to hypoxia

15

what is the presentation of myelofibrosis?

sweats
massive splenomegaly
cytopenias

16

what is haematocrit?

amount of plasma taken up with red cells

17

what is included in haematinics?

ferritin
B12
folate

18

what will a blood film in iron deficiency look like?

pencil shaped cells

19

why is it important to correct anaemia in cancer patients asap

they might need surgery

20

what is the pathology in haemochromotosis?

absorbing iron at fastest rate -> iron deposition in liver, pituitary, joints etc


this leads to
cirrhosis
diabetes
joint pain

21

why macrocytic anaemia in acute blood loss?

marrow throws out loads of reticulocytes very quickly

not quick enough to change hyper acute MCV

22

why abdo pain in haemolysis?

pigment stones

increased haem -> increased bilirubin -> stones -> cholangitis (case about the 15 yo girl)

23

what anaemia in CKD and why?

normacytic
decreased erythropoetin

24

what Ix in acute multiple myeloma?

serum and urine electrophoresis
haematincs to rule out mixed picture

25

why do we venesect in polycythemia?

stroke risk

26

why does ESR rise in inflammation?

increased protein means the erythrocytes are more neg. charged so take longer to settle

27

what are the symptoms of raised haematocrit?

headache
nose bleeds

28

what is the difference between PT and APTT?

PT measures the extrinsic pathways
APTT meaures the intrinsic pathways

29

if both PT and APTT are raised what is the clotting problem?

problem in common pathway

30

which clotting factor does the liver NOT make and where is it made?

8
endothelium and platelets

31

which Ix assesses the common pathway in coagulation?

Thrombin time

32

what converts fibrinogen to fibrin?

thrombin

33

clotting factors that are involved in the intrinsic pathway?

8
9
11
(12) not required to make thrombin

34

clotting factors in the extrinsic pathway?

VII

35

vit. K dependent clotting factors?

2
7
9
10

36

how to test the extrinsic pathway?

PT

37

what is haemophilia A?

FVIII deficiency -> easy bleeding

X linking condition

38

what is the difference between a normal and a haemophilia bruise?

there is a palpable haematoma (bump in middle of bruise) in haemophilia a

39

what are of the body does haemophilia a effect?

weight bearing joints

40

what is haemophilia b?

Factor IX deficiency

X linked

41

which is the more common type of haemophilia?

a

42

what is von willebrand factor? / how does it work?

glycoprotein involved in clotting:
-Binds platelets (Gp1b) to the subendothelium and platelet/ platelet binding in high shear stress
-Binds and stabilises FVIII

43

what is the commonest inherited bleeding disorder?

von willebrand disease

44

what effect does a von willbrande factor deficiency have on FVIII?

reduced level
it binds to FVIII so if there is less of it, less FVIII is bound so t1/2 reduced

45

how does vWD present differently to haemophilia a or b

milder - doesnt effect joints as much

46

what the three inherited bleeding disorders i need to know? how are each inherited?

haemophilia a and b - X linked
VWD - autosomal dominant

47

how can DIC present?

too much clotting or bleeding

48

how does biliary stasis lead to clotting problems?

cant emulsify fat so get vit. K deficiency

49

what is DIC and when does DIC occur?

Coagulation, normally localised to the site of injury, becomes systemic


Occurs when the balance of procoagulant and anticoagulant factors is overwhelmed by a massive systemic procoagulant signal e.g. sepsis, malignancy, trauma

50

classical lab picture of DIC?

Low platelet count
Prolonged clotting times- PT, APTT
Low fibrinogen
High d-dimers

51

how do people with Protein C and Protein S deficiency present?

thrombosis at a young age

52

main types of Venous Thrombo-embolism (VTE)?

DVT
PE

53

what scoring system is used to assess risk of DVT?

wells

54

what is D-dimer and how is it used?

break down product of F-XIII (fibrin)
measured and used to predict likelihood of DVT

55

what are protein c and s?

natural anti-coagulants

56

what is the difference between warfarin and the DOACS

DOACS act much more specifically so lead to less bleeding

57

why does warfarin take a few days to work?

it stops the enzyme that activates the vit. K dependent factors but there will be some active ones in circulation already

58

3 option for reversal of warfarin?

Omit warfarin (or stop permanently)

Vitamin K (IV or oral)

Coagulation factor replacement (concentrated 2 7 9 and 10)

59

most common symptom of intra cranial bleed?

headache

60

how to confirm EBV diagnosis

monospot test

61

typical FBC in leukaemia

very low neutrophils
very high WCC
anaemia

62

what are blast cells?

immature white cells

63

what is released in tumour lysis syndrome?

K
uric acid

64

why gout in cancer?

increased uric acid in tumour lysis syndrome

65

what do blast cells in the blood indicate?

that the bone marrow is getting into the blood

66

isolated low platelets is most likely to be ?

ITP - this is a diagnosis of exclution

67

how does ITP present? what is the onset like?

background of viral illness (could be sub-clinical)

Purpura
Menorrhagia
Epistaxis
Gingival bleeding

children - sudden
adults - slower

68

what is normally the cause of ITP in children?

viral illness
immunisation

69

effect of DIC on platelets? what about fibrinogen?

low
also low

they've been used up

70

how do you tell between Hodgkin and non- Hodgkin lymphoma?

Hodgkin has owl eyes on histology

71

what are rouleaux?

stacks of RBC on the blood film

72

what is multiple myeloma?

tumour of the plasma cells
accumulates in the bone marrow

73

symptoms of AML?

fatigue,
shortness of breath,
easy bruising and bleeding,
increased risk of infection

74

what causes the symptoms of AML?

pancytopenia

75

what is seen on a blood film in AML?

auer rods on RBC

76

warfarin patient comes in with stroke symptoms, what is the most important Ix? if in therapeutic range, what is the best management?

rapid IRN
more likely to be a bleed so give some conc. 2, 7, 9 and 10 AND IV vit K

77

how to diagnose lymphoma?

need lymph tissue

78

3 medical emergencies that lymphoma can present with?

Confusion

Dehydration

Bowel bladder disturbance

79

lymphoma cells in the blood indicates what?

stage IV disease - very bad

80

if you suspect lymphoma, what Ix do you need to diagnose it

core biopsy or excision

FNA is NOT adequate

81

what doeds abnormal lymph gland tissue look like on PET scan?

black

82

which Ix did she keep going on about how it wasnt useful in diagnosing lymphoma?

bone marrow biopsy

83

Tx for tumour lysis syndrome?

allopurinol / raspuricase (in high risk cases) for uric acid
keep hydrated

84

what makes a patient arrest in TLS?

increased K

85

what 3 things make you think lymphadenopathy is lymphoma

sustained
bigger than 1cm
no other cause (not reactive)

86

two reasons for pancytopenia?

increased destruction of cells
immune mediated
sepsis
splenomegaly
decreased production: bone marrow failure

87

3 causes of bone marrow failure?

megaloplastic anaemia (chronic B12 and folate)

aplastic anaemia (failure of bone marrow to develop)

infiltration of bone marrow with malignant disease (haematological or non-haematological)

88

symptoms of bone marrow failure

symptoms of anaemia
bruising
infection

89

what iatrogenic form of neutropenia is there?

chemo

90

why do infections get into the blood more easily in neutropenia?

neutrophils have an important role in LOCALIZING infection

91

causes of aplastic marrow failure?

idiopathic (probably auto-immune) - 60%
drugs - 40%
benzene
sulphonamides
gold / penicillamine
CHEMO
very rarely congenital

92

what is the commonest cause of bone marrow failure?

acute leukaemia

93

5 haematological causes of bone marrow failure?

acute laekaemia
myeloma
myelofibrosis
infiltration with lymphoma
myelodysplastic syndrome

94

6 non-haematological cancers that cause BMF?

breast
prostate
renal
lung
thyroid
skin

95

what is the commonest cancer in children?

acute lymphoblastic leukaemia

96

leukaemia presentation?

symptoms of pancytopenia
symptoms of cancer (sweats, weight loss etc.)
if it has spread else where: gums, skin, testes, meningies, swollen lymph glands

97

what is ALL?

cancer of the developing white blood cells

98

how to make diagnosis of leukaemia?

FBC - pancytopenia
clotting
BIOPSY of BONE MARROW will be diagnostic

99

Mx of severe neutropenia?


broad spectrum abx given within the hour eg Tazicin / gentamycin

100

what is the role of chromosome analysis in leukaemia?

prognosis
targeting treatment

101

infertility in chemo for leukaemia?

men - always but can sperm bank
women - not always but not way to protect them

102

what is produced in large quantities when a tumour dies quickly? what does this cause?

uric acid
potassium

renal failure
cardiac arrest
gout

103

how does age and sex effect prognosis of leukaemia?

boys do worse than girls (testicles act as sancutary)
old do worse than young

104

consequences of chemo in leukaemia?

infertility
increased risk of cancer
hair loss
shorter
loss of intellect
endocrine abnormalities (DM, hpt)

105

chondrocalcinosis of the knees should make me think what?

haemochromotosis

106

peripheral neuropathy is associated with a deficiency in what?

B12

107

wha tis the most common cause of macrocytosis?

alcohol excess

108

what does the kidney measure to regulate the amount of erythropoietin produced?

measures the amount of O2 getting to the kidney

this means that even in haemoglobin in normal, it will still churn out erythropoietin if youre hypoxic

109

BLASTS = ?

acute leukaemia

110

what Ix tell the difference between ALL and AML ?

WE DON'T NEED TO KNOW KNOW THAT


(according to Dr Jackson)

111

how to distinguish between lymphoma and sarcoidosis on CXR?

sarcoidosis is BILATERAL lymphadenopathy

112

what pushes the patient into kidney failure in multiple myeloma?

massive amounts of immunoglobulins (PROTEIN) produced

113

causes of prolonged APTT

Lupus anticoagulant
Heparin treatment
Heparin contamination
Factor deficiency (rare)

114

3 mx steps in suspected cerebral bleed if on warfarin?

Needs v.urgent CT
Check INR
Give beriplex to reverse the effects of warfarin

115

what are reed-sternburg cells most commonly associated with?

Hodgkins lympoma

116

describe the rash in HSP

macular rash on back of legs or buttocks