CSIM blood Flashcards
(116 cards)
1
Q
4 signs / symptoms of anaemia?
A
fatigue
pale
chest pain
brittle nails
2
Q
2 causes of microcytic anaemia?
A
bleeding -> iron deficency
thalassaemia
3
Q
4 causes of macrocytic anaemia?
A
B12 deficiency
folate deficiency
alcohol
haemolysis
4
Q
what kind an anaemia in haemolysis and why?
A
MACROCYTIC
lots of new RBCs are made which are immature therefore bigger
5
Q
2 causes of normacytic anaemia?
A
chronic disease
bone marrow pathology
6
Q
what must be excluded before anaemia of inflammatory cause can be diagnosed?
A
bone marrow pathology e.g. multiple myeloma
7
Q
what Ix in suspected haemolysis? why
A
blood film - looking for spherocytes DAT - for autoimmune haemolysis LTFs - raised bilirubin reticulocyte count LDH - raised
8
Q
what is a reticulocyte and how does it differ to a RBC?
A
immature RBC
BIGGER and has genetic material still in it
9
Q
what do RBC look like in auto immune haemolysis and why?
A
TENNIS BALLS- spherocytes
proteins bind onto it and the spleen chucks them out
10
Q
what does a DAT test tell you?
A
if haemolysis is auto immune
11
Q
reasons for increased no. of platelets?
A
secondary (reactive) to infection/ inflammation
myoproliferative disorders e.g. myelofibrosis
12
Q
caues of thrombocytopenia
A
decreased production:
haematinic deficit
acute leukaemia
increased consumption:
DIC
sepsis
ITP (idiopathic thrombocyopenia purpura)
13
Q
what is ITP
A
idiopathic thrombocyopenia purpura
auto antibodies bind to platelets and destroyed by the spleen - thought to be due to background viral illnes
14
Q
effect of smoking on Hb?
A
increase due to overcompensation to hypoxia
15
Q
what is the presentation of myelofibrosis?
A
sweats
massive splenomegaly
cytopenias
16
Q
what is haematocrit?
A
amount of plasma taken up with red cells
17
Q
what is included in haematinics?
A
ferritin
B12
folate
18
Q
what will a blood film in iron deficiency look like?
A
pencil shaped cells
19
Q
why is it important to correct anaemia in cancer patients asap
A
they might need surgery
20
Q
what is the pathology in haemochromotosis?
A
absorbing iron at fastest rate -> iron deposition in liver, pituitary, joints etc
this leads to
cirrhosis
diabetes
joint pain
21
Q
why macrocytic anaemia in acute blood loss?
A
marrow throws out loads of reticulocytes very quickly
not quick enough to change hyper acute MCV
22
Q
why abdo pain in haemolysis?
A
pigment stones
increased haem -> increased bilirubin -> stones -> cholangitis (case about the 15 yo girl)
23
Q
what anaemia in CKD and why?
A
normacytic
decreased erythropoetin
24
Q
what Ix in acute multiple myeloma?
A
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
