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Phase 2a flashcards (Alec's) > Haematology > Flashcards

Haematology Flashcards

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1
Q

What is key to look at in a FBC and what do they indicate?

A
  • RBC (anaemias)
  • Neutrophils (bacterial infection)
  • Lymphocytes (chronic infection)
  • Platelets (clotting ability)
  • Eosinophils (parasitic infection)
  • Monocytes (myelodysplastic syndromes)
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2
Q

What is a normal number of RBCs for men and women?

A

Men = 4.0 - 5.9 x 10^12 / litre

Women = 3.8 - 5.2 x 10^12 / litre

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3
Q

How is blood clotting measured (3 ways)

A
  • Prothrombin time (PT)
  • Activated partial thrombo-plastin time (APTT)
  • Bleeding/ thrombin time (TT)
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4
Q

What is prothrombin time a measure of and how long is it?

A

Extrinsic pathway (10 - 13.5 seconds)

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5
Q

What is INR

A

Patient PT / standard PT time

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6
Q

What is activated partial thrombo-plastin time a measure of and how long is it?

A

Intrinsic pathway (35 - 45 seconds)

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7
Q

What is thrombin time a measure of?

A

Fibrinogen –> fibrin (12 - 14 seconds)

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8
Q

What does mean corpuscular volume (MCV) measure?

A

Average size of your RBCs

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9
Q

What is anaemia?

A

Low levels of haemoglobin in the blood

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10
Q

What is a low haemoglobin level in grams per litre?

A

Males = <130 g/l

Females = <120 g/l

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11
Q

What are the 3 classes of anaemia?

A
  • Microcytic
  • Normocytic
  • Macrocytic
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12
Q

What is the normal MCV value?

A

Normocytic = 80-95

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13
Q

What are the general symptoms of anaemia (5)?

A
  • Fatigue
  • Pallor
  • Tachycardia
  • Raised respiratory rate
  • Dysponea (exertional)
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14
Q

What are two types of haemolysis?

A
  • Intravascular (contents released into BVs)
  • Extravascular (@spleen mostly)
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15
Q

What is the most common cause of anaemia worldwide?

A

Iron deficiency anaemia

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16
Q

What are 4 causes of microcytic anaemia?

A
  • Fe deficiency anaemia
  • Thalassaemia
  • Sideroblastic anaemia
  • Lead poisoning
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17
Q

What is Fe deficiency anaemia?

A

Low haemoglobin levels due to non-inherrited Fe deficiency

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18
Q

Where is iron absorbed in the gut?

A

Duodenum + proximal jegunum

Iron first, bro

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19
Q

What causes iron deficiency (4)?

A
  • Malnutrition
  • Malabsorption (coeliacs, IBD)
  • Menorrhagia (heavy periods)
  • GI bleeding (cancer, ulcers)
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20
Q

What medications can interfere with the absorption of iron?

A

Medications that alter stomach pH as stomach acid is required to keep iron in a soluble form (e.g. PPIs)

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21
Q

What does iron circulate bound to?

A

Transferrin

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22
Q

What is iron stored bound to?

A

Ferritin

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23
Q

Why does Fe deficiency cause microcytic anaemia?

A

Not enough iron to fatten up RBCs

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24
Q

What are the specific symtpoms of Fe deficent anaemia?

A
  • Koilonychia (spoon shaped nails)
  • Angular stomatitis (ulcers at mouth corners)
  • Atrophic glossitis (white texture on tounge)
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25
How is Fe deficiency anaemia investigated (3)?
* FBC = microcytic anaemia * Fe studies * Blood film
26
What do Fe studies show in Fe deficient anaemia? (4)
* Low ferritin * Low Fe * High transferrin * Low transferrin saturation/ total iron binding capacity (TIBC)
27
What does the blood film show in Fe defficient anaemia (3)?
* Hypochromic RBC (as low haemoglobin) * Target cells (dark RBC due to high SA/V ratio) * Howell jolly bodies (nucleated RBCs)
28
Who is given an endoscopy for Fe deficient anaemia?
Over 60s
29
How is Fe deficient anaemia treated?
Oral Fe (ferrous sulphate)
30
What is thalassaemia?
Change in the genes that code for the proteins that make up haemoglobin (2 alpha, 2 beta chains), microcytic
31
What are the two types of thalassaemia?
* Alpha * Beta
32
Which chromosome is affected in alpha thalassaemia?
16
33
What are the 4 chains found in haemoglobin?
* Alpha * Beta * Gamma * Delta
34
What is found in feta haemoglobin?
2 alpha, 2 gamma
35
What is HbH?
4 Beta chains
36
What types of thalassaemia alpha are there?
Ranging from 1 to 4 gene deletions, increasing in severity (more HbH = more severe)
37
What is Hb A2
2 alpha, 2 delta chains
38
What are the types of Beta thalassaemia?
Thalassaemia minor, intermedia and major
39
What is thalassaemia minor?
1 abnormal, 1 normal Beta gene **OR** 1 deletion, 1 normal Beta gene
40
What is thalassaemia intermedia?
2 defective genes OR 1 defective, 1 deletion gene
41
What is thalassaemia major?
2 deletion beta genes
42
What haemoglobin levels does thalassaemia increase?
* HbA2 (in beta) * HbF (in beta) * HbH (in alpha)
43
What are the specific signs/ symptoms of thalassaemia (2)?
* Chipmunk facies (look like chipmunk) * Hepatosplenomegally (increased destruction of RBCs)
44
How is thalassaemia investigated (2)?
* FBC/ blood film * Hb electrophoresis (diagnostic - shows Hb type proportions)
45
What would be abnormal on FBC and Blood film in thalassaemia (3)?
* Hypochromic RBCs * Target cells (microcytic) * High reticulocytes (fast RBC turnover)
46
How is thalassaemia treated (3)?
* Supportive * Stem cell bone marrow transplant (definitive) * Transfusion (+ chelation)
47
What supportive treatments are given for thalassaemia (4)?
* Iron chelaction (reduce iron levels) * Transfusions * Folate * Splenectomy
48
What is Sideroblastic anaemia?
Genetic problem, mitochondria not able to synthesis Hb properly
49
What are iron levels like in sideroblastic anaemia?
High
50
What are the normocytic haemolytic anaemias?
* Sickle cell * Hereditary spherocytosis * G6PDH deficiency * Malaria * Autoimmune haemolytic
51
What are the normocytic non haemolytic anaemias
* CKD * Aplastic anaemia
52
What is sickle cell disease?
Autosomal recessive condition that affects the beta chains of haemoglobin
53
What is Hb S made of?
2 Alpha chains, 2 mutated B chains
54
What nucleotides are different in sickle cell disease?
GAG --> GTG on 6th codon of beta globulin (glutamate --> valine)
55
What is the result of this mutation in sickle cell disease?
RBCs become sickle shaped under stressed conditions
56
What are some examples of conditions that stress RBCs in sickle cell disease (5)?
* Dehydration * Hypoxia * Infection * Cold temp * Acidosis
57
Specific symptoms/ signs of sickle cell disease (2)?
* Pre hepatic jaundice (lots of RBCs killed) * Painful limbs (RBCs getting stuck)
58
Complications of sickle cell anaemia (3)?
* Splenic sequestration (spleen jammed up by sickle RBCs) * Vaso-occlusive crisis (cappilaries jammed --> ischemia) * Acute chest crisis (vaso-occlusion of pul vessels)
59
Investigations for Sickle cell disease (2)
* Blood film + FBC * Hb electrophoresis (diagnostic)
60
What would blood film + FBC show in sickle cell disease (3)?
* High reticulocytes * Sickle RBCs * Howell Jolly bodies (nucleated RBCs)
61
How are acute sickle cell attacks treated (4)?
* Fluids * Analgesia (NSAIDs) * O2 * (Antibiotics)
62
How is sickle cell treated long term (5)?
* Hydroxycarbomide = hydroxyurea (reduce DNA synthesis) * Folic acid supplements * Transfusion * Fe chelation * BM transplant (last resort)
63
What drug is used for Fe chelation?
Desferrioxamine
64
What is G6PDH deficiency?
Glucose-6-phosphate dehydrogenase deficiency allows ROS to damage RBCs
65
How does G6PDH protect agains ROS
G6PDH involved with glutathione synthesis, glutathione protects against ROS by reacting with them
66
How is G6PDH deficiency inherrited?
X-linked recessive
67
What would precipitate symptoms in those with G6PDH deficiency?
Things that increase ROS e.g. smoking, fava bean consumption, certain medications
68
What sort of haemolysis occurs in G6PDH deficiency?
Intravascular
69
What is present within the blood of people with G6PDH deficiency (blood film, 2)?
* Heinz bodies (damaged/ denatures Hb by ROS) * Bite cells (chunks taken out as denatured Hb removed by spleen)
70
How is G6PDH deficiency treated?
* Blood transfusions
71
What is hereditary spherocytosis?
Deficiency in structural membrane protein **spectrin**
72
How is hereditary spherocytosis inherrited?
Autosomal dominant
73
What change in shape does hereditary spherocytosis cause?
RBC become spherical + rigid
74
What is a result and complication of these spherical RBCs in hereditary spherocytosis?
Increased splenic recycling, RBCs get stuck in capillaries --> splenomegally, autosplenectomy
75
What are some specific symptoms of hereditary spherocytosis?
* Neonatal jaundice * Splenomegally * Gall stones
76
Why are gall stones common in some anaemias?
Low iron levels --> bile supersaturation, increasing the risk of gall stones
77
How is hereditary spherocytosis diagnosed (2)?
* Blood film = spherocytes * Coombs -ve (therefore not AHA)
78
How is hereditary spherocytosis treated?
Splenectomy
79
What age is a splenectomy usually done after?
6 years (due to risk of sepsis)
80
How is neonatal jaundice treated?
Phototherapy (expose skin to UV) - helps liver break down bilirubin
81
What is a complication of neonatal jaundice?
Kernicterus - Collection of bilirubin in basal ganglia --> death
82
What is autoimmune haemolytic anaemia?
Abs bind to RBC --> haemolysis
83
How is autoimmune haemolytic anaemia tested for?
Direct Coombs test (tests for auto RBC Abs)
84
How does CKD cause anaemia?
Low production of erythropoetin
85
What is aplastic anaemia?
Pancytopenia (all 3 blood componenets low in levels) bone marrow fails to make haemopoeitic stem cells
86
What causes aplastic anaemia?
* Idiopathic * Congenital * Infection (maybe)
87
How is aplastic anaemia diagnosed?
Bone marrow biopsy (hypocellularity)
88
What are the types of Megaloblastic macrocytic anaemia?
* B-12 deficiency * Folate deficiency
89
What are the types of non-megaloblastic macrocytic anaemia?
* Hypothyroidism * Alcohol excess * Liver disease
90
What is the difference between megaloblastic and non-megaloblastic macrocytic anaemia?
Megaloblastic is to do with deficiency/ impairment of utilisation of B12/ folate
91
What is B12 needed for?
RBCs DNA to mature and condense
92
What are 3 causes of vitamin B12 deficiency?
* Malnutrition * Pernicious anaemia * Absorption problems (e.g. crohns)
93
What cells produce intrinsic factor?
Parietal cells
94
What is pernicious anaemia?
Autoimmune response against parietal cells or intrinsic factor
95
What does B12 attach to in the saliva and protect it from the stomach acid and transports it around the blood?
Transcobalamin 1 *(Cobalamin = Vit B12)*
96
Where is B12 absorbed in the gut?
Distal ileum
97
What are the specific symptoms of B12 deficiency (3)?
* Yellow skin (high bilirubin) * Angular stomatits + glossitis * Neurological symtpoms
98
What causes neurological symptoms in B12 deficiency?
Low B12 --> demyelination
99
What sort of neurological symptoms occur with Vit B12 deficiency (2)?
* Symmetrical paraesthesia * Muscle weekness *Lots of other stuff*
100
How is vit B12 deficiency diagnosed (2)?
* Blood film * Low serum B12
101
What would the blood film in vit B12 deficiency show (2)?
* Macrocytic RBCs * Megaloblasts
102
What is a megaloblast?
Large, nucleated RBC precursor
103
How is pernicious anaemia diagnosed?
Anti IF/ parietal cell antibodies present
104
How is vitamin B12 deficiency treated (2)?
* Oral B12 supplements (cyanocobalamin) * Pernicious anaemia = IM hydroxocobalamin (synthetic B12)
105
What are the causes of folate deficiency anaemia (4)?
* Malnutrition/ absorption * Alcohol * Dihydrofolate reductase inhibitors * Pregnancy
106
What is the function of folate?
DNA synthesis
107
What are the specific symptoms of folate deficiency?
Angular stomatits + glossitis
108
How is folate deficiency diagnosed (2)?
* Macrocytic megaloblasts (on blood film) * Low serum folate
109
How is folate deficiency treated?
Folate supplements Pregnancy = folate for first 12 weeks
110
What is immportant to do in people with folate and B12 deficiency?
Treat B12 deficiency first
111
Why does B12 deficiency need to be treated before folate deficiency?
Folate depletes B12 further causing demyelination (*subacute degeneration of the cord*)
112
How long does folate deficiency and B12 deficiency take to develop?
* B12 deficiency = years * Folate deficiency = months
113
How does alcoholism cause macrocytic anaemia?
Damages precursors to RBCs so not as many and larger ones produced
114
How does hypothyroidism cause macrocytic anaemia?
Interferes with erythropoetin
115
What is leukaemia?
Mutation in the precursor to WBCs in the bone marrow
116
What does this mutation seen in leukaemia cause?
Proliferation of this progenitor cell and overproduction of the cell it differentiates to
117
What types of cells can leukaemia affect?
* Myeloid (precursors to granulocytes + monocytes) * Lymphoid (precursor to lymphocytes)
118
How else can leukaemias be classified reguarding how quickly they develop?
* Chronic = slow (usually larger genetic mutation) * Acute = fast (usually smaller genetic mutation)
119
What are the 4 types of leukaemia?
* Acute myeloid leukaemia * Chronic myeloid leukaemia * Acute lymphoid (lymphoblastic) leukaemia * Chronic lymphoid (lymphocytic) leukaemia
120
What are general symptoms/ signs of leukaemia (7)?
* Bone pain * Bleeding * Infection * Pancytopenia * Fatigue * Hepatosplenomegally * Petechiae
121
What are petechiae?
Red spots on skin - sign of bleeding
122
What investigations are usually done in people suspected of leukaemia?
* FBC + blood film * BM biopsy
123
What is AML associated with?
* Down syndrome * Radiation exposure
124
What is the prognosis in AML?
Very severe 20% 3 year survival. Treatment ASAP
125
What is a specific symptom of AML?
Gum infiltration (big puffy gums)
126
How is AML diagnosed?
* Blood studies myeloperoxidase +ve and **Auer rods** * BM biopsy = >20% myeloid blasts
127
What are auer rods?
Collection of myeloperoxidase in neutrophils
128
How is AML treated?
* Chemo * BM transplant = last resort
129
What can occur from chemotherapy if tumour killed too quickly?
Tumour lysis syndrome
130
What is tumour lysis syndrome?
Death of tumour cells quickly releases uric acid
131
What is a complication of tumour lysis syndrome?
Accumulation of uric acid crystals in kidneys --> AKI
132
How is tumour lysis syndrome treated?
Allopurinol (reduce uric acid levels)
133
What are the three phases of CML?
* Chronic * Accelorated * Blast
134
How long does the chronic phase typically last?
5 years
135
What mutation often causes CML?
Translocation between chromosome 9 and 22; t(9:22)
136
What is this mutation known as in CML?
Philadelphia chromosome
137
Which two genes join together in the philadelphia chromosome?
BCR-ABL gene fusion
138
What does the philadelphia chromosome result in being irreversibly turned on?
Tyrosine kinase
139
What effect does tyrosine kinase have on cells?
Increases cell proliferation
140
What percent myeloblasts cells are the three phases of CML
* Chronic = <10% * Accelerated = 10-19% * Blast crisis = >20%
141
How is CML diagnosed?
* High myeloblast cell percent in blood * High BM biopsy myeloblast cell proportion * Philadelphia chromosme genetic test
142
How is CML treated?
* Chemo * Tyrosine kinase inhibtors
143
What is an example of a tyrosine kinase inhibitor?
Imatinib
144
What can CML progress to?
AML
145
What mutation usually causes ALL?
Mutation in B cells
146
What translocation often occurs in ALL?
t(12:21)
147
How is ALL diagnosed?
* Blood film = high lymphoblasts * BM biopsy = >20% lymphoblasts (diagnostic)
148
What is present in lymphoblasts in ALL?
Terminal deoxynucleotidyl transferase (TdT)
149
How is ALL treated?
* Chemo * Allopurinol
150
What cell does CLL usually affect?
B cells
151
How is CLL diagnosed?
Blood film = smudge cells present (fragile lymphocytes damaged in filmed preperation)
152
What is low in the blood in CLL?
Hypogammaglobulinaemia - B cells proliferate but dont differentiate to plasma cellsand produce IgG
153
How is CLL treated?
* Chemo * Allopurinol
154
What is a complication of CLL?
B cells transform to more agressive lymphoma and accumulate in lymph node
155
What is the transformation of CLL to a more agressive lymphoma known as?
Richter transformation
156
What is the most common leukaemia in adults and affects older people?
CLL
157
What is the most common leukaemia in children?
ALL
158
What is the most common acute adult leukaemia?
AML
159
What can CML progress to?
AML
160
What is a lymphoma?
Cancer of lymphocytes (T and B cells or NK cells) that collect in lymph nodes
161
How are lymphoma classified (2 ways)?
* Hodgkin/ non hodgkin * Grade (low, high, very high)
162
What cell is found in hodgkin lymphoma?
Reed sternberg cell
163
What are typical symptoms of Lymphoma?
* Fever * Night sweats * Unintentional weight loss * Lymphadenopathy
164
What are the B symptoms?
* Night sweats * Unintentional weight loss * Fever (systemic affects of lymphoma)
165
What cell is most commonly affected in lymphoma?
B cells
166
What age groups does hodgkin lymphoma usually present?
2 peaks * Teens * Elderly
167
What have Lymphoma been associated with?
* Viruses - HIV, EBV, helicobactor pylori * Autoimmune - SLE, Sjogrens
168
How is hodgkins affected by alcohol?
Hodgkins is painful after alcohol
169
How is hodgkins investigated?
* Bloods - low Hb, high ESR * BM biopsy (diagnositic) * Imaging - stage the tumour
170
What is a pop corn cell?
Variant of reed sternberg cells found in some hodgkin lymphoma
171
What is used to stage lymphomas?
Ann Arbour staging (1-4)
172
What are stages 1-4 of Ann Arbour?
1. Single lymph node. 2. Multiple lymph nodes on same diaphragm side. 3. Lymph nodes on both diaphragm sides. 4. Extranodal organ spread.
173
What chemo is used to treat hodgkin lymphoma (3)?
* Adriamycin * Bleomycin * Vinblastine
174
What are some side effects of this chemotherapy (3)?
* Alopecia * N+V * BM failure + infection
175
What are people on chemotherapy at risk of?
Febrile neutropenia
176
What is febrile neutropenia?
Infection when immune system surpressed by chemo
177
How is non-hodgkin lymphoma graded?
* Low * High * Very high
178
What is an example of a low grade lymphoma?
Follicular lymphoma
179
What is an example of a high grade lymphoma?
Diffuse B cell lymphoma
180
What is an example of a very high grade lymphoma?
Burkitts lymphoma
181
How does burkitts lymphoma present?
Differently in different areas of the world E.g. in africa = large swollen jaw
182
How is non-hodgkin lymphoma diagnosed?
* Blood tests/ films * BM biopsy (diagnostic) * Imaging to stage
183
What chemo is used for non-hodgkin lymphoma (2)?
* Rituximab - targets CD20 (on B cells) * Cyclophosphamide
184
What else is used to treat lymphoma as well as chemotherapy?
Radiotherapy
185
How can lymphomas affect the skin?
* Mycosis fungoides (NHL) * Skin excoriations (HL)
186
What is myeloma?
Cancer of plasma cells (activated B-cells) that cause rapid uncontrollable monoclonal division
187
What are the 3 types of myeloma?
* Monoclonal gammopathy of undetermined significance * Multiple myeloma * Smouldering myeloma
188
What is the most commonly affected Ig in myeloma?
IgG
189
What are 2 risk factors for myeloma?
* Old >70 * Afro-caribbean
190
What effect do plasma cells have on bone?
Release cytokines that surpress osteoblasts and increase osteoclasts activity - this degrades bone
191
What are 4 symptoms/ features of myeloma?
* Hyper**c**alaemia * **R**enal disease * **A**naemia (pancytopenia) * **B**one lesions
192
What can the high number of proteins (Igs) in myeloma result in?
Hyperviscosity
193
What can hyperviscosity cause?
* Easy bleeding/bruising * Decreased blood supply * Heart failure
194
What causes renal impairment in myeloma?
* Hypercalaemia decreases renal function * High Igs levels blocks BVs and can deposit in the nephrons
195
What is Ig deposition in the kidneys known as?
Kappa deposition
196
How is suspected myeloma initially investigated (1 test, 4 results)?
Blood tests: * Pancytopenia * Raised Ca * Raised ESR * Raised plasma viscosity
197
How is myeloma tested for (2)?
* Bence jones proteins in urine * Serum protein electrophoresis
198
What is a bence jones protein?
Monoclonal light Ig chain found in urine
199
What would serum protein electrophoresis show?
'M' spike (monoclonal Ig spike)
200
How can a myeloma diagnosis be confirmed?
Bone marrow biopsy >10% plasma cells
201
What imaging is done for myeloma?
Bone imaging to check for lesions (X-ray, mri or ct)
202
How is myeloma treated?
* Chemo * Bisphosphinates * Dialysis * Stem cell transplant
203
How do bisphosphonates work and give an example?
Surpress osteoclasts Alendronate
204
What is monoclonal gammopathy of undetermined significance (MGUS)?
Excess monoclonal antibody, but no other symptoms of myeloma (<10% plasma cells in BM biopsy)
205
What can MGUS progress to?
Smouldering myeloma
206
What is smouldering myeloma called when there is excessive IgM specifically?
Waldenstroms macroglobulinaemia
207
What are 2 myeloproliferative disorders?
* Polycythaemia * Thrombocythaemia
208
What are 2 types of polycythaemia?
* Primary (polycythaemia vera) * Secondary
209
What can cause secondary polycythaemia (3 things)?
* Hypoxia * Dehydration * High levels of EPO
210
What mutation usually causes polycythaemia vera?
JAK2 V617 mutation
211
Signs/ symptoms of polycythaemia vera (5)?
* Itching + numbness in limbs (due to cytokine production) * Red puffy face * Blurred vision * Hepatosplenomegally * Hyperviscosity
212
How is polycythaemia vera investigated (2)?
* FBC = High RBC, WBC, Platelets * Genetic testing = JAK2 V617 positive
213
How is polycythaemia vera treated (3)?
* Venesection (remove blood - 1 pint) * Aspirin (reduce clot risk) * Chemo (hydroxyurea)
214
What can polycythaemia vera cause in the bone marrow?
Myelofibrosis (BM replaced with scar tissue due to cytokines)
215
What conditions affect the coagulation cascade (3)?
* Haemophilia A/B * Von willebrand factor disease * Disseminated intravascular coagulopathy
216
How is haemophilia A/B inherited?
X linked recessive
217
What clotting factors do haemophilia A and B affect?
* A=8 * B=9
218
What are the signs/ symptoms of haemophilia?
* Easy bleeding + bruising * Haemarthrosis (bleeding into joints)
219
What would happen to PT and APTT?
* PT is normal as extrinsic pathway unaffected * APTT high as intrinsic pathway slow
220
How can Haemophilia be diagnosed?
* Coagulation factor assay (F8/9 low) * Genetic testing
221
How is haemophilia treated?
IV factor 8/9
222
What should be given with factor 8?
Desmopressin - helps synthesis + release of VWF from endothelial cells
223
What is the function of VWF?
* Prevents the breakdown of factor 8 * Helps platelets adhere to damaged endothelium
224
How is VWF disease inherited?
Autosomal dominant
225
What are the signs/ symptoms of VWF disease?
Easy bleeding/ bruising
226
How is VWF disease diagnosed?
* Family history/ genetic testing * APTT high PT normal No definitive test for diagnosis
227
How is VWF disease treated?
* VWF infusion * Desmopressin (stimulate release of VWF)
228
What causes disseminated intravascular coagulopathy (DIC)?
Overactivation of the clotting cascade e.g.: * Trauma * Sepsis
229
How is DIC treated (2)?
* Clotting factor, fibrinogen replacement * Platelet, RBC transfusion
230
What is a normal platelet count?
150-450 x 10^9 / l
231
What is thrombocytopenia?
Low platelets in the blood
232
What are the two main types of thrombocytopenia?
* Thrombotic thrombocytopenic purpura * Immune thrombocytopenic purpura
233
What Ig class causes ITP?
IgG
234
What are some causes/ risk factors fro ITP (3)?
* Recent viral infection * Other autoimmune conditions * Heparin induced thrombocytopenia (HIT)
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How is ITP diagnosed (2)?
* Thrombocytopenia * High bone marrow megakaryoblasts (biopsy)
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How is ITP treated (3)?
1. Prednisolone (steroid) 2. IV IgG (surprises IgG production) 3. Splenectomy
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How is ITP paradoxical?
There are low platelets, however the IgGs that attach to the platelets activate the clotting cascade causing more unusual blood clots.
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What causes TTP?
Tiny blood clots forming through small blood vessels using up the platelets
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What gene causes TTP?
ADAMTS13 gene problem
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What does a deficiency in ADAMTS13 protein cause?
vWF not inactivated this causes over expression of vWF --> lots of platelet adhesion and activation --> low platelet levels systemically
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What are the symptoms of thrombocytopenia (3)?
* Purpuric rash * Easy bleeding + menorrhagia * *AKI, haemolytic anaemia, neurological symptoms*
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How is TTP diagnosed (3)?
* Thrombocytopenia * Schistocytes (fragmented RBCs) * Microangiopathic haemolytic anaemia
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How is TTP treated (3)?
* Plasmapheresis (removes proteins that damage ADAMTS13) * Prednisolone (steroid) * Rituximab (monoclonal antibody agains B cells)
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What 4 parasites cause malaria?
* Plasmodium falciparum * Plasmodium ovale * Plasmodium vivax * Plasmodium malariae
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What is the most common and deadly type of malaria?
Plasmodium falciparum
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Describe how malaria replicates (5 steps).
* Sporozoites in mosquito saliva enter blood * Multiply in hepatocytes as merozoites * Divide in RBC: meroxoites --> trophozoites --> shizont --> new merozoites * RBCs replicate, plasmodium spill out
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What are the symptoms/ signs of malaria (4)?
* Fever * Anaemia * Hepatosplenomegaly * Blackwater Fever (RBCs burst releasing haemoglobin into blood + urine)
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How is malaria diagnosed (2 things)?
Blood film * Thick film - identifies malaria * Thin film - identifies species
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How is malaria treated (3)?
* Quinine + doxycycline (Abx) * Artesunate (IV) - If severe
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What can EBV put you at greater risk of?
Lots of types of cancer e.g. lymphoma (Hodgkins and Burkitts)
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How is EBV spread?
Via saliva/ bodily fluids
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How is EBV diagnosed?
* Antibody blood test * A-typical lymphocytes on blood film
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How is HIV spread (3)?
* Blood contact * Sexual contact * Mother to child
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Give 4 risk factors for HIV?
* IV drug users * Unprotected anal sex * Paid sex workers * High prevalence countries
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What are the two types of HIV and which is most common and most virulent?
* HIV-1 (most common, most virulent) * HIV-2
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How does HIV cause infection (5)?
* Enters CD4+ (TH cells) via gp120 * Endocytoses RNA + enzymes * Reverse transcriptase RNA --> DNA * Integrase - viral DNA inserted into hosts * Protein synthesis + takes control of CSM
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What are the 4 stages of HIV?
1. Infection - dip in CD4+ 2. Clinical latency (can last years) 3. Symptomatic phase 4. AIDS
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What are the symptoms of HIV (4)?
* Fever * Opportunistic infections * Weight loss * Night sweats
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What defines AIDS?
CD4+ < 200 / ml
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How is HIV diagnosed?
ELISA (enzyme linked immunosorbent assay) Tests for anti HIV Ig (P24 Ab)
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How is HIV treated?
HAART (highly active antiretroviral therapy)

Phase 2a flashcards (Alec's) (13 decks)

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