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Flashcards in Haematology Deck (88):
1

Summary of Haematology

Blood Cells
Diagnostic tests (4)
Anaemia
Thrombocytopenia
Transfusion
Heritable/Acquired Blood disorders
Haemoglobinopathies
Blood cancers
Obstetric/Paedaitric haematology

2

What is the term given for the physiological developmental process that gives rise to blood cells?

Haematopoiesis

3

Embyrologically when do the haematopietic cells penetrate aorta --> liver

day 27

4

State the two lineages of blood cells

Myeloid
Lymphoid

5

Which WBC arise from the myeloid lineage

Granulocytes:
Basophil
Eosionophil
Neutrohpil
Macrophage

6

Broadly, what are the 3 functions of blood cells?

02 transport
Immune response
Coaguation (clotting)

7

What are the 4 diagostic tests which are carried out in Haematology?

FBC
Blood film
Coagulation screen
Bone marrow aspirate

8

The components of the Coagulation screen are...?

Prothrombin Time (PT)
Activated Partial Thromboplastin Time (APTT)
Thrombin Time (TT)

9

Anaemia = ?

Decrease in RBC

10

How does the body adapt to anaemia?

Increase CO/BP/RBC/02 extraction

11

The 3 classifications of anaemia = ?

Microcytic Hypochromic
Normocytic Normochromic
Macrocytic (Megaloblastic)

12

Which anaemia has low MCV, low MCH and caused by Iron def, thallassaemias, anaemia of chronic D?

Microcytic Hypochromic

13

Which anaemia is caused by haemolysis, acute blood loss, renal D and bone marrow failure?

Normocytic Normochromic

(Normal MCV, normal pigment but less Hb)

14

Megaloblastic anaemia can be caused by Haematological cancer and what else?

B12/Folate def
Alcohol
Liver D
Drugs
Congenital ab

15

If Fe2+ def + male, what should you screen for?

Bowel Cancer

16

Haematinic def consist of...?

Fe2+ def
Folate def
B12 def

17

Iron is stored in liver by what protein?

Ferritin

18

List common causes of Fe2+ def in kids, young women etc.

Kids:
Malnutrtion/Malabsorption/Growth
Women:
Menstrual problems
Preg
GI:
Ulcers, Diverticula, Bowel cancer

19

Veganism, Gastric/SI problems can lead to what type of def?

B12 def

20

What is a complication of B12 def?

How does it present?

SACDC
Subacute Combinded degeneration of the Cord

Peripheral neuropathy, numbness/weakness, nsteady walking, Dementia

21

The clinical presentation of Folate/B12 def is identical. What is it?

What is the treatment if you dont' know the def yet?

Megaloblastic anaemia
Mild jaundice

IM B12 & Folate

22

How would you investigate Fe2+ def?

FBC (low MCV, MCH)
Blood Film
Ferritin (low)

23

How would you investigate B12/Folate def?

FBC
Blood film
Bilirubin/LDH
[B12] [Folate]
Antibodies
GI investigations

24

Apart from haematinic def, what are other causes of anaemia?

Haemolysis
Anaemia of Chronic D
Alcohol
Renal impairment

25

Examples of haemolytic anaemia...?

INSIDE CELL:
Haemoglobinopathies
Enzyme defects

CELL MEM:
Hereditory spherocyotis/ellip

OUTSIDE CELL:
Antibodies, Heart valves, Drugs, toxins

26

To treat anaemia of chronic disease, you would treat the underlying cause & give EPO. What sorts of conditions can cause it?

Malignancy
Inflammatory
Infectious
Multiple co-morbities

27

Drugs, alcohol, toxins
Autoimmune ITP, TTP
Liver D
Hypersplenism
Preg
Infections
DIC
Haematological diseases
..can all cause what?

THROMBOCYTOPENIA

28

Is TTP or ITP an autoimmune platelet disorder that often presents in kids, post-viral with bruising/bleeding/petechiae?

ITP
Immune Thrombocytopenic
Purpura

29

Treatment of ITP?

NONE

(Steroids, IV Ig, Thrombopoeitin)

30

What does TTP stand for?

What is it?

Thrombotic Thrombocytopenia Purpura

Micro-clots everywhere due to ab bv

RARE BUT EMERGENCY

31

Classic presentation of TTP?

Treatment?

Thrombocytopenia +
Haemolysis+
Fever +
Neurological symptoms

FFP, Steroids

32

What products can we transfuse?

RBC
Platelets
Plasma - FFP, Cryoprecipitate, Factors

33

"GROUP and SCREEN" is referring to what?

Pre-transfusion blood tests

34

State the steps of "GROUP and SCREEN"

1.Determine ABO & Rh group
2. Screen plasma for Ab against other blood antigens
3. Cross-matching

35

List the adverse reaction that can occur after transfusion.

Acute transfusion reactions 24hrs
Acute haemolytic reaction - 15 minutes

36

How does someone present whose had a delayed tranfusion reaction?

JAUNDICE
FEVER
FATIGUE

37

Fever, rigors, DIC, dark urine, infusion pain, shock, chest pain are all presentations of what?

Acute haemolytic reaction


FATAL IN ~30%

38

name the test performed in suspected Delayed haemolytic reaction.

Coomb's test (Anti-human Globin)

39

In coagulation/clotting disorders is bleeding prolonged & often reoccurs?

Yes

40

Describe what bleeding is like in Platelet & vessel wall defects..

Immediate & non-recurrent
-Petechiae
-Nose bleeds
-Superficial bruises
Mennorhagia

41

Aspirin can cause dysfunction in which blood cell?

Platelets

42

The most common heritable bleeding disorder which often acompanies FVIII def is...?

vWD

43

Describe the 3 types of vWD

Type 1: mild, normal structure, decreased [vWF]
Type 2: mild, normal [vWF], abornmal structure
Type 3: absent vWF, FVIII def, RECESSIVE

44

Treatments for vWD?

Tranexamic acid
DDAVP
Factor concentrates
COCP

45

Which are the most common heritable factor def?

Factor XII def
Factor VIII vWD def

46

What mode of inheritance does Haemophilia display?

X-linked

47

Describe the types of bleeding experienced in Haemophilia A/B.

Spontaeous
Post-trauma (minor)
Haemarthrosis
Muscle bleeding
Soft tissue - esp surrounding airwas
Intracranial (neonates)

48

The treatment for Haemophilia is similar to the treatment for...?

vWD

minus COCP
+Prophylaxis
+Supportive

49

Transfusion transmitted infections and Inhibition are complications of treating vWD and Haemophilia. T/F?

T

50

Bleeding disorders can be acquired from..?

Vit K def
Liver D
Massive transfusion syndrome
DIC
Acquired Inhibitors

51

Which factors are Vit K dependant in order to become active?

Factor II, VII, IX, X

52

What is the consequence of Vit K def in neonates?

Haemorrhagic Disease of the newborn

53

Causes of Vit K def in adults

Prolonged nutritional def

Obstructive jaundice (fat soluble Vit)

Broad spectrum antibioics (gut flora make vit K)

54

Define Massive transfusion syndrome.

Transfusion of RBC equal to patient’s total volume in

55

DIC = microvascular thrombosis when coagulation pathway activated + then platelet depletion --> bleeding.
Who does it tend to occur in?

Unwell patients
Sepsis
Infection
Cancer
End-stage Liver D
Retained foetus
Acute haemolytic syndrome

56

Investigations of DIC?

FBC/Film - thrombocytopenia

All Coagulation screen - prolonged

D-Dimer - elevated

57

How would you treat DIC?

Treat underlying cause

58

Warfarin is managed using INR as guidance. What drugs interact with it?

Corticosteroids
NSAIDs
Antibiotics
Amiodarone

59

Which haemaglobinopathy has acute complications of vasculo-occlusive crises?

Sickle cell

60

What types of Sickle Cell are there?

Sickle cell trait

Sickle cell Disease

61

Which haemoglobinopathy is characterised by severe anaemia, short stature, enlarged spleen/liver, maxilliary hypertrophy/Hair on head x-ray?

B-Thalassaemia Major

62

What is the leading cause of mortality in Sickle Cell disease

Chest syndrome

(vasculo-occlusive crisis)

63

Iron-rich environment is favourable for bacteria therefore tranfusions in haemoglobinopathies are a risk factor for...?

Infections

64

How would you diagnose haemoglobinopathy?

FBC/Film
HB electrophoresis

65

What haematological state are pregnant women in?

Pro-thrombotic

Increased plasma volume --> mild anaemia
Thrombocytopenia in late
Higher WCC

66

Which Ig crosses the placenta?

Where do babies get the rest of the Ig from?

IgG


Breast milk

67

Platelets are low by 18 weeks preg in the foetus. T/F?

F

Platelets reached adult values

68

Foetus is hyperresponsive to what factor?

vWF

prepare for birth

69

When do congenital bleeding disorders tend to be diagnosed?

6-9 months

70

List 4 main ways children can be anaemia from congenital causes.

Haemoglobinopathies
Bone marrow failure
Blood loss (twin-twin)
RBC destruction (ABO/Rh, sphero, G6PD)

71

List 3 congenital causes of bleeding/bruising in childhood.

Platelet problem: ITP, drugs
Clotting factor problem
Connective Tissue D

72

Trauma, Tumour, infection, ITP, TTP, bone marrow failure and drugs can lead to what in childhood

Bleeding/bruising problems

73

Name the blood cancers

Myeloma
Lymphoma
AML
ALL
CML
CMPD (3)

74

Which blood cancer is diagnosed based on CRAB features, MDEs, > 10% plasma cells neoplastic?

Myeloma

75

What are the CRAB features

C - hypercalcaemia
R - renal insufficiency
A - anaemia
B- bone pain/lesion

76

MDEs = Myeloma-defining events, which are..

> 60% plasma cells neoplastic
SFLC ratio > 100
1 bone lesion on MRI

77

What is myeloma always preceeded by?

MGUS

78

Myeloma + AKI = ?

MEDICAL EMERGENCY

79

How is myeloma diagnosed?

Protein electrophoresis
Immunofixation

80

Follicular Lymphoma often has chromosomal changes of..?

t(14,18)

81

Treatment for warfarin overdose?

PCC

Prothrombic Complex concentrate

82

Which cancer can be precipitated by EBV?

Hodgkin's Lymphoma

83

Diagnostic mutation in myeloproliferative disorders?

JAK2/CALR mutation

84

CML has the t(9,22) abnormality. How does it present?

Abdo discomfort (splenomegaly)
Fatigue (anaemia)
Venous occlusion
Gout

85

Neutropenic sepsis is a complication of intensive chemo in which cancers?

AML, ALL

86

Presentation of AML, ALL?

Anaemia
Infections
Bruising/Haemorrhage
Organomegaly

87

Which condition presents as pancytopenia, splenomegaly, B symptoms?

Idiopathic myelofibrosis

88

Which 3 conditions constitute CMPD?

1" Polycythaemia Vera
1" Thombocytosis
Myelofibrosis