Haematology Week 1 Flashcards by Claire Milne

What are the 3 types of blood cells?

Red blood cell
White blood cell
Platlets

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What is the production of blood cells called?

Haemopoiesis

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What are blood cells made from?

Pluripotent stem cells

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What are the sites of haemopoiesis in a foetus?

Yolk sac

3rd - 7th month - spleen

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What is the site of haemopoiesis in infants?

Bone marrow - most bones

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What is the site of heamopoeisis in adults?

Bone marrow of axial skeleton

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What are the 5 types of white blood cells?

Eosinophils
Basophils
Neutrophils
Monocytes
Lymphocytes

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What do eosinophils look like? What is their function?

BI-lobed nucleus
Red granules
Fight parasitic infection
Involved in hypersensitivity

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What is the function of basophils?

Involved in hypersensitivity - release histamine

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What do neutrophils look like? What is their function?

Segmented nucleus

Phagocytes, kill with granule contents

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What does optical density of RBCs tell you about the concentration?

Optical density is proportional to the concentration

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What are the 3 layers of blood after being centrifuged?

Plasma
Buffy coat - WBC
Red blood cells

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What is heamatocrit?

Ratio or % of blood that is RBC

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What are reticulocytes?

Early red blood cells after denucleification

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What doe reticulocytes look like compared to RBCs?

Bigger

No central pallor

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If MCV is low what is the problem?

Problem with haemoglobinisation

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Is MCV is high what is the problem?

Problem with maturation

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What are small RBC with low Hb called?

Microcytic and hypochromic

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What are the components of haemoglobin?

Globins

Heam - prophyrin ring and Iron (FE2+)

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What are the causes of microcytic anaemia?

Heam deficiency 
    Iron deficiency
    Porphyrin synthesis problem
    Congenital sideroblastic anaemia
Globin deficiency
    Thalassaemia

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How is iron stored?

In ferritin

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What three lab results would confirm a iron deficiency?

Low MCV
Low Haemoglobin
Low serum ferritin

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What are 3 causes of iron deficiency?

Lack of iron in diet
Blood loss - GI, menorrhagia
Malabsorption

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What transports iron?

Transferrin

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Why are macrocytic red cells large?

Because of defects in DNA synthesis and nuclear maturation | Failure to become smaller

What are the 2 main causes of macrocytic anaemia?

B12 Deficiency | Folate deficiency

Where is B12 absorbed?

Ileum

Where is folate absorbed?

Duodenum and jejunum

Name 2 symptoms of macrocytic anaemia?

Weight loss Diarrhoea Jaundice Sore tongue

Name 3 causes of B12 deficiency?

``` Veganism Pancreatitis Coeliac disease Crowns disease Bowel resection Atrophic gastritis ```

Name 2 causes of folate deficiency?

``` Inadequate intake Malabsorption Pregnancy Haemolysis Anti convulsants ```

What other conditions if pernicious anaemia associated with?

Atrophic gastritis | Hypothyroidism

What auto antibodies may be raised in pernicious anaemia?

Anti gastric parietal cell | Anti intrinsic factor

What is the treatment for pernicious anaemia?

Vitamin B12 injections for life

Name 2 causes of non-megaloblastic macrocytosis?

Alcohol Liver disease Hypothyroidism Marrow failure

Where is erythropoietin released from?

Kidney

Which globins make up metal and adult Hb?

Fetal - alpha and gamma | Adult - alpha and beta

Which chromosome is the alpha gene on?

Which chromosome is the beta gene on?

What are the 4 classifications of alpha thalassaemia?

Silent alpha trait Alpha thal trait HbH disease Hb barts hydrops fetalis

What happens to the excess beta globin in HbH disease?

Forms beta4 - incapable of carrying oxygen

What mode of inheritance is HbH?

Autosomal recessive

What are the 3 classifications of beta thalassaemia?

Beta thal trait Beta thal intermedia Beta thal major

What physical feature might you see in beta thal major and why?

Heptosplenomegaly, skeletal changes - extra medullary heamopoiesis

What mutation causes sickle cell disease?

Point mutation of beta global gene

What type of haemoglobin in seen in sickle cell disease?

HbS - alpha 2 beta s 2

What do HbS become distorted?

When exposed to low O2

What is the main problem with sickled cells?

They cause vessel occlusion and ischaemia

Name 3 causes of sickle cell crisis?

Hypoxia Dehydration Cold exposure Stress, fatigue

When might someone with sickle trait have symptoms?

At altitude under anaesthetic - hypoxia

What long term preventative treatment can be given in sickle cell anaemia?

``` Education - avoiding triggers Vaccination Prophylactic penicillin Folic acid supplements Hydroxycarbanide ```

What mode of inheritance is sickle cell anaemia?

Autosomal recessive

What is the function of DMT-1?

Transports iron into duodenal enterocyte

What is the function of ferroportin?

Facilitates iron export from the enterocyte to transferrin

What is the function of hepcidin?

Down regulates ferroportin in response to iron overload - limits iron uptake

What causes iron overload in hereditary haemochromatosis?

Reduced hepcidin synthesis

What is the treatment of hereditary heamochromatosis?

Regulary venesection

What is the treatment of secondary iron overload in patients with anaemia?

Iron chelating agents e.g. desferrioxamine

What is the difference between blood products and blood components?

Blood components are made from 1 or a small number of donors blood Blood products can be made from 1000's of donors blood

On which chromosome is blood group gene?

Chromosome 9

Why do people have antibodies to blood that is not their own?

Because bacteria can mimic other blood groups so you make antibodies against these non self antigens

What does the indirect anti globulin or indirect coombs test do?

Tests for irregular antibodies

What 3 things should you do in the case of an immediate haemolytic transfusion reaction?

Stop transfusion, iv fluids, take blood samples

What is the definition of haemolysis?

Premature red cells destruction -shortened red cells survival

What is the difference between compensated and decompensated haemolysis?

Compensated - Hb level maintained | Decompensated - Hb level falls

What is the bone marrow response to haemolysis?

Reticulocystosis | Erythroid hyperplasia

What is extravascular haemolysis?

Destruction of red cells in liver and spleen

What is intravascular haemolysis?

Red cells destroyed in the circulation

What is the difference between products of extravascular and intravascular haemolysis?

Extravascular - normal products in excess | Intravascular - abnormal products - may be life threatening

Name 3 side effects of oral iron supplements?

Constipation, heart burn, black stools

By how much should iron rise per week if patient is compliant with treatment?

10g/l/week

Is anti gastric parietal cell antibody more sensitive or specific?

Sensitive - most patients with pernicious anaemia have it, not everyone with the antibody has anaemia

Is anti intrinsic factor more sensitive or specific?

Specific - if present it is always pernicious anaemia - but it is not always present

What is the pathogenesis of pernicious anaemia?

Autoimmune condition causing destruction of gastric parietal cells - which make intrinsic factor that binds to B12

If patient has low B12 and Folate what must you do and why?

Replace B12 first - otherwise it may cause subacute degeneration of the cord

Haematology Week 1 Flashcards

(75 cards)