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Heamatology Flashcards

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1
Q

To be A positive what could you have inherited

A

AA or AO alleles

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2
Q

To be O postive what could you inherit

A

Both OO

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3
Q

How many rhesus antigens are there

A

4
D
Cc
Ee

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4
Q

What are the consequence of haemolytic disease of he newborn

A

Anaemia/ jaundice
Intrauterine death
Hydropis fetus

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5
Q

How is haemolytic disease of newborn managed

A

Pregnant women all offered anti-D if rhesus negative and postnatally if have rhesus d positive child
All women of childbearing age should be given kell negative blood transfusion if required

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6
Q

What alleles do you have to inherit to be rhesus d negative

A

cde and cde

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7
Q

What alleles can you inherit to be rhesus d positive

A

CDe and cde

CDe and CDe

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8
Q

How can the patient serum be tested pretransfusion

A

Antiglobulin test
Direct
Indirect
Red cell comparability testing

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9
Q

What are the risks of blood transfusion

A

immediate- ABO ag ab interaction
Delay- iron loading
RBC alloimmunisation
transfusion related acute lung injury (6hours, oedema)
Fluid overload
Purples
Dilution of clotting factors and hypoglycaemia ( massive transfusion)
Other none immune - infections and febrile or allergic reactions

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10
Q

What is blood made up of in percentages

A

45% RBC
55% plasma
1% WBC and platelets

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11
Q

RBC life span

A

100-120 days (4 months)

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12
Q

What is haematocrit a measure of

A

% of blood volume that is RBC

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13
Q

Life span of a platelet

A

7-14 days

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14
Q

What are platelets for and what happens to them when activated

A

Clotting in high flow areas ( arteries)

Circulate as smooth discs but become sticky and spikey when activated

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15
Q

What are the two divisions of white cells

A

Phagocytic ( granulocytes and monocytes)

Lymphoid- t and b and NK

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16
Q

Lifespan and functions of a neutrophil

A

8 hours
Phagocytosed bacteria with free radicals
Many fine red granules

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17
Q

Function of a monocyte

A

Phagocytosed dead or dying cells and accelerate material

Macrophages in transit

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18
Q

What is the lifespan and role of eosinophils

A 
Circ-8-12 hours
Tissues 8-12 days
Anti-parasitic 
Allergic response 
IgE activity link 
Characteristic bilobed and red granules
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19
Q

What is the lifespan and function of basophils

A

2-3 days

Unclear maybe inflammatory

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20
Q

What do lymphocytes look like

A

Roundish uncles with blue cytoplasmic, mostly agranular

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21
Q

What are the general cause of anaemia

A

Under production
Increased destruction
Increased loss

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22
Q

What is polycythaemia

A

Over production in the marrow or reduced plasma = pseudo

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23
Q

How can anaemia be assessed

A

MCV - how big the red cells are indicate hb or iron content
MHC- mean cell haemoglobin
Reticulocytes- immature red cells

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24
Q

What are the cause of microcytic anaemia

A 
a/b Thalasseamia 
Iron deficiency 
Chronic disease ( make the body deficient to limit bacterial growth )
Sideroblastic anaemia
Blood loss is most common
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25
What are the causes of macrocyclic anaemia
``` Reticulocytosis (haemorrhage or haemolytic) Megoblastic anaemia (b12 or folate deficiency) Marrow dysfunction - primary- leukaemia/ myeloma/ myelodysplasia, secondary to renal failure/ thyroid dysfunction/ chemotherapy/ ```
26
What is thrombocytosis
Too many platelets formed due to marrow over production or reaction to inflammation or infection
27
What is thrombocytopenia
``` Reduced platelets Caused by consumption but clotting Infection Liver damage Marrow underproduction ```
28
What is neutrophils a reaction to
Infection ( increased)
29
What is neutropenia a reaction to
Under production or over consumption
30
What is monocytosis a reaction to
Chronic inflammation or TB
31
What is eosinophilia a reaction ton
Parasites, fungi, allergies ( asthma)
32
What is Virchow triad
Explains why blood clots Reduction in blood flow Disturbance in blood vessel Disturbance of blood properties
33
Why does normal blood not clot
Complex balance between prothrombotic and anticoagulant factors
34
What are the types of clot, what are they based on and what drug treats them
Arterial- platelets- aspirin | Venous-fibrinogen- warfarin
35
What can you measure the intrinsic clotting pathway with
ATPP Activated partial thromboplastin time Usually 22-32 seconds Assesses effect of u fractionated heparin
36
What is ATPP elevated in
``` Haemophilia a+b Von Williebrands disease Lupus Liver disease DIC ```
37
How can you asses the extrinsic pathway of clotting
Prothrombin time Usually 9-12 seconds Monitors effects of warfarin and liver function ( factor 7) Pathologically prolonged in liver dysfunction or DIC
38
What clotting factors are vitamin K dependant
10 9 7 2
39
What does thrombin time measure | How long is it usually and when is it prolonged
Common pathway function 12-20 seconds Heparin treatment but esp UFH Or in liver disease or DIC
40
Why might you do a mixing study of a patients blood
Prolonged PT/INR or APTT, checks that the patient doesn't have something other than a clotting factor dysfunction eg an inhibitor
41
What is the d-dimer test
Normally less than 250, raised means lots of chopped up fibrin by plasmin ( recent clot) Doesn't tell you cause of the clot
42
What is the problem with ATPP PT and TT
Measure isolated cogilation without endothelium and platelets Better to do basic bleeding time
43
What is bleeding time usually
2-8 mins
44
Name 7 cause of abnormal bleeding
``` Dysfunction of clotting factors Insufficient clotting factors Abnormal biochemical environment (pH) Dysfunctional platelets Insufficient platelets Dysfunctional vascular endothelium Dysfunctional vessel constriction ```
45
What is haemophilia
X linked disease A- reduced factor 8 B- reduced factor 9 Causes prolonged ATPP and joint bleeding and bruises
46
explain DIC
Disseminated intravascular coagulation . Causes by infection of gram -ve, malignancy, pregnancy, massive bleeding Microscopic clots in circ use up all platelets and clotting factors and leading to widespread bleeding
47
What is transfusion coagulopathy
Occurs when situations of massive transfusion Platelets and clotting factors depleted and then diluted by the transfusion leading to circ becoming acidotic and hypthermic further inhibiting clotting factors
48
What are dysfunctional platelets most likely caused by
Drugs- aspirin clopidogrel and abciximab
49
How does platelet dysfunction manifest
Bleeding from mucosal surface
50
What are three causes of low platelets
Liver disease Marrow failure Immune theomboctypaenic purpura
51
What are risk factors for arterial clots (8)
``` Old age Hypertension Diabetes Smoking High cholesterol Past history of stroke or heart attack Family history of stroke or heart attack Infection/inflammation/cancer ```
52
Name 8 risk factors for venous clots
``` Increasing age Immobility Surgery Hospitalisation Long plane journeys Pregnancy Cancer/infection/inflammation Pregnancy COPD ```
53
what is the acute treatment for arterial clots
Heparins
54
What is the immediate treatment for venous clots
High dose heparin
55
Explain how heparin works | And the difference between LMWH and UFH
Deactivation of factors 10 and 2 | LMWH - more consistent anticoagulants on that UFH but UFH more easily reversed
56
Explain how warfarin works
Antagonises vitamin k needed for factors 10 9 7 and 2 | Lots of interactions
57
What classical blood groups are there and what antigen antibody and prevalence do each have
``` O = no a or b antigen, anti-a and anti-B 43% A= a antigen, anti-B 43% B= b antigen, anti-A 9% AB= a and b antigens, no antibodies 3% ```
58
What are the classifications of haematological malignancy
Myeloid- granulocytes monocytes megakaryocytes and rbcs | Lymphoid- lymphocytes
59
Name some myeloid disorders
Active myeloid leukaemia Chronic myeloid leukaemia Myeloproliferative disorders Myelodysplasia syndromes
60
Name some lymphoid disorders
``` Acute lymphoblastic leukaemia Chronic lymphocytic leukaemia Plasma cell disorders- myeloma T cell lymphomas Non Hodgkin's lymphoma ```
61
What are myeloproliferative disorders
Excess mature cells in the blood Polycythaemia Rubro Vera- RBC Essential thrombocythaemia- platelets Have underlying problem with jamuskinase gene. Myelofibrosis ( abnormal megokaryocytes) Systemic mastocytosis Increased clotting
62
What are acute leukaemia a, what do they present with and how are they treated
``` Malignancy of bone marrow Very rapid cell growth Abnormal cells fill bone marrow then spill out into circulation Present with Anaemia- fatigue, tiredness, and pallor Thrombocytopenia- bleeding and bruising Neutropenia-infections AML Strong chemotherapy in bursts ALL- strong chemo mixed with persistent milder tablets ```
63
What is the commentary leukaemia of children
Acute lymphoblastic leukaemia
64
What is the prognosis like for acute l l in children
90% revision | 85% cured
65
What characterises chronic myeloid leukaemia
White white cell count with or without leukostasis Splenomegaly Priapism Cause by Philadelphia chromosome - translocation 9 : 22
66
What is the treatment for chronic M leukaemia
Tumour cell specific enzyme- Imantinib
67
What characteristics chronic lymphoblastic leukaemia
``` Relative common high lymphocyte count but normal RBC Smudge cells in blood film Hypoammaglobuliaemia Defective apoptosis May have lymphadenopathy/spenomegaly Immune disturbance Marrow suppression ```
68
What is the prognosis like for CLL
Good, ten years | Can be left untreated when without symptoms, bulk disease or bone arrow failure
69
What is the difference between a non Hodgkin's lymphoma and leukaemia
Leukaemia effects the blood cells in the bone marrow | Lymphoma effects WBC in tissues (30%) and lymph nodes (70%)
70
What virus's may non Hodgkin's lymphoma be related to
EBV HTLV HHV8 HIV
71
What other than virus's is NHlymphoma related to
Chemical and sunlight exposure
72
What are the signs of NH lymphoma
B symptoms- wt loss, drenching night sweats, fevers and lymphadenopathy
73
What is Hodgkin's disease
Related to EBV infection Peaks of prevalence in terms and elderly- when EBV has interstates into lymphocyte DNA closer or further from proto-oncogenes
74
What does Hodgkin's disease present with and how is a diagnosis made
B symptoms and contiguous nodal spread | Diagnosis- biopsy lymphadenopathy , CT to stage tumour
75
What does grade of lymphoma indicate
Low grade- slow grumbling chronic | High grade- fast aggressive and acute
76
What the different igs for
``` IgD- newly made lymphocyte IgM- clear pathogens IgE- parasites IgG - pathogens from tissues fluids IgA- mucosal surface ```
77
What are paraproteins
Protein caused by abmormal clonal proliferation of plasma cells. Monoclonal antibodies cause a spike in normal globulin pattern in electrophoresis
78
What are the three steps to diagnosing myeloma
Plasma cells in marrow Paraproteins detectable in blood or urine Lytic lesions on skeletal survey (X-ray)
79
What is igM paraprotein indicative of
Waldenstorms macroglobulinaemia
80
When would you think of myeloma
Old person with anaemia back pain high ESR unexplained renal failed or unusual fractures
81
What is hyperviscosity syndrome
Sticky treacle blood Fibrinogen igM igA or polycythaemia Symptoms- fatigue headache confusion

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