Introduction To Haematology

Question 1

Where do all blood cells come from

Answer 1

Bone marrow

Question 2

What cells are blood cells derived from

Answer 2

Haemopoietic stem cells

Question 3

What are the site of haemopoiesis during embryogenesis

Answer 3

Yolk sac

Question 4

At birth what is the site for haemopoeisis

Answer 4

Bone marrow

Question 5

In certain condition what is the major site for haemopoiesis

Answer 5

Liver

Question 6

When can you have too few red blood cells

Answer 6

Hereditory haemoglobinopathies

Acquired secondary anaemia e.g iron, vitamin b12 or folate deficiency, autoimmune hameolytic anaemia, aplastic anaemia

Question 7

When can you have too many/dysfunctional

Answer 7

Hereditory haemochomatosis due to iron overload

Question 8

When can you have too few/dysfunctional white cells

Answer 8

Rare congenital anaemias
Acquired seconday deficiency- vitamin b12 or folate deficiency, autoimmune neutropenia, aplastic anaemia, drug or viral suppression

Question 9

When can you have too many white blood cells

Answer 9

Myeloproliferative disorders

Acute leukemia

Question 10

When can you have too few platelets

Answer 10

Bone marrow failure syndromes

Acquired secondary deficiency: vitamin b12, folate deficiency, immune thrombocytopenia, drug induce thrombocytopenia

Question 11

When can you have too many platelets

Answer 11

Infection
Trauma
Iron deficiency
Essential thrombocythaemia

Question 12

When can you have dysfunctional platelets

Answer 12

Inherited platelet dysfunction: bernard soulier, glanzmanss

Acquired platelet dysfunction: aspirin, heparin, uraemia

Question 13

What is contained in plasma

Answer 13

Water
Plasma proteins
Electrolyte e.g sodium and chloride
Nutrients: glucose and amino acids
Hormone
Waste: ureea and creatinne 
Gases: oxygen and carbon dioxide

Question 14

What is the difference between plasma and serum

Answer 14

Plasma: liquid part of the blood with no cells that has been treated with anti-coagulants to allow appropiate testing
Serum: liquid part of blood that is coagulated therefore removes fibrinogen (serum=plasma-fibrinogen)

Question 15

How is a bone marrow examination carried out

Answer 15

1. Patient will lie in a lateral position
2. Expose the iliac crest
3. Use a needle to go into the bone marrow cavity
4. Take a sample of the liquid bone marrrow
5. Send for an analysis
6. Then take sample of the periosteum itself called the trephine

Question 16

What is an aspirate

Answer 16

Removal of the liquid bone marrow

Question 17

What is a trephine

Answer 17

Solid histology section and allows study of marrow cellularity

Question 18

What are exmaples of inherited haemoglobinopathies

Answer 18

Thalassemia

Sickle cell disease

Question 19

What are the 2 types of thalassemia

Answer 19

Alpha

Beta

Question 20

What is beta thalassemia

Answer 20

Abnormality of the beta chain

Question 21

What is a feature of the bone marrow compensation of RBC

Answer 21

Nucleated red blood cells - the bone marrow is trying to compensate for the anaemia which is pushing out nucleated RBC

Question 22

What is the treatment for beta thalassemia

Answer 22

Transfusion

Genetic counselling if they have a child

Question 23

What is alpha thalassemia

Answer 23

Abnormality in the alpha gene

Question 24

What are the classification of anaemia by

Answer 24

Size of the red blood cell:
Microcytic
Normocytic
Macrocytic

Question 25

What are the causes for microcytic anaemia

Answer 25

Iron deficiency anaemia | Thalassemia

Question 26

What are the causes for normocytic anaemia

Answer 26

Bone marrow failure Aplastic anaemia Chronic disorders Renal disease

Question 27

What are the causes of macrocytic anaemia

Answer 27

B12 and folate deficiency | Alcoholism

Question 28

What are the causes of iron deficiency anaemia

Answer 28

Chronic blood loss: GI bleed or menstruation Poor diet Malabsorption: parasitic infection or GI disease

Question 29

What is the treatment of iron deficiency anaemia

Answer 29

``` Treating the underlying disease Ferrous sulphate (iron tablets) ```

Question 30

What are the causes of macrocytic anaemia

Answer 30

Alcohol | Pernicious anaemia: cant absorb vitamin b12 or folate

Question 31

What are the features of macrocytic anaemia

Answer 31

Pallor | Macroglossia (beef tongue)

Question 32

What are the complicatiomns of macrocytic anaemia

Answer 32

``` Folate deficiency- spina bifida Hypersegmented neutrophils (you can get 5 nuclei of neutrophils) ```

Question 33

What is haemolytic anaemia

Answer 33

This is when the RBC are brocken down rapidly so anaemia occur

Question 34

What is a clinical feature of haemolytic anaemia

Answer 34

Jaundice as RBC breakdown leads to increase in bilirubin

Question 35

What are the causes of haemolytic anaemia

Answer 35

Inherited: membrane, haemoglobin, enzyme Acquired: immune and non immune

Question 36

How does blood clotting occur

Answer 36

1. Endothelium on the blood vessel is damaged 2. VWF binds to the injured vessel wall 4. VWF changes configuration 5. Platelets stick to the VWF 6. GP1B and GP2B/3A will then stick to more platelets can bind

Question 37

What can the pattern on bleedin tell us

Answer 37

Mucosal or skin bleed- vascular or platelet abnormality | Coagulation disorders- bleeding into joints and muscles

Question 38

What can the causes of thrombosis be

Answer 38

Inherited: factor 5 leids, antithrombin, protein c or s abnormality Acquired: vessel damage, stasis, change in blood composition

Question 39

What are the 4 major sets of leukemia

Answer 39

Acute myeloid leukemia Chronic myeloid leukemia Acute lymphoid leukemia Chornic lymphoid leukemia

Question 40

What are lymphomas

Answer 40

Tumours of lymphocytes- commonly in b than t

Question 41

Give examples of lymphoma

Answer 41

Non hodgkin lymphoma | Hodgkin lymphome

Question 42

What does hodgkin lymphoma in histology show

Answer 42

Owl eye

Question 43

What is myeloma

Answer 43

Maligancy of the plasma cells that produce a monoclonal immunoglobulin called paraprotein

Question 44

What is myeloma likely to present with

Answer 44

Renal failure Bone pain Anaemia Infection

Question 45

In transfusion what can we give

Answer 45

``` Packed red blood cells Platelets Fresh frozen plasma and cryoprecipitate Fresh frozen plasma Cyroprecipitate ```

Question 46

What is in the packed red blood cells

Answer 46

Platelts and plasma are removed just the RBC

Question 47

What does fresh frozen plasma contain

Answer 47

Coagulation factors

Question 48

What does cyroprecipitate contain

Answer 48

Factor 8,13,vwf and fibrinogen