Introduction to Haematology

Question 1

How many cells do we have in our body?

Answer 1

35-40 trillion cells

Question 2

How many white and red cells do we produce in a minute?

Answer 2

White 5-7 million/minute
Red 100-150 million/minute

Question 3

How many cells in total divide in a minute?

Answer 3

Somewhere between 200-300 million cells

Question 4

What are the cells involved in haematopoiesis from the multipotent stem cell?

Answer 4

Multipotent stem cell - haematopoietic stem cell
Primitive progenitor cells - common myeloid progenitor & common lymphoid progenitor
Committed precursor cells - (CMP) megakaryocyte and erythroid progenitor, granulocyte and macrophage progenitor; (CLP) T-cell and natural killer cell progenitor, B-cell progenitor
Lineage committed cells - (MEP) megakaryocyte->platelets, erythrocyte progenitor->erythrocytes; (GM) monocyte progenitor->macrophage/monocyte/dendritic cell, granulocyte progenitor->neutrophil/basophil/eosinophil; (TNK) T-cell progenitor->T-cell, natural killer cell progenitor->NK cell; (BCP) B-cell; (CLP) dendritic cell

Question 5

Which components of the blood are seen in a normal FBC?

Answer 5

Platelets
Neutrophils/WBC
Red cells

Question 6

What condition is seen in iron deficiency anaemia?

Answer 6

Angular stomatitis

Question 7

What determines iron deficiency anaemia?

Answer 7

Microcytic hypochromic RBCs (pale/small)
Low haemoglobin (Hb)/Mean corpuscular volume (MCV)/Ferritin levels

Question 8

What are the causes of iron deficiency?

Answer 8

Dietary deficiency
Malabsorption
Blood loss
GI tract conditions eg coeliac and Crohn’s
Menorrhagia

Question 9

What deficiency is a smooth tongue an indication of?

Answer 9

B12 deficiency

Question 10

What type of anaemia is caused by vitamin B12 or B9 (Folate) deficiency?

Answer 10

Macrocytic anaemia

Question 11

How long does folate stored in the body usually last?

Answer 11

4 months

Question 12

What are the main sources of folate?

Answer 12

Leafy vegetables
Fruits
Liver

Question 13

What are the main sources of B12?

Answer 13

Meat
Fish
Eggs
Dairy
Fortified breakfast cereals

Question 14

Where are folates usually absorbed?

Answer 14

Duodenum and jejunum (small intestine)

Question 15

Where is B12 usually absorbed?

Answer 15

Ileum (small intestine)

Question 16

How long does the body supply of B12 usually last?

Answer 16

2-6 years

Question 17

What protein is involved in the absorption of B12?

Answer 17

Intrinsic factor (IF)

Question 18

Apart from a smooth tongue, what may occur in B12 deficiency?

Answer 18

Macroglossia

Question 19

What do neutrophils and red cells look like in macrocytic anaemia?

Answer 19

Hypersegmented (extensive lobing) neutrophils and large red cells

Question 20

What will the blood test results of a patient with macrocytic anaemia show?

Answer 20

Low Hb
High MCV (large RBCs)
Low B12 and folate

Question 21

What can cause folate deficiency?

Answer 21

Reduced intake
Increased requirements/demands eg pregnancy
Malabsorption eg coeliac disease
Alcoholism
Drugs eg septrin & methotrexate

Question 22

What can cause B12 deficiency?

Answer 22

Inadequate intake
Low gastric acid (10-30% patients with partial gastrectomy)
Intrinsic factor antibodies against parietal cells (pernicious anaemia)
Abnormal terminal ileum

Question 23

How to diagnose B12 and folate deficiency?

Answer 23

Measure red cell folate levels
Measure vitamin B12 levels
Measure intrinsic factor antibodies

Question 24

How to treat B12 and folate deficiency?

Answer 24

Identify underlying cause
Oral folate replacement
Lifelong injections of B12 (every 3 months)

Question 25

Apart from B12/folate deficiency, what can cause macrocytic anaemia?

Answer 25

Drugs eg methotrexate Alcohol Myelodysplasia

Question 26

What is myelodysplasia?

Answer 26

A type of rare blood cancer where blood cells are poorly formed or don't function properly

Question 27

What are petechiae?

Answer 27

Small red dots on the hard palate

Question 28

Where may petechiae manifest on apart from hard palate?

Answer 28

Legs (bruises)

Question 29

Can we give dental treatments to patients with petechiae?

Answer 29

No as patient will bleed excessively

Question 30

What causes petechiae?

Answer 30

Immune thrombocytopenia (ITP) Disseminated intravascular coagulation (DIC) Recent infection eg mononucleosis/glandular fever Bone marrow infiltration eg acute leukaemia Bone marrow failure syndromes eg aplastic anaemia, myelodysplastic syndrome (MDS)

Question 31

Petechiae presents due to reduced _________

Answer 31

Platelets

Question 32

What disease is gingival hyperplasia seen in?

Answer 32

Acute leukaemia

Question 33

What do primary marrow disorders such as acute leukaemia usually present with?

Answer 33

Bruising Bleeding Infection Skin rash Lymphadenopathy Gum hypertrophy

Question 34

What may primary marrow disorders treatment include?

Answer 34

Bone marrow transplantation

Question 35

What is the 5-year-prognosis/survival rate depending on leukaemia type and treatment?

Answer 35

30-70%

Question 36

Which patients have a poorer leukaemia prognosis?

Answer 36

Elderly

Question 37

What treatment is osteonecrosis of the jaw associated with?

Answer 37

Bisphosphonate

Question 38

Osteonecrosis of the jaw is a severe ____ disease affecting the jaws leading to ______, probably _______ related

Answer 38

Bone, necrosis, ischaemia

Question 39

_________-containing bisphosphonates, especially ________ and __________, are associated with worse osteonecrosis.

Answer 39

Nitrogen, pamidronate, zoledronate

Question 40

Should bisphosphonates be stopped if dental extraction or root canal treatment is required?

Answer 40

Yes

Question 41

What should be given to patients treated with oral and intravenous bisphosphonates prior to oral surgery and why?

Answer 41

Antibiotics eg augmentin to avoid osteonecrosis and promote healing of the affected area

Question 42

Nearly all ________ patients are on bisphosphonates

Answer 42

Myeloma (bone marrow cancer)

Question 43

What is the median age of presentation of myeloma?

Answer 43

67 y/o

Question 44

What symptoms are present in myeloma patients?

Answer 44

Anaemia Bone pain Infection Constipation Stomach upsets secondary to hypercalcaemia

Question 45

What are the lab findings for myeloma?

Answer 45

Normochromic normocytic anaemia Paraprotein Bence Jones proteinuria High plasma viscosity or erythrocyte sedimentation rate (ESR)

Question 46

What would a myeloma skull present in an X-ray?

Answer 46

Bare punched out holes

Question 47

Where does lymphomatous lesion affect?

Answer 47

Hard palate

Question 48

What is the clinical feature of lymphoma parotid?

Answer 48

Parotid swelling

Question 49

Axillary lymphadenopathy could be a more benign form of lymphoma or __________ ________ ________ (CLL)

Answer 49

Chronic lymphocytic leukaemia

Question 50

What are the 2 types of lymphoma?

Answer 50

Non-Hodgkin lymphoma Hodgkin's lymphoma

Question 51

What are the two different types of non-Hodgkin lymphoma?

Answer 51

High-grade or aggressive non-Hodgkin lymphoma Low-grade or indolent non-Hodgkin lymphoma

Question 52

What is the cancer growth of high-grade non-Hodgkin lymphoma?

Answer 52

Quickly and aggressively

Question 53

What is the cancer growth of low-grade non-Hodgkin lymphoma?

Answer 53

Slowly and may not experience any symptoms for many years

Question 54

How common is non-Hodgkin lymphoma compared to Hodgkins?

Answer 54

3 to 4 times as common as HD

Question 55

How many different subtypes are there under non-Hodgkin lymphoma?

Answer 55

~50

Question 56

Treatment of non-Hodgkin lymphoma depends on ___ and ______. It may be anything from innocuous oral chemotherapy to _________ chemotherapy and transplant. In terms of outcome, some subtypes are incurable but _________ for long periods, whereas others have a 5-year survival rate of ____ to ____%

Answer 56

Age, subtype, intensive, controllable, 30 to 40%

Question 57

What is mucositis?

Answer 57

Inflammation of the mucosal surfaces throughout the body

Question 58

What are the clinical manifestations of oral mucositis?

Answer 58

Erythema, inflammation, ulceration, haemorrhage in the mouth and throat

Question 59

When is oral mucositis frequently seen?

Answer 59

Post-chemotherapy and radiotherapy

Question 60

What can be used to get some relief from oral mucositis?

Answer 60

Mouthwashes Anti-inflammatories

Question 61

According to the World Health Organisation's Oral Toxicity Scale, what are the grades for severe mucositis?

Answer 61

Grade 3 and 4

Question 62

What are the 4 conditions that can coexist in immunocompromised patients and require differential diagnosis?

Answer 62

Petechiae or local, denture-related lesions Oral thrush Aphthous ulcer Oral mucositis

Question 63

What can oral candidiasis be treated with?

Answer 63

First line - nystatin Severe cases - oral fluconazole

Question 64

What can be used to treat reactivated herpes simplex?

Answer 64

Topical aciclovir

Question 65

What is herpes simplex virus 3 also known as?

Answer 65

Herpes zoster

Question 66

What does herpes zoster or HSV3 cause?

Answer 66

Shingles Chickenpox/varicella

Question 67

How to treat shingles?

Answer 67

Oral aciclovir

Question 68

How are shingles distributed?

Answer 68

Dermatomal/centripedal distribution (more in trunks than limbs)

Question 69

What is the normal range of Hb in female?

Answer 69

11-18 g/dl

Question 70

What is the normal range of Hb in male?

Answer 70

13-18 g/dl

Question 71

What are the main types of anaemia and their indications?

Answer 71

1. Iron deficiency - microcytic hypochromic RBCs 2. Anaemia of chronic disease eg rheumatoid arthritis and chronic kidney disease - normocytic RBCs 3. B12 & folate deficiency - macrocytic RBCs

Question 72

What is the normal white cell count?

Answer 72

4-11 x 10^9 per litre

Question 73

When will white cell count increase past the normal?

Answer 73

During infections or leukaemia

Question 74

When will white cell count decrease outside the normal?

Answer 74

Viral infections

Question 75

What is the normal platelet count?

Answer 75

150-400 x 10^9 per litre