Week 8

Question 1

In neonates it is normal to see NRBC before day ____ after that it would suggest haemolysis, hypoxia or infection

Answer 1

5

Question 2

In neonates is the RDW elevated or decreased?

Answer 2

Elevated RDW at birth

Anisocytosis on film

Question 3

Do Neonates have a high or low haematocrit in days after birth?

Answer 3

High

Question 4

In neonates at birth is the WBC elevated or decreased

Answer 4

Elevated - Wide reference range

Question 5

What are the Vit K dependent factors?

Answer 5

• II, VII, IX & X

* Protein C, S & Z

Question 6

Do elderly people have similar or lower tolerance of anaemia?

Answer 6

Lower

Question 7

At birth, what is extremely cellular?

Answer 7

red marrow

Question 8

At birth what lineages are multiplying and differentiating

Answer 8

all

Question 9

In a full term infant there is little scattered haemopoiesis in ______ which ceases soon after birth

Answer 9

liver

Question 10

Extra-medullary haemopoiesis may be common in ________ liver, spleen, lymph nodes, thymus

Answer 10

pre-term babies

Question 11

What type of Hb predominates at birth

Answer 11

Hb F (alpha 2 + Gamma 2)

Question 12

What type of Hb predominates from 2-adulthood?

Answer 12

Hb A1 (Alpha 2 + Beta 2)

Question 13

Full term =
Premature/Preterm =
Postterm =

Answer 13

37 -42 weeks gestation
<37 weeks gestation
>42 weeks gestation

Question 14

In newborns does the Hb and MCV begin high or low?

Answer 14

high

Question 15

Ranges for pre-term infants depends on what two things?

Answer 15

level of prematurity and birth weight

Question 16

Neonatal (≤ 4weeks) haematological values are affected by:

Answer 16

o Gestational age
o Birth weight
o Age after delivery
o Presence of illness
o Sampling site (Capillary, venous or arterial)

Question 17

What causes “Polycythaemia of the newborn”

Answer 17

• Degree of hypoxia in utero stimulates increased erythropoietin

Question 18

Following birth, oxygenation increases which suppresses what?

Answer 18

Suppresses erythropoietin level

Question 19

In newborns erythrocytes are macrocytic until day ___
Orthochromatic normoblasts in film until around day ____ (Persist longer in premature infants)
NRBC after day _____ suggests haemolysis, hypoxia or infection

Answer 19

5, 3, 5

Question 20

Capillary samples may have higher _____ and _____than venous

Answer 20

Hb, and Hct

Question 21

The more premature the baby the higher the MCV or lower?

Answer 21

Higher

Question 22

Is the RDW raised or lowered in newborns?

Answer 22

Elevated

Question 23

At birth is the WCC elevated or lowered? Which white cell predominates? Are there increased band forms?

Answer 23

Elevated WCC
Predominance of neutrophils
Yes - Increased band forms

Question 24

Would you expect to se a greater left shift with prematurity?

Answer 24

Yes • Myelocytes, metamyelocytes, band forms

Question 25

What would indicate an infection in neonates?

Answer 25

Neutropenia or neutrophilia, vacuoles, hypergranulation, dohle bodies

Question 26

Describe why neonates should get a vit K injection.

Answer 26

Neonates have ~ 30% of adult levels of Vit K dependent factors • because their intestines have not been colonised by bacteria needed to synthesize Vit K • Vit K poorly transported across placenta (stores depleted quickly after birth) • human breast milk contain relatively low conc of vit K →Risk vit K deficiency bleeding (VKDB) Reach adult values around 2 to 6 months

Question 27

What is the most common cause of anaemia in children?

Answer 27

iron deficiency

Question 28

Most cases of Haemolytic Uraemic Syndrome are associated with what?

Answer 28

Shigella dysenteriae or E. coli O157:H7 infection in gut

Question 29

In children Haemolytic Uraemic Syndrome resembles what other condition?

Answer 29

Thrombotic Thrombocytopenic Purpura (TTP)

Question 30

What are the 5 main features of HUS and TTP

Answer 30

* fever * anaemia (microangiopathic haemolytic anaemia) * thrombocytopenia * renal problems more in HUS * neurological problems more in TTP

Question 31

Which White Blood Cell has decrease in function and which functions are affected?

Answer 31

Neutrophil function : chemotaxis, phagocytosis, superoxide generation

Question 32

B cells rely on _____ interaction to produce antibodies.

Answer 32

T cell

Question 33

What are the contributing factors of anaemia in the elderly.

Answer 33

``` Contributing factors: • ↓ BM function • ↓ physical activity • Nutritional deficiencies • Cardiovascular Disorders • Chronic inflamm disorder ```

Question 34

Anaemia of chronic inflammation depends on severity of underlying disease what can happen to the RBC's?

Answer 34

▪ Proinflammatory cytokines may impair erythropoiesis | ▪ ↓ RBC survival

Question 35

Iron deficiency anaemia in the elderly is often associated with what other conditions? (6)

Answer 35

``` ▪ Chronic GI bleed ▪ Long term use of NSAID ▪ Gastritis ▪ Peptic ulcer ▪ Colon cancer ▪ May be asso with poor diet ```

Question 36

Do plasma concentrations of many coagulation factors increase or decrease with aging?

Answer 36

Increase | Incidence of venous thromboembolism (VTE) ↑ with aging.

Question 37

What does HELLP syndrome stand for?

Answer 37

(Haemolysis, Elevated Liver enzymes, Low Platelet count)

Question 38

What are some common causes of DIC in obstetrics? (6)

Answer 38

``` Amniotic fluid embolism HELLP syndrome Pre-eclampsia Placental abruption Septic abortion Postpartum haemorrhage ```

Question 39

What is the most severe form of Haemolytic Disease of the New Born and what is the most common?

Answer 39

Rh HDNB is most severe (IgG Ab) | ABO HDNB – more common but less severe (mostly IgM Ab)

Question 40

How does pregnancy affects RBC and WBC?

Answer 40

Decreased Hb - no symptoms | Increased WBC, mostly neutrophils, may have hypergranulation & left shift