2. Introduction to Heamatology

Question 1

What is haematology?

Answer 1

The investigation of blood and bone marrow

The management of disorders of blood and bone marrow

Question 2

What are the components of blood?

Answer 2

Red blood cells
Buffy coat- Platelets, White cells
Plasma- Clotting or coagulation factors, albumin, antibodies

Question 3

What is the difference between plasma and serum

Answer 3

Plasma- contains clotting factors

Serum- has clotted, does not contain clotting factors

Question 4

What is the function of the blood?

Answer 4

Transports:

• oxygen and carbon dioxide
• Nutrients
• waste
• messages

Question 5

How does blood maintain vascular integrity?

Answer 5

Contains platelets and clotting factors, prevents leaks

Prevents blockages through anticoagulants and fibronocytes

Question 6

How does the body protect from pathogens?

Answer 6

Phagocytosis and killing

Antigen recognition and antibody formation

Question 7

How do you classify heamatological abnormalities?

Answer 7

Increased rate of production- High level
Deceased rate of loss- High levels

Decreased rate of produciton- Low levels
Increased rate of loss

Question 8

What are myeloid cells?

Answer 8

All the cells coming out of the bone marrow

Erythrocytes, platelets, neutrophil, monocyte, basophils eosinophils, lymphocyte

Question 9

What are stem cells?

Answer 9

Totipotent
Self renewal
Home to narrow niche e.g. CXCR4 (antagonist plerixafor)
Binary fission and flux through differntiation pathways amplify numbers
Flux regulated by hormones/growth factors

Question 10

Discuss bone marrow

Answer 10

Most in children, axial in elderly

Contains stroma and sinusoids

Question 11

Describe erythronium differentiation

Answer 11

Eryhtrobloast—-> reticulocyte—-> erythrocyte
Erythropoietin (made in kidney in response to hypoxia)
Reticulocyte count (a measure of red cell production)

Question 12

What are the consequences of anaemia?

What are the heamatinics

What are the causes of aneamia

Answer 12

Poor gas transfer, dyspnoea, fatigue

Deficiency in “heamatinics”- iron, folate vitamin B12

Thalassaemias

Bleeding, haemolytic

Question 13

What are the functions of platelets?

Where are they produced

How long do they last

Answer 13

Haemostasis and immune response

Production regulated by thrompoietin
Produced in Liver

Lifespan- 7 days

Question 14

What diseases happen with platelets?

Answer 14

Thrombocytosis- too many platelets, spontaneous clots

Thrombocytopenia- too little platelets marrow failure, immune destruction

Question 15

What is the job of neurtrophils?

Answer 15

Ingest and destroy pathogens especially bacteria and fungi

Lifespan 1-2 days, speed of response a few hours

Question 16

How do neutrophils differentiate?

Answer 16

Blast (present in acute myeloid leukaemia)

Neutrophil

Question 17

What is neutropenia?

What are it’s causes

Answer 17

Low neutrophil count,

caused by drugs, marrow failure, sepsis,autoimmune consumption, altered function e.g. chronic granulomatous disease

Question 18

What are monocytes?

Answer 18

Ingest and destroy pathogen, especially bacteria and fungi
Subset of monocytes migrate into tissues and become macrophages or dendritic cells
Some macrophages are self maintaining

Question 19

What are all the different names for monocytes

Answer 19

Langerhan cells- skin
Kupifner cells- liver
Lung alveolar macrophages
Brain microglia
serosal macrophages
Sinus macrophages
Spleen sinus macrophages

Question 20

What are the other myeloid cells?

Answer 20

Eosinophils- fight parasites, double nucleated. Cause allergies
Basophils

Question 21

What causes altered lymphocyte counts?

Answer 21

Lymphocytosis- infectious mononucleosis
Pertussis
Lymphopenia- usually post viral, lymphoma

Question 22

What do the different T cells do?

Answer 22

Helper- assist immune response or cytotoxic cells
Cytotoxic- Kills cells that should not be there
Regulatory- prevent autoimmune disease

Question 23

How are antibodies generated?

Answer 23

Each lymphocyte has one T or B cell receptor.
Variable regions are created by V-D-J recombination
Mistakes in the V-D-J recombination leads to malignancies due to oncogenes being incoparated into the process and then being matured

Question 24

Describe the basic structure of antibodies.

Answer 24

Two heavy chains and two light chains to form a “Y” shape

Top bit is the FAB region

Question 25

What are The different types of antibodies

Answer 25

IgG- main one
IgE- immunity to parasites
IgD- activates B cells
IgM- generated early in immune response 
IgA- gut

Question 26

What is the difference between type 1 and type two human leukocyte antigen (HLA or MHC).

Answer 26

Type 1- displays internal antigens of a cell on all nucleated cells

Type 2- displays antigens eaten by professional antigen presenting cells

Question 27

Why is everyone with rhaemuatoid arthritis anemic?

Answer 27

Taking non steroidals tend to bleed 
Anaemia that occurs with chronic diseases 
Folate deficiency
Immune heamolysis
Neutrophilia
Immune throbocytopenia
Cytopenias secondary to medication

Question 28

What abnormalities can occur with plasmas?

Answer 28

Too much- paraproteins

Too little- clotting factors- haemophilia

Abnormal function- clotting factors; haemophilia

Question 29

What blood count normal ranges do you have to know?

Answer 29

Male heamoglobin- 135-170g/l
Female heamoglobin-120-160g/l
Platelets-150-400
White blood cell count-4-10

Question 30

What other diagnostic tools are there?

Answer 30

Clotting times
Bone marrow and lymph biopsy
Chemical analysis- iron, B12, ferrate
Imaging