2011 exam Flashcards
haemolytic disease for newborn - does anti D - extra or intra vascular
extravascular
Additional tests you ask the blood bank to complete on baby and mother
?
Clinical symptoms of leukaemia
how to confirm?
- tiredness
- severe brusing
- unusual bleeding from gums
- low haemoblobin
- lowplatelets
- low nuetrophils
Anaemia - fatigue, dyspnoea , chest pain
Neutropenia - infection, wounds slow to heal as less good white blood cells
Thrombocytopenia - bruising and bleeding
Bone marrow pain
Enlarger liver, spleen, lymph nodes
Gums
- take a bone marrow examination and could do bone marrow morphology – see if more than 20% are myeloid or lymphoid
- aspirate
- trephine
Would it benefit to give G-CSF colony stimulating factor? side effects?
G-CSF - is a haemoatopoitic growth factor, that redcues the impact of neutropenia bu stimulating bone marrow to make more neutrophils
-have seen that this can benefit patients by increasing number of neutrophils, so that the patient can fight of infections better and not get as sick
risk factors - ??
Risk factors for leuakaemia
congenital / inherited risk factors - e.g down sydrome have an increased incidence
viral infections
radiation
chemical/dna damaging drugs
Transfusion support is critical in management of patients with acute leukaemia. Outline blood products that could be used by this patient and when they may be prescribed?
- platelets
- red cells
general / supportive care for leukaemia
General/ supportive care
-intensive transfusion support - red cells, platelets
management of infection
-ID and lab support, antibiotic therapy
Chemotherapy
Stem cell transplantation
what is another cause of macrosytic anaemia
liver disease
Risk factors for DVT
Stasis of blood
immobility - post op, plane
Pressure - (blockages) catheter, tumour obstruction
Increased viscosity - polycthaemia, dehydration, EPO
Blood hyper coagulability
increased procoagulants
decrease in inhibitors
impaired fibrinolysis (rare)
Hereditary abnormalities which may increase the risk of DVT, how common are these?
Inherited thrombophilia - increased tendency to develop VT
- Factor V leiden
- most common hereditary cause (4% northern europeans)
- Where protein C is unable to cleave factor 5a
- this slows down production of activated 10a - APCR gene - heterozygotes carry a 3-7 fold increased risk of thrombosis
- homozygotes carry a 50-100 fold increase risk of thrombosis - deficiencey of inhibitors - e.g antithrombin, protein C, protein S
- increased factor levels - e.g prothrombin gene mutation 20210a
- elevated factor 8
if you have both factor 5 leiden and are homozygotes for apcr - have an 80 relative risk comapared to a normal person
what are the causes of a prolonged APPT with a normal PT?
- lupus anticagulant
- (rare) Autoimmune disease, making an inhibitor bind onto a clotting factor (usually 8) - causes “aquired haemophilia”
- Heparin (drugs), these are inhibitors of coagulation system
- can cause bleeding
- upregulates the affect of anti-thrombin
- so it blocks activated thrombin
- because it is blocking the activated protein, it doesnt overcome the effect of the inhibitor and this is why 1 + 1 is prolonged
Also - Dibigatran
How can you distinguish between dibigatran and heparin
-both have prolonged APPT, and 1 + 1, however if you add protamine this will correct heparin but not dibigatran
How can you have deficiencies with common pathway factors, with a normal APPT ? (but have an abnormal PT)
- because APPT is less sensitive that prothrombin time
- prothrombin will be prolonged if factors are reduced to 40-50%
- but APPT is less sensitive then that, so if have mild common factor deficiencies, the APPT can be normal with a mild prolongation of PT time
What further micro test to obtain more info>
Disc suceptibility testing
- on an agar dish, place bacteria all over
- then place an antibiotic disc that you want to test suceptibility onto the agar
- this will difuse into agar in a conc gradient
- then can measure the distance around the disc to see the suceptibility of antibiotic to that certain bacterium grown
What further micro test to obtain more info>
Disc suceptibility testing
- on an agar dish, place bacteria all over
- then place an antibiotic disc that you want to test suceptibility onto the agar
- this will difuse into agar in a conc gradient
- then can measure the distance around the disc to see the susceptibility of antibiotic to that certain bacterium grown
- then can use thsi info to presribe antibiotics
