301. Heam, general Flashcards
What is meant by blasts seen on a blood film?
nucleated precursor cells
myelofibrosis, leukeamia, malignant marrow infiltration
What are howeel jolly bodies, seen on blood films
DNA rememnants from RBC normally removed by spleen
Post splenectomy
Hyposlpenism (sickle cell, coeliacs, UC/crohns)
myelodysplasia, megaloblastic anaemia
What is meant by hypochromia seen on blood film
Less densestaining of RBC’s due to decreased heamoglobin synthesis.
Seen in IDA thalaseammia and sideroblastic anaemia
On a blood film you see leukoeryhtoblastic film. What is this?
Immature cells and tear drop RBC’s from heamolysis or marrow infiltration/infection
What would you see in a blood film of an individual with DIC, HUS, TTP, pre-eclampsia, Gd6p
Schistocytes.
What is a causes increased neutrophils
bacterial infections inflammation myeloproliferative disorders drugs disseminated malignancy stress
When are neutrophils decreased
Viral infections Drugs- post chemo Severe sepsis Neutrophil antibodies (SLE) Hypersplenism Bone marrow failure
What causes an increase in lymphocytes?
Acute viral infections
Chronic infections (TB, brucelosis)
Leukemias and lymphomas
In what scenario would lymphocytes be deplete?
Steroids SLE Uraemia Legionarries disease HIV
Eosinophills increase in what scenario?
Drug reactions
Allergies
Parasitic infections
Skin disease
What is hypereosinophillic syndrome
Eosinophilia sustained for 6 weeks leading to end organ damage-
endomyocardial fibrosis, restrictive cardiomyopahty, lung disease, neuropathy and hepatosplenomegaly
What causes an increase in monocytes
Aftermath of chemo/radiotherapy
Chronic infections
Malignant disease
Myeoldyplasia
What causes an increase in basophils?
Myeloproliferative disease
Viral infections
IgE mediated hypersensitivity
Inflammatory disorders
Describe the anti-coagulation pathway?
On contact with broken endothelium factor XII is produced.
XIIa acts on XI
XIa (heparin disrupts this) acts on IX
IXa (+phospholipid +tissue factor) works on X
X turns prothrombin into thrombin
Thrombin turns fibrinogen into fibrin
Thrombin has negative feedback on V and XI
What is ESR?
Sensitive but not specific indicator of inflamamtion.
RBC fall through medium, if they have inflammatory markers attached they fall quicker and result is higher
What is a general way of calculating ESR range?
Men- age/2
Woman (age +10) /2
What conditions can cause a falsely low ESR?
Polycytheamia
Sickle cell anaemia
What are the symptoms of hyperviscocity syndrome?
Lethargy, confusion, reduced cognition
Chest pain, abdo pain
Visual distrubance
retinopathy, amaurosis fugax - watery car windscreen
What are the causes of a high blood viscocity?
High red cell
High white cell
Paraproteinaemia
Oral contraceptive, diuretics, Iv IG, EPO, chemo, radio-contrast media
What is the treatment for hyperviscocity syndrome?
Treatment depends on cause
Venesection- PCV
Leukapheresis- leukaemia
plasmapheresis- myeloma
What are the causes of splenomegaly, classified by spleen size
Massive- CML, myelofribrosis, malaria, leishmaniasis
Moderate- infection, heam, conn. tissue, others
Give some examples of splenomegaly in the following categories:
Infection
Heamatological
Connective tissue disease
Others
Infection-EBV, endocarditis, TB, leishmaniasis, schistosomiasis
Heam- heamolytic anaemia, leukaemia, CML,lymphoma
Conn. tissue- RA, SLE
Others- sarcoidosis, portal hypertension
What are the indications for a splenectomy
Splenic trauma,
hyperslenism
Autoimmune heamolysis
Warm autoimmune heamolytic anaemia
Congential heamolytic anaemia’s
What should be done in those post-splenectomy?
Pneumoccocal vaccine, heam flu b vaccine, meningococcal vaccine, flu vaccine
Life long prophylactic antibiotics
Seek urgent medical attention in unwell
