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8. CP - Core Haematology > (35) Intro to haematology > Flashcards

(35) Intro to haematology Flashcards

1
Q

What is haematology?

A

Biology and pathology of the cells that normally circulate in the blood

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2
Q

What is haemopoiesis?

A

The physiological development process that gives rise to the cellular components of blood

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3
Q

What can a single multipotent haemopoietic stem cell give rise to?

A

Can divide and differentiate to form different cell lineages that will populate the blood

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4
Q

What are the characteristics/features of a haemopoietic stem cell?

A
  • differentiation potential for all lineages
  • high proliferative potential
  • long term activity throughout lifespan of individual
  • self renewal
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5
Q

Where was experimental proof of the potential of haemopoietic stem cells derived from?

A

From serial murine transplants

Durand & Dziernak 2005

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6
Q

What does symmetric self-renewal lead to?

A
  • increase stem cell pool

- no generation of differentiated progeny

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7
Q

What does asymmetric self-renewal lead to?

A
  • maintain stem cell pool

- generation of differentiated progeny

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8
Q

What does lack of self-renewal lead to?

A
  • deplete stem cell pool
  • generation of ONLY differentiated progeny

OR

  • maintain stem cell pool
  • no differentiated progeny
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9
Q

Name 2 types of differentiation that stem cells might undergo

A
  • lymphopoiesis

- myelopoiesis

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10
Q

What is lymphopoiesis?

A

The generation of lymphocytes, one of the five types of white blood cell

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11
Q

What is myelopoiesis?

A

Formation of myeloid leukocytes (myelocytes), including eosinophilic granulocytes, basophilic granulocytes, neutrophilic granulocytes, and monocytes

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12
Q

What is produced in asymmetric division?

A
  • a stem cell
    AND
  • a differentiated daughter cells
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13
Q

What are the 2 main haemopoietic lineages?

A
  • myeloid

- lymphoid

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14
Q

Give examples of myeloid cells

A
  • granulocytes (WBCs)
  • erythrocytes (RBCs)
  • platelets
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15
Q

Give examples of lymphoid cells

A
  • B-lymphocytes (WBCs)

- T-lymphocytes (WBCs)

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16
Q

In haemopoiesis, a multipotent stem cell gives rise to myeloid and lymphoid lineage. What types of stem cells are these?

A

Pluripotent stem cells

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17
Q

Multipotent stem cells gives rise to pluripotent stem cells which give rise to what?

A

Committed stem cells

Then mature cells

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18
Q

Give examples of types of mature cells

A
  • red cells
  • platelets
  • neutrophils
  • monocytes
  • eosinophils
  • basophils
  • lymphocytes
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19
Q

Are mature blood cells infinite or finite?

A

Finite

eg. an erythrocyte has a life span of about 120 days

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20
Q

What is the life span of an erythrocyte?

A

120 days

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21
Q

What is the life span of a neutrophil?

A

Lasts only 6-10 hours in the blood stream

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22
Q

At what day does haemopoiesis start in the embryo?

A

Day 27

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23
Q

In which region does haemopoiesis start?

A

In the aorta gonad mesonephros region

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24
Q

Where do haematopoietic stem cells migrate to in the foetus?

A

To the foetal liver, which becomes the subsequent site of haemopoiesis

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25
Q

Describe haemopoiesis in the foetus

A

Starts at day 27 in the aorto-gonad-mesonephros region, expands rapidly at day 35 and then disappears at day 40. Disappearance correlates with migration of the stem cells to foetal liver = new site of haemopoiesis

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26
Q

State the functions of blood cells

A
  • oxygen transport
  • coagulation
  • immune response to infection
  • immune response to abnormal cells (senescent, malignant etc)
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27
Q

Describe the appearance of erythrocytes

A
  • bi-concanve discs

- 7.5um diameter

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28
Q

How many red cells do we have?

A

333,200 x 10^6

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29
Q

What do erythrocytes contain?

A

Haemoglobin

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30
Q

What is reduced red cells?

A

Anaemia

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31
Q

What is raised red cells?

A

Polycythaemia

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32
Q

What is relative polycythaemia?

A

When plasma volume is reduced

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33
Q

What are the functions of leukocytes (white blood cells)?

A

Immunity and host defence

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34
Q

Name 3 types of leukocytes

A
  • granulocytes
  • lymphocytes
  • monocytes
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35
Q

Give a feature of granulocytes

A

Have cytoplasmic granules

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36
Q

Name 3 types of granulocyte

A
  • neutrophils
  • eosinophils
  • basophils
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37
Q

What is the most common white blood cells in adult blood?

A

Neutrophil (10x10^9 per litre)

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38
Q

What are neutrophils?

A

Phagocytes

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39
Q

What is increased numbers of neutrophils called?

A

Neutrophilia

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40
Q

What is decreased numbers of neutrophils called?

A

Neutropenia

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41
Q

What may be a cause of neutropenia?

A

Side effect of a drug

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42
Q

Why might you get neutrophilia?

A
  • bacterial infection

- inflammation

43
Q

What is increased number of eosinophils called?

A

Eosinophilia

44
Q

Why might you get eosinophilia?

A
  • parasitic infection

- allergies

45
Q

Are basophils common or rare?

A

Rare

Part of primitive immune system

46
Q

What is increased number of basophils called?

A

Basophilia

47
Q

When might you get basophilia?

A

In chronic myeloid leukaemia

48
Q

What are monocytes?

A

Phagocytic and antigen-presenting cells

49
Q

Monocytes migrate to tissues and are then identified as what?

A

Macrophages

or histiocytes

50
Q

Give 2 specific types of macrophage

A
  • Kupffer cells in liver

- Langerhans cells in skin

51
Q

What is increased numbers of monocytes called?

A

Monocytosis

52
Q

When might you get monocytosis?

A

In tuberculosis

53
Q

Name 4 types of lymphocyte

A
  • natural killer cells
  • B lymphocytes
  • T lymphocytes
  • plasma cells
54
Q

Natural killers (NK) are part of what immune system?

A

Innate immune system

55
Q

Describe natural killer cells

A

Large granular lymphocytes

56
Q

What do natural killer cells recognise?

A

Non-self eg. cells, viruses

57
Q

B-lymphocytes are part of what immune system?

A

Adaptive immune system

Humoral immunity

58
Q

What do B cells do?

A

Rearrange the immunoglobin genes to enable antigen specific antibody production

59
Q

T-lymphocytes are part of what immune system?

A

Adaptive immune system

Cell-mediated immunity

60
Q

What do T cells do?

A
  • rearrange the T cell antigen receptor
  • target specific cytotoxicity
  • interact with B cells, macrophages
  • regulate immune responses
61
Q

What is increased numbers of lymphocytes called?

A

Lymphocytosis

62
Q

When might you get lymphocytosis?

A
  • atypical lymphocytes of glandular fever (infectious mononucleosis)
  • chronic lymphocytic leukaemia
63
Q

What is decreased numbers of lymphocytes called?

A

Lymphopenia

64
Q

When might you get lymphopenia?

A

Post bone marrow transplant

65
Q

What is an increased number of plasma cells called?

A

Plasmacytosis

66
Q

When might you get plasmacytosis?

A
  • infection

- myeloma

67
Q

What are platelets derived from?

A

Bone marrow megakaryocytes

68
Q

How many platelets do we have?

A

200 x10^9 per litre

69
Q

What is the purpose of platelets?

A

They form part of the blood clotting system - aggregate to plug holes in damaged blood vessels

70
Q

Platelets form part of the blood clotting system together with what?

A

Soluble plasma clotting factors and endothelial cells

71
Q

What are the 4 main subdivisions of haematology clinical practices?

A
  • coagulation
  • malignant
  • non-malignant
  • transfusion
72
Q

Name 3 types of diagnostic test

A
  • full blood count
  • blood film (or “smear”)
  • coagulation screen
73
Q

What is included in the FBC diagnostic test?

A
  • haemoglobin concentration
  • red cell parameters (MCV, MCH)
  • white cell count (WCC)
  • platelet count
74
Q

What do coagulation screen tests measure?

A

The time taken for a clot to form when plasma is mixed with specified reagents

75
Q

In a coagulation screen, various parts of the coagulation cascade can be assayed including..

A
  • prothrombin time
  • activated partial thromboplastin time
  • thrombin time
76
Q

How is a bone marrow aspirate done?

A

Under local anaesthetic, liquid marrow is aspirated from the posterior iliac crest of the pelvis and a trephine core biopsy is then taken with a hollow needle

77
Q

What is a trephine?

A

A hole saw used in surgery to remove a circle of tissue or bone.

78
Q

Where is a bone marrow aspirate taken from?

A

Posterior iliac crest of the pelvis

79
Q

How do you ensure an accurate FBC and correct interpretation of a blood film?

A
  • appropriate sample from patient
  • collected into EDTA anti coagulated blood
  • samples get to lab promptly
80
Q

Why is it important that blood samples get to the lab quickly?

A

Since EDTA artefact can affect the results

81
Q

A blood samples should be collected into EDTA anti coagulated blood. What are the specific requirements?

A
  • mixed well
  • [K2EDTA] = 1.5 - 2.2 mg ml-1
  • blood should be filled to the line on tube ed
82
Q

Why might test results vary due to technical failure?

A
  • clotted sample

- variation in reagents

83
Q

Why might test results vary due to the individuals?

A
  • intra-individual eg. diurnal variation in cortisol levels

- inter-indvidiual eg. platelet count

84
Q

How is a reference range established?

A
  • define the reference population
  • reference population should be relevant to the test population
  • consider if separate ranges are required for adults vs. children, men vs. women etc
  • determine the expected range of inter-individual variation
85
Q

What is a reference range?

A

The set of values for a given test that incorporates 95% of the normal population

  • determined by collecting data from vast numbers of lab tests
86
Q

What is sensitivity?

A

The proportion of abnormal results correctly classified by the test
- expresses the ability to detect a true abnormality

87
Q

What is the formula for sensitivity?

A

TP/(TP+FN)

88
Q

What is specificity?

A

The proportion of normal results correctly classified by the test
- expresses the ability to exclude an abnormal result in a healthy person

89
Q

What is the formula for specificity?

A

TN/(TN+FP)

90
Q

What is the normal range of haemoglobin?

A

Male = 135-180g/L

Female = 115-160g/L

91
Q

What is the normal range for WBC?

A

4.00-11.00 x10^9/L

92
Q

What should you be alert to when interpreting FBC?

A

Technical problems eg. thrombocytopenia (may be real, may be artefact)

93
Q

What happens when FBC comes back with abnormal results?

A
  • flagged by lab
  • may trigger additional tests e.g.. blood film
  • if serious = lab staff alert on-call doctors eg. new leukaemia
94
Q

An FBC may be outside of normal range but appropriate for clinical situation. Give examples

A
  • post-splenectomy mild lymphocytosis

- 3 months post-bone marrow transplant lymphopenia

95
Q

How is microcytic hypochromic anaemia classified according to MCV and MCH?

A
  • MCV
96
Q

How is normocytic normochromic anaemia classified according to MCV and MCH?

A
  • MCV 80-95fl

- MCH >27pg

97
Q

How is macrocytic anaemia classified according to MCV?

A
  • MCV > 95fl
98
Q

What are the other features of microcytic hypochromic anaemia?

A
  • iron deficiency
  • thalassaemia
  • anaemia of chronic disease (some)
  • lead poisoning
  • sideroblastic anaemia (some cases)
99
Q

What are the other features of normocytic normochromic anaemia?

A
  • many haemolytic anaemias
  • anaemia of chronic disease (some cases)
  • after acute blood loss
  • renal disease
  • mixed deficiencies
  • bone marrow failure (eg. post-chemotherapy, infiltration by carcinoma etc)
100
Q

Macrocytic anaemia can be divided into which 2 types?

A
  • megaloblastic

- non-megaloblastic

101
Q

What are the causes of megaloblastic macrocytic anaemia?

A

Vitamin B12 or folate deficiency

102
Q

What are the causes of non-megaloblastic macrocytic anaemia?

A
  • alcohol
  • liver disease
  • myelodysplasia
  • aplastic anaemia
    etc
103
Q

How do the red cells appear in iron deficiency?

A
  • small, pale (low MCV and MCH)
  • variable size and shape
  • some long thin “pencil” cells
104
Q

What is seen in B12 deficiency on a blood film?

A

Hypersegmented neutrophils and oval macrophages

8. CP - Core Haematology (11 decks)

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