6. BAMS Haematology Flashcards
List 3 functions of blood
Name 3 conditions caused by low numbers of blood components
What are they due to
Name 3 conditions caused by high numbers of blood components
What are they due to
List 2 functions of therapeutic coagulopathy
Transport nutrients, remove waste, transport host defences
Anaemia (low Hb), leukopenia (low WCC), thrombocytopenia (low PLT)
One - reactive change to environment; multiple - due to bone marrow failure
Polycythaemia (high Hb), leucocytosis (high WCC), thrombocythaemia (low PLT)
One - reactive change to environment; multiple - pre-neoplastic
Reduce platelet adhesion and function and reduce coagulation cascade activity
Porphyria
What is porphyria
List 2 types of porphyria
List 4 symptoms/signs
List 5 triggers
Abnormality in haem metabolism
Hepatic, erythropoietic
Photosensitive rash, neuropsychiatric disturbances, HTN, tachycardia
Drugs, pregnancy, alcohol, fasting, acute infection (possible cause of LA allergy)
Malignancies
List 4 stages of normal blood disorder process
List the 4 stages of tumour formation
List 4 treatments for blood malignancies
Induction, remission, maintenance and consolidation and relapse
Clonal proliferation, cancer cell formation by uncontrolled proliferation, loss of apoptosis, loss of normal functions/products
Chemotherapy, radiotherapy, stem cell transplants, monoclonal antibodies
Leukaemia
What is leukaemia
List 5 presentations of leukaemia
List and describe 4 different types of leukaemia
Neoplastic proliferation of white cells, usually a disseminated malignancy
Anaemia, neutropenia, thrombocytopenia, bone pain, lymphadenopathy, splenomegaly/hepatomegaly
Acute lymphoblastic leukaemia - younger patient, catabolic state, lymphadenopathy, tissue infiltration, fever
Acute myeloid leukaemia - similar to ALL but elderly patient
Chronic lymphoblastic leukaemia - elderly patient, B-cell lymphoproliferative disease, slow progression
Chronic myeloid leukaemia - older adults, neutrophils and precursors, weight loss, tired, bleeding, anaemia. 95% Philadelphia chromosome
Lymphoma
What is lymphoma
What does staging involve
List and describe 2 different types of lymphoma
Features of multiple myeloma
Neoplastic proliferation of white cells, usually a solid tumour
Number of nodes, extra-nodal involvement, systemic symptoms
Hodgkin’s lymphoma - younger adults, lymphadenopathy, fever, night sweats, weight loss
Non-Hodgkins lymphoma - autoimmune disease, immunosuppression, microbial factors, lymphadenopathy, marrow failure
Malignant proliferation of plasma cells, lytic bone lesions, marrow failure, elderly, infection, bone pain, renal failure
Anaemia
What is anaemia
What are the 3 main causes of anaemia
What are the 3 types of anaemia and give an example of a cause for each type
List 4 symptoms
List 2 main types of treatment
List 3 causes of iron deficiency
List 4 intra-oral side effects of iron deficiency
List 2 causes of vitamin B12 deficiency
List 2 causes of folate deficiency
What can a folate deficiency in foetus cause
Reduction in haemoglobin
Increased demand, increased loss, decreased production
Microcytic (iron deficiency), microcytic (folate/vitamin B12 deficiency), normocytic (reduced number - bleeding)
SoB, tired, dizzy, weak, pale, increased HR
Replace haematinics, blood transfusion
Gastric ulcers/erosion, IBDs, bowel cancer
Mucosal atrophy, candidiasis, ROU, burning mouth syndrome
Lack of intake, lack of intrinsic factor
Lack of intake, absorption failure
Defect in neural tube –> spina bifida
Thalassemia and Sickle Cell Anaemia
What is thalassemia
What can thalassemia cause
How is it managed
What is sickle cell anaemia
How can it lead to ischaemia
List 2 main causes of blood loss
Globin chain mutation
Chronic anaemia, marrow hyperplasia, splenomegaly, cirrhosis, gallstones
Blood transfusion (prevent iron overload)
Abnormal global chains - curved RBCs due to low Hb and oxygen environments
RBCs cannot pass through capillaries, leading to ischaemia, pain and necrosis
Gastritis (alcohol) and NSAIDs
Drugs
What does warfarin do
How is it measured
List 3 warfarin potentiating ‘drugs’
List 1 warfarin inhibiting ‘drug’
List 2 contraindications of warfarin
Name 1 major risk of warfarin
List 3 antiplatelets and what they do
Which 2 are often used together and why
Inhibits synthesis of vitamin K-dependent clotting factors
INR - target of 1.0 (<3.5/4.0 for dental treatment)
Antibiotica, NSAIDs, alcohol with liver disease
Alcohol without liver disease
Aspirin, antifungals
Haemorrhage
Aspirin - reduces platelet aggregation
Clopidogrel - reduces ADP-induced platelet aggregation
Dipyridamole - inhibits platelet phosphodiesterase
Aspirin and clopidogrel - to enhance their effect and secondary to MI
Haemophilia
What type of genetic condition is haemophilia and what are the requirements to develop it
What are the 3 types of haemophilia, with their associated deficiencies
How are main types treated
Sex-linked recessive (males affected, females carriers) - both parents must have it (mother carrier, father affected)
Type A (FVIII deficiency), Type B (FIX deficiency), Type C (FXI deficiency)
A - if severe/moderate with recombinant FVIII, if mild/carriers - DDAVP, if very mild - oral tranexamic acid (prevents blood loss). B - do not respond to DDAVP so prophylactic cover requires recombinant FIX
Von Willebrand Disease
What type of genetic condition is it and what are the requirements to develop it
What effect does von Willebrand disease have
What are the 3 types and describe the presentation
Treatment
Autosomal dominant, both sexes equally affected
Reduced FVIII and platelet aggregation
Types 1 and 2 (dominant and mild), type 3 (recessive and severe)
Majority to DDAVP, some only require oral tranexamic acid
Thrombophilia
What is this
What does it cause
What can it lead to
List 4 exacerbating factors
Acquired disease superimposed on genetic condition
Increased risk of clotting/excessive tendency to clot (DVT)
Pulmonary embolism
Smoking, immobility, surgery, pregnancy
Haemostasis
List the three stages involved in clotting
Describe each stage
Bleeding and vasodilation, platelet plug formation, coagulation
Bleeding and vasodilation
Platelet plug formation - platelets aggregate and form a temporary seal in broken BV wall, activated by von Willebrand factor in plasma
Coagulation - fibrin reinforces platelet plug. Clotting factors (coagulation cascade) –> insoluble fibrin formation
Inherited Syndromes
What does antithrombin III do
What are protein C and S and what do they do
Name 2 types of bleeding tests
Name 2 types of clotting tests
Inactivates coagulation system enzymes
Vitamin K-dependent glycoproteins - co-factors that inactivate FVa and FVIIIa –> regulate anticoagulation, inflammation, cell death and maintains BV permeability
FBC, PLT
INR, APPT
