8) Bleeding Dysfunction

Question 1

What can cause neutrophilia?

Answer 1

Bacterial infection 
Cancer
Myeloproliferative disease
Drugs e.g. Steroids 
Smoking

Question 2

What are the functions of monocytes?

Answer 2

Respond to inflammation and antigenic stimuli

Phagocytosis and pinocytosis

Question 3

What can cause monocytosis?

Answer 3

Chronic inflammatory conditions: RA, SLE, UC, Crohn’s
Chronic infection: TB
Malignancy
Myelodysplasia

Question 4

What is the function of eosinophils?

Answer 4

Mediate hypersensitivity reactions

Phagocytosis

Question 5

What can cause eosinophilia?

Answer 5

Allergic diseases
Parasitic infections
Churg-Strauss
Lymphomas and leaukemias

Question 6

What is the function of basophils?

Answer 6

Allergic reactions and inflammatory conditions

Question 7

What can cause basophilia?

Answer 7

Immediate hypersensitivity reactions
UC
RA
Myeloproliferative: CML

Question 8

What can cause a lymphocytosis?

Answer 8

Viral and bacterial infections
Stress related: MI, cardiac arrest
CLL
Lymphoma

Question 9

What can cause a thrombocytosis (reactive)?

Answer 9

Infection and inflammation
Post surgery
Malignancy
Bleeding

Question 10

What primary haematological conditions can result in thrombocytosis?

Answer 10

Essential thrombocythemia
CML
Myelofibrosis
Polycythemia vera

Question 11

What is the pathophysiology behind leucoerythroblastic anaemia?

Answer 11

Due to space occupying lesions in bone marrow

Question 12

Why may there be anaemia in renal disease?

Answer 12

Lack of erythropoietin

Question 13

How can there be secondary polycythemia in renal disease?

Answer 13

Post renal transplant (EPO production)

Renal tumour

Question 14

Why might there be high white cell count in renal disease?

Answer 14

Inflammation
Underlying connective tissue disease
Infection

Question 15

Why might there be a low white cell count in renal disease?

Answer 15

Immunosuppression

Drugs

Question 16

What might there be a high platelet count in renal disease?

Answer 16

Reactive

Due to bleeding

Question 17

What might there be a low platelet count in renal disease?

Answer 17

Effect or uraemia on production of platelets

Haemolytic uraemia syndrome

Question 18

How should anaemia in renal disease be managed?

Answer 18

Treatment with erythropoietin

Iron infusion

Question 19

What might there be anaemia in rheumatoid arthritis?

Answer 19

Blood loss due to NSAIDs

Anaemia of chronic disease

Question 20

What might there be a high WCC in rheumatoid arthritis?

Answer 20

Inflammation

Infection

Question 21

What might there be a low WCC in rheumatoid arthritis?

Answer 21

Drugs e.g. Methotrexate

Reactive neutropenia

Question 22

What might there be a high platelet count in rheumatoid arthritis?

Answer 22

Bleeding related to NSAID use

Question 23

What might there be a low platelet count in rheumatoid arthritis?

Answer 23

Drugs
Autoimmune
Splenomegaly

Question 24

What is the role of the vessel wall during the clotting cascade?

Answer 24

Vasoconstriction
Production of Von Willebrand’s factor
Exposure of collagen and tissue factor

Question 25

What are the function of platelets?

Answer 25

Adhesion Secretion- ADP, thromboxane, fibrinogen Aggregation Coagulation factor activation

Question 26

What are some natural anticoagulants?

Answer 26

Protein C and S Anti-thrombin Tissue factor pathway inhibitor

Question 27

How can we measure coagulation in the body?

Answer 27

Prothrombin time Activated partial thromboplastin time Thrombin time

Question 28

What is prothrombin time?

Answer 28

Measure of clotting time by extrinsic pathway

Question 29

What is activated partial thrombolplastin time?

Answer 29

Speed of blood clotting by intrinsic and common coagulation pathways

Question 30

What is thrombin time?

Answer 30

Measure time it takes for a clot to form in plasma after excess thrombin has been added

Question 31

What is INR?

Answer 31

Normalised ratio of prothrombin time

Question 32

Describe the features of hereditary haemorrhagic telangiectasia:

Answer 32

Autosomal dominant Dilated microvascular swellings Chronic bleeding problems

Question 33

What acquired problems can affect blood vessels?

Answer 33

Senile purpura Steroids Infection - measles, meningococcal Scurvy

Question 34

How do problems with blood vessels present clinically?

Answer 34

Easy bruising Spontaneous bleeds from small vessels Seen on skin and mucous membranes

Question 35

What can cause disorder to platelet function?

Answer 35

Bernard-Soulier Aspirin/NSAIDs/clopidogrel Uraemia Myeloma

Question 36

What is Von Willebrand's disease?

Answer 36

Abnormal platelet adhesion to vessel wall Reduced vWF production Bleeding tendency

Question 37

How does Von Willebrand's disease present clinically?

Answer 37

Skin and mucous membrane bleeding- epistaxis, gum bleeding, bruising Prolonged bleeding after trauma - heavy periods, post surgery/dental

Question 38

What conditions can affect coagulation factor function?

Answer 38

Haemophilia A and B Liver disease Warfarin Vitamin K deficiency

Question 39

How do problems with clotting factors present clinically?

Answer 39

``` Recurrent haemarthroses Muscle haematoma Joint pain Prolonged bleeding post trauma and operation Intracerebral haemorrhage ```

Question 40

What physiological factors affect the rate of red cell production?

Answer 40

``` Exercise Altitude Age Sex Temperature ```

Question 41

What are some differences between thrombocytopenia due to marrow failure and thrombocytopenia due to peripheral destruction?

Answer 41

Increased progenitor cells and increased breakdown products in peripheral destruction