benign haematology Flashcards
describe the components and functions of blood
the four main components are plasma, white blood cells, red blood cells and platelets
the functions of blood are transportation, clotting, immunity and temperature regulation
what is anaemia
low haemoglobin in the blood
what are the different causes of anaemia
impaired production
increased breakdown (haemolysis)
increased demand
increased blood loss
what are the oral manifestations of anaemia
what are the common haematology blood tests
what is the role of blood transfusions in the management of haemotology patients
what is found in plasma
salts, glucose, amino acids, vitamins, proteins, urea, hormones and coagulation factors
what is included in the white blood cell category
neutrophils, monocytes, b cells, T cells and granulocytes
function of platelets
clotting
what does cytosis mean
excess of
what does penia mean
lack of
what does microcytic mean
small cell size
what does normocytic mean
normal cell size
what does microcytic mean
large cell size
what are the two lineages of blood
myeloid and lymphoid
what is haemoglobin
protein found in red blood cells that transports oxygen around the body
what is essential for haemoglobin function
iron
what is the structure of haemoglobin
2 alpha chains and 2 beta chains
4 haem groups, the oxygen will bind to the iron ion
what is the life span of a red blood cell
120 days, and is broken down in the spleen and in the liver
how many haemoglobin molecules per red blood cell
270 million
describe how impaired production of haemoglobin can arise leading to anaemia
issue with the marrow, such as congenital aplasia, medication side effects
lack of erythropoietin in chronic kidney disease
lack of raw materials to produce haemoglobin
what are the raw materials for haemoglobin production
iron
vitamin b12
folic acid
describe how the increased haemolysis of haemoglobin can arise
issues with red blood cells, such as g6pd deficiency, or hereditary spherocytosis
issues with the haemoglobin ie thalassaemia, or sickle cell disease
immune driven impacts ie autoimmune haemolysis
what is spherocytosis
this is when the red blood cell is spherical instead of biconcave
what can lead to increase haemoglobin demand resulting in anaemia
pregnancy and growth phases in children
what can cause increased blood loss leading to anaemia
acute bleeding ie tooth extraction
menstrual bleeding
gastrointestinal losses
what are the symptoms of anaemia
tiredness
shortness of breath
dizziness
palpitations
what are the signs of anaemia
pale skin
conjunctival pallor
what is the difference between symptoms and signs
symptoms are what the patient feels and tells you whereas signs are what you actually notice
what are the classical signs of anaemia
angular cheilitis
koilonychia
what is koilonychia
spoon shaped nails due to iron deficiency
what are the haematinics
iron
folate
vitamin b12
deficiency in these can cause anaemia
what is iron deficiency anaemia
this is a reduction in iron leading to impaired haemoglobin production, and as a result, the red blood cells are smaller ie microcytic
what are the causes of iron deficiency anaemia
reduced dietary intake
impaired absorption in the duodenum
increased loss of blood through menstruation etc
increased demands due to pregnancy or growth
what does iron deficiency anemia present as in the red blood cells
microcytic red blood cells
describe iron absorption
this takes place mainly in the duodenum, and requires stomach acid.
there is reduced absorption if there is inflammation in the duodenum, as seen in coeliac disease or if there is lack of stomach acid such as seen in the taking of omeprazole which is a proton pump inhibitor
how can iron deficiency be managed
oral supplementation and IV supplementation if severe
what are the causes of vitamin b12 deficiency
reduced intake
impaired absorption
medication side effects eg metformin
what are the features of vitamin b12 deficienchy
anaemia symptoms
peripheral neuropathy
visual changes
what does vitamin b12 deficiency do to the red blood cells
makes them macrocytic
how can vitamin b12 deficiency be managed
oral supplementation and intra muscular supplementation
what is b12 important for
neuron development
why does vitamin b12 deficiency lead to peripheral neuropathy
b12 is important for neuron development so when there is deficiency, patients can feel tingling in the hands or feet or experience visual impairment
which muscle is injected when there is vitamin b12 deficiency
deltoid
how is vitamin b12 absorbed
in the ileum, alongside intrinsic factor
what are the causes of impaired vitamin b12 absorption
pernicious anaemia
gastrectomy
crohns disease
following bowel surgery
ie any inflammation in the bowels
what is pernicious anaemia
loss of production of intrinsic factor so b12 cannot be absorbed through the gut
autoimmune condition, seen commonly in middle aged patients.
the antibodies destroy parietal cells in the stomach, and can target intrinsic factor itself
how is pernicious anaemia managed
IM supplementation, 3 monthly
where is folic acid absorbed
jejunum
what are the causes of folic acid deficiency
dietary deficiencies
medications
alcohol excess
bowel inflammation
what can be caused by folic acid deficiency in foetal development
spinal bifida
how is folic acid deficiency managed
simple oral replacement
what are the two main methods for investigation of anaemia
blood tests
endoscopy/colonscopy
what are the four blood tests for detecting anaemia
Full blood count
Ferritin
Folate
B12
when would you consider doing an end/colonoscopy to test for anaemia
if suspicious of gi bleeding, eg blood in the stool, weight loss or an elderly patient
what is ferritin
the molecule in which iron is stored in cells, which is raised when there is infection or inflammation
what is the full blood count blood test
includes lots of information, but the important parts are:
- haemoglobin
- white cell count
- platelets
- mean cell volume
what is WCC
white cell count
what is the mean cell volume
MCV
what does a microcytic red blood cell indicate
iron deficiency
thalassamemia
lead poisoning
what does a normocytic cell indicate
bleeding
kidney disease
anaemia of chronic diseases
what does a microcytic cell indicate
folic acid deficiency
b12 deficiency
alcohol excess
what is the MCV value for microcytic cells
less than 80
what is the MCV value for normocytic cells
80-100
what is the MCV value for microcytic cells
mcv greater than 100
what is thalassaemia
a genetic defect in the protein chains which make up haemoglobin
it is an autosomal recessive gene defect
can affect the alpha or the beta chains.
because this makes the red blood cells more fragile, the spleen detects this and destroys the damaged red blood cells
what type of anaemia is associated with thalassaemia
microcytic
how to manage thalassaemia
monitoring, if minor
blood transfusions
splenectomy
bone marrow transplant
what is sickle cell anaemia
a genetic condition that results in crescent shaped red blood cells.
autosomal recessive genetic mutation
the crescent shape leads to the red blood cells being more fragile and more easily destroyed
when is screening for sickle cell anaemia carried out
in newborns
what does sickle cell anaemia do for malaria
makes it less severe
what can lead to complications with sickle cell anaemia
known as crises, the complications are triggered by dehydration, infections, stress and cold weather
how is sickle cell anaemia managed
avoid triggers
antibiotic prophylaxis
specialist medications
blood transfusions
bone marrow transplant
what are the oral manifestations of anaemia
angular cheilitis
mucosal atrophy
glossitis, which can be smooth or beefy
recurrent aphthous stomatitis
candidate infections
oral dysaesthesia
what is oral dysaesthesia
this is a burning mouth sensation caused by the nerve endings in the mouth misfiring
which anaemia increases the chance of angular cheilitis
iron deficiency anaemia
what is atrophic glossitis
this is when there is iron deficiency leading to a smooth tongue
angular cheilitis
atrophic glossitis from iron deficiency causing smooth tongue
beefy tongue
recurrent aphthous stomatitis
candidal infection
what is the most common blood transfusion
packed red cells, meaning a unit of red blood cells are given to the patient. some patients can get platelets or clotting factors if needed
what are the possible indicators for blood transfusions
anaemia
acute blood loss from trauma
surgery
complex haematological conditions
what are the important antigens on red blood cells
A B O AB
what are the important antibodies in the blood
anti B anti A , one, neither or both of these
what is essential to be carried out before administering a blood transfusion
check the recipients blood group before giving the blood, and cross match the blood types
what is cross matching of blood
this is when a sample is taken from the recipient and is tested against the donors blood
what are the complications of blood transfusions
- transfusion associated fever
- incompatible blood
- fluid overload
- anaphylaxis
- infection
what is TACO
transfusion associated circulatory overload
what does incompatible blood lead to
haemolysis
