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Biochemistry and Haemotology > Clotting > Flashcards

Clotting Flashcards

1
Q

What is haemopoeis regulated by?

A

Interleukin 1,3,5,6
Stem cell factor
Erythropoietin
Thrombopetin

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2
Q

What are haemotinics

A

Products that are required for the formation of red blood cells.
The main ones being folate, but b 12, and iron

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3
Q

Where is the bodies iron found

A

70% haemoglobin

25% ferritin

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4
Q

Why are patients normally deficient in iron

A

Inadequate oral intake
Inadequate absorption
Haemorrhage

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5
Q

What does ferritin do

A

Acute phase protein

Transport iron in a none toxic form

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6
Q

What is folate used for

A

For nation if dba and rna

And amino acid metabolism

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7
Q

Cause of macrocytic anaemia

A

Folate deficiency

Vitamin b12 deficiency

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8
Q

What is renal anaemia

A

CKD leading to a lack of erythropoietin, leading to a lack of RBC production in the bone marrow. Normochromic and normocytic anaemia.
Uraemia may also cause platelet dysfunction.

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9
Q

Symptoms of Vit b12 deficiency

A

Tiredness, lethargy, feeling faint, becoming breathless easily. Sore mouth and beef steak tongue.

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10
Q

What causes Vit b12 deficiency

A

Pernicious anaemia - most common cause - autoimmune in nature. Can be detected - antibodies to confirm the diagnosis.
Stomach or GI issues leading to lack of absorption
Lack of Vit b12 in the diet - such as vegans.

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11
Q

Treatment options for Vit b12 Deficiency

A

B12 injection - 1 every 2-4 days and then one every 3 months

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12
Q

Define Polycythemia

A

Increase in the level of RBCs/Hb.
Relative - due to reduction in plasma volume
Primary - chronic resp disease, congenital heart disease, working at high altitude.
Secondary - some renal disorders - Renal Cell carcinoma - increased levels of erythropoietin

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13
Q

`What is Polycythemia Rubra Vera

A

Primary Polycythemia - myeloproliferative disorder
Causes itching, enlarged spleen, blood clots and bleeding.
Neurological symptoms such as dizziness, headache, lethargy and visual disturbances due to the increased size of red cells.

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14
Q

What are the 4 main blood groups

A

A, B, AB and O

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15
Q

What antibodies and antigens are present in AB and O blood

A

AB - A and B antigens and no antibodies
O - no antigens and anti-A and anti B antibodies
AB - universal recipient and O is the universal donor

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16
Q

Which is the most important Rhesus antigen

A

D - that gives the blood positive or negative after the blood group
Others include C,c,D E, e

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17
Q

What is the clinical significance of the Rhesus status of women of childbearing age

A

HDFN - Haemolytic disease of the fetus and newborn
If Rh D positive blood is given to an Rh-negative woman, from either transfusion or if the mother has developed these alloantibodies then

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18
Q

What are the two main types of white blood cells

A

Mono-nuclear cells and granulocytes

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19
Q

Whicch of the white blood cells are classed as phagocytes

A

neutrophils, monocytes, eosinophils and basophills

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20
Q

What do lymphocytes do?

A

Help to identify the antigen - antigen presenting cells.

Create a memory - antibodies so the body is able to fight further infections

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21
Q

What does an increase in atypical cells represent

A

potentially leukemia

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22
Q

Define Leucopenia

A

Reduction in white cell count - maybe specific - neutropenia, lymphopenia or eosinopenia

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23
Q

Define Leucocytosis

A

Increase in the number of white cells, neutrophillia, lymphocytosis, eosinophilia, monocytosis and basophilia

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24
Q

An increase in WCC would suggest

A

infections, systemic illness, allergy, inflammation and certain types of cancer such as leukaemia

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25
Q

An increase in WCC would suggest

A

certain medication - such as chemotherapy, auto-immune disease, viral or some severe bacterial infections, bone marrow failure, liver disease and alcohol excess

26
Q

What would a Neutrophillia suggest

A

Bacterial or viral infection

27
Q

Lymphocyctosis would suggest

A

elevated in some infections such as glandular fever, lymphocytic leukaemia,

28
Q

Monocytosis would suggest

A

raised in bacterial infection, TB, Malaria, monocytic leukaemia, chronic UC and regional enteritis

29
Q

Eosinophilia would suggest

A

parasitic infection, asthma or allergy

30
Q

Basophilic would suggest

A

hypersensitivity reactions, certain allergens and parasites

31
Q

What is the significance of neutropenic sepsis

A

neutropenia with a count of less than 1, the patient would become rapidly unwell due to the bodies inability to mount a full reaction, therefore patients can become ill quickly and become overwhelmingly sceptic quickly.

32
Q

What WCC does multiple myeloma effect

A

Lymphocyte - Myeloproliferative disorder

33
Q

Myeloma produces

A

immunoglobulins and antibodies - these are abnormal and are collectively called paraproteins.

34
Q

What electrolytes disturbance is likely to occur in Multiple Myeloma

A

Hypercalcemia - due to the increased osteoclast activity causing the bones to break down and release stored Ca.

35
Q

Due to the formation of plasmacytomas in multiple myeloma what secondary issues may occur

A

Due to the degradation of the bone marrow, anaemia, leucopenia and thrombocytopenia may also occur.

36
Q

What would you expect to see in relation to the ESR and CRP in Multiple myeloma

A

Increased ESR due to increased plasma viscosity - attributed to an increase in cellular components within the blood, normal CRP as not an inflammatory process

37
Q

Define Thrombocytopenia

A

Platelet levels that are too low and increases the patient’s risk of bleeding and bruising. Less than 20 is considered life-threatening

38
Q

Define Thrombocytosis

A

Platelet levels that are too high and predisposes the patient to spontaneous thrombus formation

39
Q

Causes of thrombocytopenia

A

Acute infection - temp fall, certain drugs such as aspirin, heparin and some antibiotics, alcohol and liver disease, ITP, TTP, Leukaemia, Bone marrow infiltration - metastatic malignancy, myeloma
Pregnancy,
Hypersplenism, SLE, B12/folate deficiency

40
Q

Causes of thrombocytosis

A

as a response to blood loss, surgery, trauma
infection and inflammatory disorders,
Malignancy - important if its persistent
Myeloproliferative disorders - chronic myeloid leukemia
Essential thrombocythaemias

41
Q

Symptoms of Vit B12 and Folate

A 
Irritability 
Confusion
Depression
Paranoia
Dizziness, weakness, fatigue, sore mouth or tongue
42
Q

Causes of normocytic anaemia

A

Decreased production - malignancy or bone marrow failure
Increased destruction - hemolytic anaemia
Blood loss

43
Q

What changes are present in a normocytic anaemia

A

Rbc count is low but the HB is normal

44
Q

What changes are present in microcytic anaemia

A

Smaller than normal RBC’s, also hypochromic so pale in colour

45
Q

What causes an increase in the levels of RBCs

A

Polycythemia

Reduction in plasma content through fluid loss, dehydration or burns

46
Q

Define Haematocrit

A

Haematocritor packed cell volume (PCV) measures the fraction of whole blood volume that consists of red blood cells. It is reported as a percentage (0 to 100)

47
Q

What are the four stages of haemostasis

A

Vasoconstriction.
Platelet Response.
Blood Coagulation.
Fibrinolysis.

48
Q

What 2 substances are secreted from the vascular endothelium to prevent haemostasis

A

Heparin

Prostacyclin

49
Q

Damaged vascular endothelium release ….. which are pro-coagulant

A

IL- 1

Tissue necrotizing factor

50
Q

In the Clotting cascade, what are two of the main coagulation inhibitors

A

Anti-thrombin 3 - inactivates thrombin and is enhanced by endogenous heparin
Protein C, inactivates factors Va and VIIIa so fibrinogen is not converted into fibrin

51
Q

What are the 3 main components of the fibrinolysis system

A

Plasminogen (produced by the liver), the precursor to plasmin.

Tissue-type plasminogen activator (t-PA), released from vascular endothelial cells.

Urokinase-type plasminogen activator ( u-PA ), produced principally by the kidney and endothelial cells.

52
Q

Where is fibrinogen produced

A

Liver

53
Q

Increased amoutns of fibrinogen suggest

A

inflammation and can be found in smokers

54
Q

Decreased amounts of fibrinogen suggest

A

consumption by clot formation or a lack of production

55
Q

What is the PTT

A

Partial thromboplastin time - time is taken for the blood to clot.
PTT measures the efficacy of the intrinsic pathway of the clotting cascade and is used to monitor the effects of heparin therapy. Prolonged PTT may indicate coagulation factor deficiency (e.g. haemophilia)

56
Q

What is the PT

A

PT measures the extrinsic pathway and is used to monitor warfarin therapy.

57
Q

Define INR

A

International normalised ratio

Simply put this is the ratio between the time taken for blood to clot normally compared with the time it takes to clot due to warfarin.

58
Q

Define D-Dimer

A

When fibrin is lysed by the proteolytic activity of plasmin, various cleavage fragments are released. These can be measured. Minor elevations as seen in trauma, renal failure, post-op, sepsis and venous thrombosis do not indicate excessive fibrinolysis.

High D-dimer (positive) concentrations suggest excess fibrinolysis and may indicate DVT, PE or DIC.

59
Q

What is DIC

A

Disseminated intravascular coagulation
Widespread activation of coagulation leading to a reduction in the availability of clotting factors leading to haemorrhage

60
Q

What conditions are associated with DIC - causes

A

Trauma - fractures, fat embolism, head injury
Infection - Bacterial or viral
Cardiovascular disease - MI, Valvular disease, endocarditis
Obstetrics - Eclampsia, death in utero, retained products
Malignancy - disseminated carcinoma
Vasculitis- collagen vascular disorders, haemolysis
Transplant
Thermal injuries
Toxin release
Liver disease

Biochemistry and Haemotology (8 decks)

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