Clotting Flashcards
What is haemopoeis regulated by?
Interleukin 1,3,5,6
Stem cell factor
Erythropoietin
Thrombopetin
What are haemotinics
Products that are required for the formation of red blood cells.
The main ones being folate, but b 12, and iron
Where is the bodies iron found
70% haemoglobin
25% ferritin
Why are patients normally deficient in iron
Inadequate oral intake
Inadequate absorption
Haemorrhage
What does ferritin do
Acute phase protein
Transport iron in a none toxic form
What is folate used for
For nation if dba and rna
And amino acid metabolism
Cause of macrocytic anaemia
Folate deficiency
Vitamin b12 deficiency
What is renal anaemia
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.
Symptoms of Vit b12 deficiency
Tiredness, lethargy, feeling faint, becoming breathless easily. Sore mouth and beef steak tongue.
What causes Vit b12 deficiency
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.
Treatment options for Vit b12 Deficiency
B12 injection - 1 every 2-4 days and then one every 3 months
Define Polycythemia
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
`What is Polycythemia Rubra Vera
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.
What are the 4 main blood groups
A, B, AB and O
What antibodies and antigens are present in AB and O blood
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
Which is the most important Rhesus antigen
D - that gives the blood positive or negative after the blood group
Others include C,c,D E, e
What is the clinical significance of the Rhesus status of women of childbearing age
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
What are the two main types of white blood cells
Mono-nuclear cells and granulocytes
Whicch of the white blood cells are classed as phagocytes
neutrophils, monocytes, eosinophils and basophills
What do lymphocytes do?
Help to identify the antigen - antigen presenting cells.
Create a memory - antibodies so the body is able to fight further infections
What does an increase in atypical cells represent
potentially leukemia
Define Leucopenia
Reduction in white cell count - maybe specific - neutropenia, lymphopenia or eosinopenia
Define Leucocytosis
Increase in the number of white cells, neutrophillia, lymphocytosis, eosinophilia, monocytosis and basophilia
An increase in WCC would suggest
infections, systemic illness, allergy, inflammation and certain types of cancer such as leukaemia
An increase in WCC would suggest
certain medication - such as chemotherapy, auto-immune disease, viral or some severe bacterial infections, bone marrow failure, liver disease and alcohol excess
What would a Neutrophillia suggest
Bacterial or viral infection
Lymphocyctosis would suggest
elevated in some infections such as glandular fever, lymphocytic leukaemia,
Monocytosis would suggest
raised in bacterial infection, TB, Malaria, monocytic leukaemia, chronic UC and regional enteritis
Eosinophilia would suggest
parasitic infection, asthma or allergy
Basophilic would suggest
hypersensitivity reactions, certain allergens and parasites
What is the significance of neutropenic sepsis
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.
What WCC does multiple myeloma effect
Lymphocyte - Myeloproliferative disorder
Myeloma produces
immunoglobulins and antibodies - these are abnormal and are collectively called paraproteins.
What electrolytes disturbance is likely to occur in Multiple Myeloma
Hypercalcemia - due to the increased osteoclast activity causing the bones to break down and release stored Ca.
Due to the formation of plasmacytomas in multiple myeloma what secondary issues may occur
Due to the degradation of the bone marrow, anaemia, leucopenia and thrombocytopenia may also occur.
What would you expect to see in relation to the ESR and CRP in Multiple myeloma
Increased ESR due to increased plasma viscosity - attributed to an increase in cellular components within the blood, normal CRP as not an inflammatory process
Define Thrombocytopenia
Platelet levels that are too low and increases the patient’s risk of bleeding and bruising. Less than 20 is considered life-threatening
Define Thrombocytosis
Platelet levels that are too high and predisposes the patient to spontaneous thrombus formation
Causes of thrombocytopenia
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
Causes of thrombocytosis
as a response to blood loss, surgery, trauma
infection and inflammatory disorders,
Malignancy - important if its persistent
Myeloproliferative disorders - chronic myeloid leukemia
Essential thrombocythaemias
Symptoms of Vit B12 and Folate
Irritability Confusion Depression Paranoia Dizziness, weakness, fatigue, sore mouth or tongue
Causes of normocytic anaemia
Decreased production - malignancy or bone marrow failure
Increased destruction - hemolytic anaemia
Blood loss
What changes are present in a normocytic anaemia
Rbc count is low but the HB is normal
What changes are present in microcytic anaemia
Smaller than normal RBC’s, also hypochromic so pale in colour
What causes an increase in the levels of RBCs
Polycythemia
Reduction in plasma content through fluid loss, dehydration or burns
Define Haematocrit
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)
What are the four stages of haemostasis
Vasoconstriction.
Platelet Response.
Blood Coagulation.
Fibrinolysis.
What 2 substances are secreted from the vascular endothelium to prevent haemostasis
Heparin
Prostacyclin
Damaged vascular endothelium release ….. which are pro-coagulant
IL- 1
Tissue necrotizing factor
In the Clotting cascade, what are two of the main coagulation inhibitors
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
What are the 3 main components of the fibrinolysis system
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.
Where is fibrinogen produced
Liver
Increased amoutns of fibrinogen suggest
inflammation and can be found in smokers
Decreased amounts of fibrinogen suggest
consumption by clot formation or a lack of production
What is the PTT
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)
What is the PT
PT measures the extrinsic pathway and is used to monitor warfarin therapy.
Define INR
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.
Define D-Dimer
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.
What is DIC
Disseminated intravascular coagulation
Widespread activation of coagulation leading to a reduction in the availability of clotting factors leading to haemorrhage
What conditions are associated with DIC - causes
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
