Concepts of Haematology Flashcards
3 reasons cell count might be low
underproduction,
increased destruction,
redistribution e.g. spleen
3 reasons cell count might be high
increased production in response to stimulus,
increased production with no stimulus intrinsic e.g. malignancy,
redistribution e.g. steroids can make neutrophils stick to walls less and seem higher
thrombocytosis = thrombophilia. T/F?
False - thrombocytosis means too many platelets, thrombophilia means excessive tendency to thrombosis
In coeliac disease, how does erythropoiesis system respond?
Low iron absorption leads to low output as reticulocyte formation kinda crap so is seen as an absence of an increase in reticulocyte count,
Hb gradually drops,
erythropoietin levels increase to stimulate marrow so mild-moderate hyperplasia,
but no iron so all of them being made are not high in Hb
24yr old woman presents with acute blood loss following the delivery of her third child. Bleeding is rapidly controlled by a combination of local pressure and oxytocin but she has lost approximately a litre of blood in a very short period of time. Hb rapidly falls. What immediate physiological changes be observed clinically? (4)
Hypotension,
Tachycardia,
Cold, clammy ,
Becomes anaemic because increased fluid decreases amount of haemoglobin in blood
24yr old woman presents with acute blood loss following the delivery of her third child. Bleeding is rapidly controlled by a combination of local pressure and oxytocin but she has lost approximately a litre of blood in a very short period of time. Hb rapidly falls.How will she respond to the anaemia to restore homeostasis?
- Pre-formed rbc be released early,
* Later down line -> erythron will become more active, puts demand on iron stores so may need iron
A 3 year old boy with glucose-6-phosphate dehydrogenase deficiency is anaemic. He has normal levels of the necessary materials to make haemoglobin but due to the deficiency in G6PD his red cells cannot withstand the oxidative stresses of normal life and so have a vastly reduced survival (30 days compared to the usual 120 days) in the circulation.
What are the consequence of this reduced red cell survival?
Hypoxic stress,
Plenty of haem and globin, active erythron, high reticulocyte count, haemoglobin will come up – not always anaemic but evidence of high turnover visible by high reticulocytes and high bilirubin so basically is running really high
A 3 year old boy with glucose-6-phosphate dehydrogenase deficiency is anaemic. He has normal levels of the necessary materials to make haemoglobin but due to the deficiency in G6PD his red cells cannot withstand the oxidative stresses of normal life and so have a vastly reduced survival (30 days compared to the usual 120 days) in the circulation.Any potential limitations to restoring homeostasis?
Erythron is gonna get big, bone marrow hyperplasia so B12 and folate under more demand, typically folate deficiency
A 63 year old man with poorly controlled diabetes and progressive chronic renal failure. His kidneys are small and scarred on renal ultrasound. They no longer make erythropoietin in response to hypoxia.
What are the consequences to red cell production as the erythropoietin level gradually falls?
Red cell production will decrease, erythroid hypoplasia, low reticulocytes, Hb lower, breakdown without production will lead to high iron levels because broken down but not used
A 55yr old man who is a lifelong smoker. He has developed chronic obstructive pulmonary disease. He has finally managed to stop smoking and has seen the respiratory team who think he is a candidate for domiciliary oxygen for his chronic severe hypoxia due to type one respiratory failure.
What is the response in the kidney to chronic hypoxia?
If he gets oxygen what will happen?
Initially EPO increases to make up for hypoxia, then because stores of everything are there the Hb will rise and the EPO will fall again as a new steady state is reached.
If he gets oxygen, then EPO and erythron will reduce and will restabilise at new normal to match oxygen levels
