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4TH YEAR > CSIM blood > Flashcards

CSIM blood Flashcards

1
Q

4 signs / symptoms of anaemia?

A

fatigue
pale
chest pain
brittle nails

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2
Q

2 causes of microcytic anaemia?

A

bleeding -> iron deficency

thalassaemia

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3
Q

4 causes of macrocytic anaemia?

A

B12 deficiency
folate deficiency
alcohol
haemolysis

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4
Q

what kind an anaemia in haemolysis and why?

A

MACROCYTIC

lots of new RBCs are made which are immature therefore bigger

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5
Q

2 causes of normacytic anaemia?

A

chronic disease

bone marrow pathology

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6
Q

what must be excluded before anaemia of inflammatory cause can be diagnosed?

A

bone marrow pathology e.g. multiple myeloma

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7
Q

what Ix in suspected haemolysis? why

A 
blood film - looking for spherocytes
DAT  - for autoimmune haemolysis
LTFs - raised bilirubin 
reticulocyte count
LDH - raised
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8
Q

what is a reticulocyte and how does it differ to a RBC?

A

immature RBC

BIGGER and has genetic material still in it

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9
Q

what do RBC look like in auto immune haemolysis and why?

A

TENNIS BALLS- spherocytes

proteins bind onto it and the spleen chucks them out

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10
Q

what does a DAT test tell you?

A

if haemolysis is auto immune

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11
Q

reasons for increased no. of platelets?

A

secondary (reactive) to infection/ inflammation

myoproliferative disorders e.g. myelofibrosis

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12
Q

caues of thrombocytopenia

A

decreased production:
haematinic deficit
acute leukaemia

increased consumption:
DIC
sepsis
ITP (idiopathic thrombocyopenia purpura)

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13
Q

what is ITP

A

idiopathic thrombocyopenia purpura

auto antibodies bind to platelets and destroyed by the spleen - thought to be due to background viral illnes

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14
Q

effect of smoking on Hb?

A

increase due to overcompensation to hypoxia

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15
Q

what is the presentation of myelofibrosis?

A

sweats
massive splenomegaly
cytopenias

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16
Q

what is haematocrit?

A

amount of plasma taken up with red cells

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17
Q

what is included in haematinics?

A

ferritin
B12
folate

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18
Q

what will a blood film in iron deficiency look like?

A

pencil shaped cells

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19
Q

why is it important to correct anaemia in cancer patients asap

A

they might need surgery

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20
Q

what is the pathology in haemochromotosis?

A

absorbing iron at fastest rate -> iron deposition in liver, pituitary, joints etc

this leads to
cirrhosis
diabetes
joint pain

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21
Q

why macrocytic anaemia in acute blood loss?

A

marrow throws out loads of reticulocytes very quickly

not quick enough to change hyper acute MCV

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22
Q

why abdo pain in haemolysis?

A

pigment stones

increased haem -> increased bilirubin -> stones -> cholangitis (case about the 15 yo girl)

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23
Q

what anaemia in CKD and why?

A

normacytic

decreased erythropoetin

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24
Q

what Ix in acute multiple myeloma?

A

serum and urine electrophoresis

haematincs to rule out mixed picture

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25
Q

why do we venesect in polycythemia?

A

stroke risk

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26
Q

why does ESR rise in inflammation?

A

increased protein means the erythrocytes are more neg. charged so take longer to settle

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27
Q

what are the symptoms of raised haematocrit?

A

headache

nose bleeds

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28
Q

what is the difference between PT and APTT?

A

PT measures the extrinsic pathways

APTT meaures the intrinsic pathways

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29
Q

if both PT and APTT are raised what is the clotting problem?

A

problem in common pathway

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30
Q

which clotting factor does the liver NOT make and where is it made?

A

8

endothelium and platelets

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31
Q

which Ix assesses the common pathway in coagulation?

A

Thrombin time

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32
Q

what converts fibrinogen to fibrin?

A

thrombin

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33
Q

clotting factors that are involved in the intrinsic pathway?

A

8
9
11
(12) not required to make thrombin

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34
Q

clotting factors in the extrinsic pathway?

A

VII

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35
Q

vit. K dependent clotting factors?

A

2
7
9
10

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36
Q

how to test the extrinsic pathway?

A

PT

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37
Q

what is haemophilia A?

A

FVIII deficiency -> easy bleeding

X linking condition

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38
Q

what is the difference between a normal and a haemophilia bruise?

A

there is a palpable haematoma (bump in middle of bruise) in haemophilia a

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39
Q

what are of the body does haemophilia a effect?

A

weight bearing joints

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40
Q

what is haemophilia b?

A

Factor IX deficiency

X linked

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41
Q

which is the more common type of haemophilia?

A

a

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42
Q

what is von willebrand factor? / how does it work?

A

glycoprotein involved in clotting:

  • Binds platelets (Gp1b) to the subendothelium and platelet/ platelet binding in high shear stress
  • Binds and stabilises FVIII
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43
Q

what is the commonest inherited bleeding disorder?

A

von willebrand disease

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44
Q

what effect does a von willbrande factor deficiency have on FVIII?

A

reduced level

it binds to FVIII so if there is less of it, less FVIII is bound so t1/2 reduced

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45
Q

how does vWD present differently to haemophilia a or b

A

milder - doesnt effect joints as much

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46
Q

what the three inherited bleeding disorders i need to know? how are each inherited?

A

haemophilia a and b - X linked

VWD - autosomal dominant

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47
Q

how can DIC present?

A

too much clotting or bleeding

48
Q

how does biliary stasis lead to clotting problems?

A

cant emulsify fat so get vit. K deficiency

49
Q

what is DIC and when does DIC occur?

A

Coagulation, normally localised to the site of injury, becomes systemic

Occurs when the balance of procoagulant and anticoagulant factors is overwhelmed by a massive systemic procoagulant signal e.g. sepsis, malignancy, trauma

50
Q

classical lab picture of DIC?

A

Low platelet count
Prolonged clotting times- PT, APTT
Low fibrinogen
High d-dimers

51
Q

how do people with Protein C and Protein S deficiency present?

A

thrombosis at a young age

52
Q

main types of Venous Thrombo-embolism (VTE)?

A

DVT

PE

53
Q

what scoring system is used to assess risk of DVT?

A

wells

54
Q

what is D-dimer and how is it used?

A

break down product of F-XIII (fibrin)

measured and used to predict likelihood of DVT

55
Q

what are protein c and s?

A

natural anti-coagulants

56
Q

what is the difference between warfarin and the DOACS

A

DOACS act much more specifically so lead to less bleeding

57
Q

why does warfarin take a few days to work?

A

it stops the enzyme that activates the vit. K dependent factors but there will be some active ones in circulation already

58
Q

3 option for reversal of warfarin?

A

Omit warfarin (or stop permanently)

Vitamin K (IV or oral)

Coagulation factor replacement (concentrated 2 7 9 and 10)

59
Q

most common symptom of intra cranial bleed?

A

headache

60
Q

how to confirm EBV diagnosis

A

monospot test

61
Q

typical FBC in leukaemia

A

very low neutrophils
very high WCC
anaemia

62
Q

what are blast cells?

A

immature white cells

63
Q

what is released in tumour lysis syndrome?

A

K

uric acid

64
Q

why gout in cancer?

A

increased uric acid in tumour lysis syndrome

65
Q

what do blast cells in the blood indicate?

A

that the bone marrow is getting into the blood

66
Q

isolated low platelets is most likely to be ?

A

ITP - this is a diagnosis of exclution

67
Q

how does ITP present? what is the onset like?

A

background of viral illness (could be sub-clinical)

Purpura
Menorrhagia
Epistaxis
Gingival bleeding

children - sudden
adults - slower

68
Q

what is normally the cause of ITP in children?

A

viral illness

immunisation

69
Q

effect of DIC on platelets? what about fibrinogen?

A

low
also low

they’ve been used up

70
Q

how do you tell between Hodgkin and non- Hodgkin lymphoma?

A

Hodgkin has owl eyes on histology

71
Q

what are rouleaux?

A

stacks of RBC on the blood film

72
Q

what is multiple myeloma?

A

tumour of the plasma cells

accumulates in the bone marrow

73
Q

symptoms of AML?

A

fatigue,
shortness of breath,
easy bruising and bleeding,
increased risk of infection

74
Q

what causes the symptoms of AML?

A

pancytopenia

75
Q

what is seen on a blood film in AML?

A

auer rods on RBC

76
Q

warfarin patient comes in with stroke symptoms, what is the most important Ix? if in therapeutic range, what is the best management?

A

rapid IRN

more likely to be a bleed so give some conc. 2, 7, 9 and 10 AND IV vit K

77
Q

how to diagnose lymphoma?

A

need lymph tissue

78
Q

3 medical emergencies that lymphoma can present with?

A

Confusion

Dehydration

Bowel bladder disturbance

79
Q

lymphoma cells in the blood indicates what?

A

stage IV disease - very bad

80
Q

if you suspect lymphoma, what Ix do you need to diagnose it

A

core biopsy or excision

FNA is NOT adequate

81
Q

what doeds abnormal lymph gland tissue look like on PET scan?

A

black

82
Q

which Ix did she keep going on about how it wasnt useful in diagnosing lymphoma?

A

bone marrow biopsy

83
Q

Tx for tumour lysis syndrome?

A

allopurinol / raspuricase (in high risk cases) for uric acid

keep hydrated

84
Q

what makes a patient arrest in TLS?

A

increased K

85
Q

what 3 things make you think lymphadenopathy is lymphoma

A

sustained
bigger than 1cm
no other cause (not reactive)

86
Q

two reasons for pancytopenia?

A 
increased destruction of cells 
    immune mediated
    sepsis
    splenomegaly
decreased production: bone marrow failure
87
Q

3 causes of bone marrow failure?

A

megaloplastic anaemia (chronic B12 and folate)

aplastic anaemia (failure of bone marrow to develop)

infiltration of bone marrow with malignant disease (haematological or non-haematological)

88
Q

symptoms of bone marrow failure

A

symptoms of anaemia
bruising
infection

89
Q

what iatrogenic form of neutropenia is there?

A

chemo

90
Q

why do infections get into the blood more easily in neutropenia?

A

neutrophils have an important role in LOCALIZING infection

91
Q

causes of aplastic marrow failure?

A 
idiopathic (probably auto-immune) - 60%
drugs - 40%
   benzene
   sulphonamides
   gold / penicillamine
   CHEMO
very rarely congenital
92
Q

what is the commonest cause of bone marrow failure?

A

acute leukaemia

93
Q

5 haematological causes of bone marrow failure?

A 
acute laekaemia
myeloma
myelofibrosis
infiltration with lymphoma
myelodysplastic syndrome
94
Q

6 non-haematological cancers that cause BMF?

A 
breast
prostate
renal
lung 
thyroid
skin
95
Q

what is the commonest cancer in children?

A

acute lymphoblastic leukaemia

96
Q

leukaemia presentation?

A

symptoms of pancytopenia
symptoms of cancer (sweats, weight loss etc.)
if it has spread else where: gums, skin, testes, meningies, swollen lymph glands

97
Q

what is ALL?

A

cancer of the developing white blood cells

98
Q

how to make diagnosis of leukaemia?

A

FBC - pancytopenia
clotting
BIOPSY of BONE MARROW will be diagnostic

99
Q

Mx of severe neutropenia?

A

broad spectrum abx given within the hour eg Tazicin / gentamycin

100
Q

what is the role of chromosome analysis in leukaemia?

A

prognosis

targeting treatment

101
Q

infertility in chemo for leukaemia?

A

men - always but can sperm bank

women - not always but not way to protect them

102
Q

what is produced in large quantities when a tumour dies quickly? what does this cause?

A

uric acid
potassium

renal failure
cardiac arrest
gout

103
Q

how does age and sex effect prognosis of leukaemia?

A

boys do worse than girls (testicles act as sancutary)

old do worse than young

104
Q

consequences of chemo in leukaemia?

A 
infertility
increased risk of cancer
hair loss
shorter
loss of intellect
endocrine abnormalities (DM, hpt)
105
Q

chondrocalcinosis of the knees should make me think what?

A

haemochromotosis

106
Q

peripheral neuropathy is associated with a deficiency in what?

A

B12

107
Q

wha tis the most common cause of macrocytosis?

A

alcohol excess

108
Q

what does the kidney measure to regulate the amount of erythropoietin produced?

A

measures the amount of O2 getting to the kidney

this means that even in haemoglobin in normal, it will still churn out erythropoietin if youre hypoxic

109
Q

BLASTS = ?

A

acute leukaemia

110
Q

what Ix tell the difference between ALL and AML ?

A

WE DON’T NEED TO KNOW KNOW THAT

according to Dr Jackson

111
Q

how to distinguish between lymphoma and sarcoidosis on CXR?

A

sarcoidosis is BILATERAL lymphadenopathy

112
Q

what pushes the patient into kidney failure in multiple myeloma?

A

massive amounts of immunoglobulins (PROTEIN) produced

113
Q

causes of prolonged APTT

A

Lupus anticoagulant
Heparin treatment
Heparin contamination
Factor deficiency (rare)

114
Q

3 mx steps in suspected cerebral bleed if on warfarin?

A

Needs v.urgent CT
Check INR
Give beriplex to reverse the effects of warfarin

115
Q

what are reed-sternburg cells most commonly associated with?

A

Hodgkins lympoma

116
Q

describe the rash in HSP

A

macular rash on back of legs or buttocks

4TH YEAR (12 decks)

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