CSIM blood Flashcards
4 signs / symptoms of anaemia?
fatigue
pale
chest pain
brittle nails
2 causes of microcytic anaemia?
bleeding -> iron deficency
thalassaemia
4 causes of macrocytic anaemia?
B12 deficiency
folate deficiency
alcohol
haemolysis
what kind an anaemia in haemolysis and why?
MACROCYTIC
lots of new RBCs are made which are immature therefore bigger
2 causes of normacytic anaemia?
chronic disease
bone marrow pathology
what must be excluded before anaemia of inflammatory cause can be diagnosed?
bone marrow pathology e.g. multiple myeloma
what Ix in suspected haemolysis? why
blood film - looking for spherocytes DAT - for autoimmune haemolysis LTFs - raised bilirubin reticulocyte count LDH - raised
what is a reticulocyte and how does it differ to a RBC?
immature RBC
BIGGER and has genetic material still in it
what do RBC look like in auto immune haemolysis and why?
TENNIS BALLS- spherocytes
proteins bind onto it and the spleen chucks them out
what does a DAT test tell you?
if haemolysis is auto immune
reasons for increased no. of platelets?
secondary (reactive) to infection/ inflammation
myoproliferative disorders e.g. myelofibrosis
caues of thrombocytopenia
decreased production:
haematinic deficit
acute leukaemia
increased consumption:
DIC
sepsis
ITP (idiopathic thrombocyopenia purpura)
what is ITP
idiopathic thrombocyopenia purpura
auto antibodies bind to platelets and destroyed by the spleen - thought to be due to background viral illnes
effect of smoking on Hb?
increase due to overcompensation to hypoxia
what is the presentation of myelofibrosis?
sweats
massive splenomegaly
cytopenias
what is haematocrit?
amount of plasma taken up with red cells
what is included in haematinics?
ferritin
B12
folate
what will a blood film in iron deficiency look like?
pencil shaped cells
why is it important to correct anaemia in cancer patients asap
they might need surgery
what is the pathology in haemochromotosis?
absorbing iron at fastest rate -> iron deposition in liver, pituitary, joints etc
this leads to
cirrhosis
diabetes
joint pain
why macrocytic anaemia in acute blood loss?
marrow throws out loads of reticulocytes very quickly
not quick enough to change hyper acute MCV
why abdo pain in haemolysis?
pigment stones
increased haem -> increased bilirubin -> stones -> cholangitis (case about the 15 yo girl)
what anaemia in CKD and why?
normacytic
decreased erythropoetin
what Ix in acute multiple myeloma?
serum and urine electrophoresis
haematincs to rule out mixed picture
why do we venesect in polycythemia?
stroke risk
why does ESR rise in inflammation?
increased protein means the erythrocytes are more neg. charged so take longer to settle
what are the symptoms of raised haematocrit?
headache
nose bleeds
what is the difference between PT and APTT?
PT measures the extrinsic pathways
APTT meaures the intrinsic pathways
if both PT and APTT are raised what is the clotting problem?
problem in common pathway
which clotting factor does the liver NOT make and where is it made?
8
endothelium and platelets
which Ix assesses the common pathway in coagulation?
Thrombin time
what converts fibrinogen to fibrin?
thrombin
clotting factors that are involved in the intrinsic pathway?
8
9
11
(12) not required to make thrombin
clotting factors in the extrinsic pathway?
VII
vit. K dependent clotting factors?
2
7
9
10
how to test the extrinsic pathway?
PT
what is haemophilia A?
FVIII deficiency -> easy bleeding
X linking condition
what is the difference between a normal and a haemophilia bruise?
there is a palpable haematoma (bump in middle of bruise) in haemophilia a
what are of the body does haemophilia a effect?
weight bearing joints
what is haemophilia b?
Factor IX deficiency
X linked
which is the more common type of haemophilia?
a
what is von willebrand factor? / how does it work?
glycoprotein involved in clotting:
- Binds platelets (Gp1b) to the subendothelium and platelet/ platelet binding in high shear stress
- Binds and stabilises FVIII
what is the commonest inherited bleeding disorder?
von willebrand disease
what effect does a von willbrande factor deficiency have on FVIII?
reduced level
it binds to FVIII so if there is less of it, less FVIII is bound so t1/2 reduced
how does vWD present differently to haemophilia a or b
milder - doesnt effect joints as much
what the three inherited bleeding disorders i need to know? how are each inherited?
haemophilia a and b - X linked
VWD - autosomal dominant
how can DIC present?
too much clotting or bleeding
how does biliary stasis lead to clotting problems?
cant emulsify fat so get vit. K deficiency
what is DIC and when does DIC occur?
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
classical lab picture of DIC?
Low platelet count
Prolonged clotting times- PT, APTT
Low fibrinogen
High d-dimers
how do people with Protein C and Protein S deficiency present?
thrombosis at a young age
main types of Venous Thrombo-embolism (VTE)?
DVT
PE
what scoring system is used to assess risk of DVT?
wells
what is D-dimer and how is it used?
break down product of F-XIII (fibrin)
measured and used to predict likelihood of DVT
what are protein c and s?
natural anti-coagulants
what is the difference between warfarin and the DOACS
DOACS act much more specifically so lead to less bleeding
why does warfarin take a few days to work?
it stops the enzyme that activates the vit. K dependent factors but there will be some active ones in circulation already
3 option for reversal of warfarin?
Omit warfarin (or stop permanently)
Vitamin K (IV or oral)
Coagulation factor replacement (concentrated 2 7 9 and 10)
most common symptom of intra cranial bleed?
headache
how to confirm EBV diagnosis
monospot test
typical FBC in leukaemia
very low neutrophils
very high WCC
anaemia
what are blast cells?
immature white cells
what is released in tumour lysis syndrome?
K
uric acid
why gout in cancer?
increased uric acid in tumour lysis syndrome
what do blast cells in the blood indicate?
that the bone marrow is getting into the blood
isolated low platelets is most likely to be ?
ITP - this is a diagnosis of exclution
how does ITP present? what is the onset like?
background of viral illness (could be sub-clinical)
Purpura
Menorrhagia
Epistaxis
Gingival bleeding
children - sudden
adults - slower
what is normally the cause of ITP in children?
viral illness
immunisation
effect of DIC on platelets? what about fibrinogen?
low
also low
they’ve been used up
how do you tell between Hodgkin and non- Hodgkin lymphoma?
Hodgkin has owl eyes on histology
what are rouleaux?
stacks of RBC on the blood film
what is multiple myeloma?
tumour of the plasma cells
accumulates in the bone marrow
symptoms of AML?
fatigue,
shortness of breath,
easy bruising and bleeding,
increased risk of infection
what causes the symptoms of AML?
pancytopenia
what is seen on a blood film in AML?
auer rods on RBC
warfarin patient comes in with stroke symptoms, what is the most important Ix? if in therapeutic range, what is the best management?
rapid IRN
more likely to be a bleed so give some conc. 2, 7, 9 and 10 AND IV vit K
how to diagnose lymphoma?
need lymph tissue
3 medical emergencies that lymphoma can present with?
Confusion
Dehydration
Bowel bladder disturbance
lymphoma cells in the blood indicates what?
stage IV disease - very bad
if you suspect lymphoma, what Ix do you need to diagnose it
core biopsy or excision
FNA is NOT adequate
what doeds abnormal lymph gland tissue look like on PET scan?
black
which Ix did she keep going on about how it wasnt useful in diagnosing lymphoma?
bone marrow biopsy
Tx for tumour lysis syndrome?
allopurinol / raspuricase (in high risk cases) for uric acid
keep hydrated
what makes a patient arrest in TLS?
increased K
what 3 things make you think lymphadenopathy is lymphoma
sustained
bigger than 1cm
no other cause (not reactive)
two reasons for pancytopenia?
increased destruction of cells
immune mediated
sepsis
splenomegaly
decreased production: bone marrow failure3 causes of bone marrow failure?
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)
symptoms of bone marrow failure
symptoms of anaemia
bruising
infection
what iatrogenic form of neutropenia is there?
chemo
why do infections get into the blood more easily in neutropenia?
neutrophils have an important role in LOCALIZING infection
causes of aplastic marrow failure?
idiopathic (probably auto-immune) - 60% drugs - 40% benzene sulphonamides gold / penicillamine CHEMO very rarely congenital
what is the commonest cause of bone marrow failure?
acute leukaemia
5 haematological causes of bone marrow failure?
acute laekaemia myeloma myelofibrosis infiltration with lymphoma myelodysplastic syndrome
6 non-haematological cancers that cause BMF?
breast prostate renal lung thyroid skin
what is the commonest cancer in children?
acute lymphoblastic leukaemia
leukaemia presentation?
symptoms of pancytopenia
symptoms of cancer (sweats, weight loss etc.)
if it has spread else where: gums, skin, testes, meningies, swollen lymph glands
what is ALL?
cancer of the developing white blood cells
how to make diagnosis of leukaemia?
FBC - pancytopenia
clotting
BIOPSY of BONE MARROW will be diagnostic
Mx of severe neutropenia?
broad spectrum abx given within the hour eg Tazicin / gentamycin
what is the role of chromosome analysis in leukaemia?
prognosis
targeting treatment
infertility in chemo for leukaemia?
men - always but can sperm bank
women - not always but not way to protect them
what is produced in large quantities when a tumour dies quickly? what does this cause?
uric acid
potassium
renal failure
cardiac arrest
gout
how does age and sex effect prognosis of leukaemia?
boys do worse than girls (testicles act as sancutary)
old do worse than young
consequences of chemo in leukaemia?
infertility increased risk of cancer hair loss shorter loss of intellect endocrine abnormalities (DM, hpt)
chondrocalcinosis of the knees should make me think what?
haemochromotosis
peripheral neuropathy is associated with a deficiency in what?
B12
wha tis the most common cause of macrocytosis?
alcohol excess
what does the kidney measure to regulate the amount of erythropoietin produced?
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
BLASTS = ?
acute leukaemia
what Ix tell the difference between ALL and AML ?
WE DON’T NEED TO KNOW KNOW THAT
according to Dr Jackson
how to distinguish between lymphoma and sarcoidosis on CXR?
sarcoidosis is BILATERAL lymphadenopathy
what pushes the patient into kidney failure in multiple myeloma?
massive amounts of immunoglobulins (PROTEIN) produced
causes of prolonged APTT
Lupus anticoagulant
Heparin treatment
Heparin contamination
Factor deficiency (rare)
3 mx steps in suspected cerebral bleed if on warfarin?
Needs v.urgent CT
Check INR
Give beriplex to reverse the effects of warfarin
what are reed-sternburg cells most commonly associated with?
Hodgkins lympoma
describe the rash in HSP
macular rash on back of legs or buttocks
