Diseases of the Blood

Question 1

What is a FBC? (Full blood count)

Answer 1

A measure of all the cells in the blood.

Question 2

What is a HCT? (Haematocrit)

Answer 2

The proportion of cells to liquid.

Question 3

What does a low HCT mean?

Answer 3

Losing blood cells quicker than you can replenish them.

Question 4

What does a high HCT mean?

Answer 4

Lots of blood cells create a viscous blood which is prone to clotting.

Question 5

What is the MCV? (Mean cell volume?)

Answer 5

The average size of the cells.

Question 6

Define anaemia.

Answer 6

Low amounts of haemoglobin in the blood.

In the form of:
Lots of RBC with little haemoglobin.
Small amounts of RBC with lost of haemoglobin.

Question 7

What is leukopenia?

Answer 7

Low white blood cell count .

Question 8

What is thrombocytopenia?

Answer 8

Low platelet count. (Platelets create clotting capacity)

Question 9

What is pancytopenia?

Answer 9

Reduction in all cells of the blood.

Can be an indication of bone marrow issues - where blood cells formed.

Question 10

What is polycythaemia?

Answer 10

Raised levels of haemoglobin.

Question 11

Define leukocytosis.

Answer 11

Raised white blood cell count

Question 12

Define thrombocythaemia.

Answer 12

Raised platelet levels.

Question 13

Define leukaemia.

Answer 13

Neoplastic proliferation of white cells, usually disseminated throughout the blood.

Question 14

Define Lymphoma.

Answer 14

Neoplastic proliferation of white blood cells, SOLID tumor.

Question 15

Describe the indications for blood transfusion? (In what two situations are blood transfusions given)

Answer 15

Where 1 or more components of the blood have to be replaced quickly (from a great loss.)

When bone marrow cannot produce blood cells.
i.e. in leukaemia - bone marrow overproducing WBC and not producing RBC or platelets etc.

Question 16

Name the 2 blood antigen systems.

Answer 16

ABO

D (rhesus)

Question 17

What is the safest way a blood transfusion can be given?

Answer 17

Blood given by yourself.
The donor blood is taken weeks in advance of when the blood is required. Gives the patients blood time to recover before the operation/transfusion.

Question 18

What blood type is universally given?

Answer 18

Group O

Question 19

What blood group can recieve any blood?

Answer 19

Group AB

Question 20

List the complications of blood transfusions.

Answer 20

Incompatible blood:
leads to lysis of RBC = jaundice, fever and death.
The cells burst and release the contents into circulation.

Fluid overload:
Going from a low volume of blood to a high volume can over work the heart.
Dangerous in those with cardiovascular problems, the old and the young.

Transmission of infection:
Blood borne viruses, prion disease (causes brain damage) and bacterial infections.

Question 21

What PROTEINS regulate clotting/haemostasis?

Answer 21

Protein C and S

Question 22

Describe the 3 components of haemostatic disorders.

Answer 22

Vascular component - associated with collagen disorders

Cellular component - platelet no. and function

Coagulation component - ability to balance clotting and break down of clots.
Availability of clotting factors.

Question 23

What is involved in the cellular component of haemostatic disorders.

Answer 23

platelet number and function.

Question 24

What assumption is made in terms of the cellular component? (Haemostatic disorders)

Answer 24

Adequate number of cells = adequate function

Question 25

What have an effect on the cellular component?

Answer 25

NSAIDs and Asprin. | Permanent effect on platelets, takes 7-10 days for regeneration.

Question 26

What is involved in the coagulation component of haemostatic disorders.

Answer 26

Is there adequate amounts of clotting factors being made and used. BALANCE Is there adequate amounts of clotting and adequate amounts of clot lysis. BALANCE

Question 27

What is coagulation regulated by?

Answer 27

The chemicals released by the blood vessels

Question 28

In a clinical sitation how do you approach diagnosis of a haemostatic disorder?

Answer 28

Take a history - attention made to prolonged bleeding after extractions and minor cuts. Visual cues: (Blotches on skin from bruising underneath) Purpura ecchymosis Petechiae

Question 29

What investigations can you carry out to determine haemostatic disorders?

Answer 29

Most common/useful: Full blood count - count platelet numbers. INR and APPT - How well the clots are produced Bleeding time - determines platelet funtion. LFT (clotting factor synthesisi)

Question 30

What is haemophilia? What are the types of haemophilia?

Answer 30

Tendency to excessively bleed. Range of severity Haemophilia A - inherited deficiency of factor 8 (clotting factor) Christmas disease/Haemophilia B - inherited deficiency of factor 9 (clotting factor) Von Willebrand's disease - Inherited deficiency of factor 8 paired with a lack of VW protein on platelets.

Question 31

WHo is affected by haemophilia?

Answer 31

Males (females are carrers)

Question 32

What is thrombophilia?

Answer 32

Tendency to clot.

Question 33

What factors increase the risk of thrombophilia?

Answer 33

Smoking Immobility; Travel and surgery associated Trauma: Body goes into exaggerated clotting. Medication: the pill Pregnancy

Question 34

List anti platelet drugs (old and new) what is their action?

Answer 34

Prevent platelet aggregation - leads to clot formation. Aspirin Clopidogrel New: Prasugrel

Question 35

List anticoagulant drug (old and new) what is their action?

Answer 35

Prevents clots from forming and growing Warfarin New: Rivaboxaban Apixaban

Question 36

What is porphyria?

Answer 36

VERY DANGEROUS - most individuals are unaware Abnormality of haem metabolism.

Question 37

What are the 2 main groups of porphyria?

Answer 37

Hepatic prophrias | Erythropoietic porphyrias

Question 38

What are the clinical effects of porphyria?

Answer 38

``` Photosensitive rash Neuropsychiatric disturbances: Motory/sensory changes, seizures. Hypertension Tachycardia Death ```

Question 39

What are the triggers of porphyria?

Answer 39

``` Medications: LOCAL ANAESTHETIC Pregnancy Acute infections Alcohol Fasting ```

Question 40

What will many dental patients confuse an episode of porphyria with?

Answer 40

An allergy to local anaesthetic.

Question 41

What could multiple reductions in blood cells indicate?

Answer 41

Bone marrow failure.

Question 42

What could multiple increases in blood cells indicate?

Answer 42

Pre-neoplastic myelodysplasia which can lead to leukaemia.

Question 43

Describe the process of blood transfusion.

Answer 43

Blood taken from patient Tested against blood types; ABO and rhesus Tested against the donor sample Matched blood is given to the patient

Question 44

In terms of haemostasis; what occurs in trauma?

Answer 44

Chemicals are released by cells that enhance/speed up clotting

Question 45

What are the visual signs of clotting disorders?

Answer 45

Petechiae - Bleeding under the skin Ecchymosis - bruising from blood under the skin Purpura - prurple blotches on the skin/mucous membrane.

Question 46

What are anti platelet drugs used in?

Answer 46

Treating atherosclerosis

Question 47

What are anticoagulant drugs used in?

Answer 47

Treating thrombphilia