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BDS2 - diseases of the blood > disorders of the blood > Flashcards

disorders of the blood Flashcards

1
Q

what are the functions of the blood?

A
  • transport of nutrients
  • removal of waste
  • transport host defences
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2
Q

what does the blood need to be able to carry out its functions

A
  • ability to carry nutrients / wastes / defences

- ability to self repair

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3
Q

what is in blood

A 
> cell components
> plasma proteins (albumin and globulin)
> lipids 
> nutrients
`> water
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4
Q

what does FBC mean

A

full blood count

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5
Q

what does RBC mean

A

red blood cells

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6
Q

what does RCC mean

A

red cell count

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7
Q

what does PLT mean

A

platelets

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8
Q

what does HCT mean

A

haematocrit

the proportion of liquid to cells

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9
Q

what does MCV mean

A

mean cell volume

different diseases cause cell sizes to change

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10
Q

define anaemia

A

low haemoglobin (Hb)

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11
Q

what is Hb

A

haemoglobin

measure of anaemia

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12
Q

define leukopenia

A

low white cell count

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13
Q

what does WCC mean

A

white cell count

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14
Q

define thrombocytopenia

A

low platelets

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15
Q

define pancytopenia

A

all cells reduced
bone marrow not working as cells aren’t being produced and cells are made in the bone marrow
if only one type of cell was missing the blood would just be deficient in that one cell type and it would not be a problem with the bone marrow

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16
Q

what does one cell type being reduced tell us

A

that this problem is a reactive change to the environment

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17
Q

what does multiple cell types being reduced tell us

A

bone marrow failure

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18
Q

define polycythaemia

A

raised Hb

opposite to anaemia

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19
Q

define leucocytosis

A

raised wcc

can happen naturally with infection or can be caused by a disease

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20
Q

define thrombocythemia

A

raised platelets

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21
Q

what does one cell type being raised tell us

A

it is reactive to the environment or it is pre-neoplastic

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22
Q

what does multiple cell types being raised tell us

A

pre-neoplastic

myelodysplasia

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23
Q

define leukaemia

A

neoplastic proliferation of white cells, usually disseminated (spread)
WCC very high
usually no obvious signs (no lumps or bumps externally - may be little blobs in the blood)

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24
Q

define lymphoma

A

neoplastic proliferation of white cells usually a solid tumour
not in circulation
may occur in lymph nodes

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25
Q

when would you have a blood transfusion

A

when one or more components of the blood has to be replaced quickly

26
Q

when would you need a transfusion of red cells and platelets

A

> in an emergency situation where the patient has lost a lot of blood which needs to be replaced before they can undergo surgery

> for a patient with leukaemia when the bone marrow produces lots of wbc so there is a limited capacity to create other cells

> if a patient can’t produce enough platelets they will bleed a lot after a tooth extraction so a transfusion of platelets would help them to clot better

27
Q

when would you need a transfusion of clotting factors (fresh frozen plasma)

A

trauma might use up all the clotting factors faster than the body can make new ones so by giving patient a plasma transfusion they receive clotting factors to aid this process

28
Q

what is the different categories of blood antigens in the ABO system

A

> A
B
O
AB

29
Q

what are the categories of blood antigens in the D system (rhesus)

A

>

  • positive

>

  • negative
30
Q

when is a blood transfusion given

A 
> blood loss
> specific production problems 
- rbc, platelets
- plasma proteins 
~ clotting factors
~ albumin
~ gamma globulins
31
Q

why is it best to avoid giving a transfusion if at all possible

A

dont know exactly what is in someone’s blood eg Hep C
although blood is tested for every known disease within the blood there could be diseases we cant test for what we dont know

32
Q

how can you guarantee a safe blood transfusion

A
  • get your own blood in a transfusion so you don’t receive anything you don’t already have
    eg hip replacement means a patient will lose 2 units of Hb so if patient gives sample of their own blood 12 weeks in advance of the operation and this blood is stored, then the patient’s body has enough time to replace the cells / blood naturally in their own body using their own bone marrow then after the operation the patient will receive their own blood from the sample
33
Q

what is the process of a blood transfusion

A
  • sample taken from donor
  • tested against known blood types
    > basic ABO compatibility
    > rhesus compatibility
    > does not always detect irregular antibodies
  • tested against donated sample
  • matched blood given to patient
34
Q

explain the ABO blood groups

A

> group A has A antigens and anti-B antibodies in the plasma

> group B has B antigens and anti-A antibodies in the plasma

> group AB has A and B antigens and no antibodies in the plasma
patient’s with group AB blood can receive any blood group = universal receiver

> group O has no antigens and anti-A and anti-B antibodies in the plasma
group O can be given to anyone = universal donor

35
Q

can you still have problems with a compatible blood transfusion

A

yes

36
Q

what happens in an incompatible blood transfusion

A

rbc lysis which can lead to fever, jaundice and death

the rbc burst into the system

37
Q

explain fluid overload in relation to a blood transfusion

A

when there has been lots of blood lost in trauma / emergency then we want the extra fluid from the transfusion
but if you are healthy and haven’t lost blood then you dont need the extra fluid so people (particularly elderly pateints) struggle to cope with the extra fluid
can lead to heart failure

38
Q

what infection can be transmitted through blood transfusions

A

> blood borne virues

  • CMV
  • Hep B / C
  • HIV
  • TT virus

> prion disease
- vCID

> bacterial infection
- syphillis

39
Q

define haemostasis

A

stopping of the flow of blood

40
Q

what are the different components of haemostatic disorders

A

> vascular components

  • reaction of vessel (collagen disorder)
  • inherited disorders of collagen = rare
  • blood vessels dont work like they should work

> cellular components

  • platelets number and function
  • can be dynamic, change quickly

> coagulation component

  • adequate clotting
  • adequate clot lysis
41
Q

explain the cellular component

A

> check platelet number with FBC
check platelet function
- remember aspirins / NSAIDS have permanent effect on platelets
adequate amount and range of clotting factors
proper balance between thrombotic and thrombolytic systems

42
Q

how can you test the platelet functin

A

there is no good test for this
- cut the patient and time how long it takes for them to stop bleeding
not a good idea

platelets are generally assumed to be working normally if they are a normal number in the blood

43
Q

how long does it take to form new platelets

A

7-10 days

44
Q

what is disseminated intravascular coagulation

A

is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels

45
Q

how do haemostatic disorders show in a clinical situation

A

> history of prolonged bleeding

  • after extractions
  • after minor cuts

> visual signs

  • purpura
  • ecchymosis
  • petechiae
46
Q

what are the investigations into haemostatic disorders

A

> FBC (platelet numbers)
bleeding time (platelet function)
INR and APPT
LFT (clotting factor synthesis)

47
Q

what does INR test for

A

tests how well you can produce a clot

tests how well the system works and how well you can make clotting factors

48
Q

what is LFT

A

liver function test

49
Q

what is haemophilia

A

inherited deficiency of VIII or IX
males are mostly affected (on the X chromosome)
females are mostly carriers

50
Q

what is thrombophilia

A

excessive tendency to clot - usually DVT
life threatening due to pulmonary embolism
(clots in legs can circulate into vena cava and get stuck in the heart resulting in blockagesthat the heart can’t pump anymore)
exacerbated by thrombo-promoting actions
> smoking
> immobility
> surgery
> pregnancy
> medicines = oestrogen contraceptive pill

51
Q

what is therapeutic coagulopathy

A

when coagulation system is manipulated by medicine to make clotting less likely
> reduce platelet adhesion and function
- usually prevent arterial thrombosis
> reduce activity in the coagulation cascade
- usually prevent venous thrombosis

52
Q

name antiplatelet drugs

A

> standard antiplatelets

  • aspirin
  • dipyrimadole
  • clopidogrel

> new antiplatelets

  • plasugrel
  • ticagrelor
53
Q

name anticoagulant drugs

A

> standard anticoagulant drugs
- warfarin

> new anticoagulant drugs

  • apixban
  • dabigatran
  • rivaroxaban
54
Q

how can you looking for bleeding problems on the patient

A

> skin

  • red spots
  • purpura

> mucosa

  • purpura
  • blood blisters
55
Q

what is porphyria

A

abnormality of haem metabolism
affects 1 in 10,000 population
most people dont know they have them until an acute episode
cant tell from appearance

56
Q

what are the 2 main groups of porphyria

A

> hepatic porphyrias

> erythropoietic porphyrias

57
Q

what are clinically relevant porphyrias

A

> variegate
- afrikaans descent

> acute intermittent
- any population group

> hereditary coproporhyria

58
Q

what are the clinical effects of porphyrias

A

> photosensitive rash (at any time)

> neuropsychiatric disturbance in acute attacks
- motor and sensory changes, seizures
~ unpredictable
- autonomics disturbances

> hypertension and tachycardia

> may be fatal

59
Q

what are triggers of porphyrias

A

> poorly understood

  • mainly drugs (LA)
  • pregnancy
  • acute infections
  • alcohol
  • fasting
60
Q

what needs to be considered from a dental aspect with porphyria

A

drug administration - be cautious

BDS2 - diseases of the blood (5 decks)

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