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Haematology > DUMS > Flashcards

DUMS Flashcards

1
Q

what is a haem group

A

iron and flat porphyrin ring

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2
Q

erythropoiesis

A

production of RBCs

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3
Q

where are iron stores

A

liver, spleen, bone marrow

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4
Q

how are red cells produced in hypoxia

A

hypoxia sensed by kidneys > EPO produced which stimulates red cell production

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5
Q

site of haematopoeisis

A

Embryo – yolk sac (week 3 -7) then liver (week 6) then marrow (week 16)
At birth – mostly bone marrow, liver and spleen
Birth to maturity – number of active bone marrow sites decreases
Adult – skull, ribs, sternum, pelvis, proximal ends of femur (axial skeleton)

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6
Q

monocyte

A

large single nucleus
faintly saining granules
becomes macrophage

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7
Q

what does an eosinophil look like

A

bi-lobed nucleus
bright orange/red granules

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8
Q

what does a neutrophil look like

A

segmented nucleus
neutral staining granules
(acute inflammation)

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9
Q

basophil

A

large deep purple granules obscuring nucleus

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10
Q

normal haemoglobin

A

males: 130–180 g/L
females: 120–160 g/L

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11
Q

when could you see target cells in blood film

A

iron deficiency anaemia
hyposplenism
thalassaemia
sickle cell
liver disease

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12
Q

causes of microcytic anaemia

A

TAILS
thalassaemia
anaemia of chronic disease
iron deficiency
lead poisoning
sideroblastic anaemia

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13
Q

why does microcytic anaemia happen

A

because you are missing the building blocks to make Hb
however the nuclear machinery still works so the cell is still dividing but the it produces smaller cells (and paler)

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14
Q

types of haem deficiency

A

lack of iron erythropoiesis
- iron deficiency
- anaemia of chronic disease
problems with porphyrin ring synthesis
- lead poisoning
- congenital sideroblastic anaemia (X-linked)
globin deficiency
- thalassaemia

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15
Q

transferrin

A

transfer iron

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16
Q

ferritin

A

stores iron

17
Q

low ferritin

A

suggest iron deficiency

18
Q

causes of iron deficiency

A

loss of iron (blood loss: menorrhagia, GI tumour, ulcers, NSAIDs)
malabsorption: coeliac or crohns
lack in diet

19
Q

where is iron absorbed

A

proximal small bowel (duodenum and proximal jejunum)

20
Q

what control iron absorption

A

hepcidin (produced in the liver)

21
Q

causes of true macrocytic anaemia

A

megaloblastic (impaired DNA) or non-megaloblastic

22
Q

what does a megaloblastic red blood cell look like

A

larger than normal RC precursor with immature nucleus

23
Q

causes of megaloblastic

A

B12 deficiency
folate deficiency

24
Q

how does megaloblastic anaemia happen

A

DNA damage affects cells ability to divide
Hb production carries on as normal

25
Q

where do you get B12 and how long can you store it

A

animal products
stores for 2-4 years

26
Q

causes of B12 deficiency

A

low dietary intake
pernicious anaemia
gastrectomy and congenital def of intrinsic factor

27
Q

what is pernicious anaemia

A

autoimmune condition
causing destruction of gastric parietal cells
resulting in intrinsic factor deficiency with B12 malabsorption in the ileum

28
Q

why can pernicious anaemia patients appear mildly jaundiced

A

intramedullary haemolysis

29
Q

testing for pernicious anaemia

A

auto-antibodies
- intrinsic factor antibody (first line)
- gastric parietal cell antibody

30
Q

presentation of pernicious

A

peripheral neuropathy with numbness or paraesthesia
loss of vibration or proprioception
visual changes
mood or cognitive changes

31
Q

management of pernicious anaemia

A

1Mg hydroxocobalamin 3x a week then every 3 months

32
Q

what food contains folate and where is it absorbed

A

found in plant food and absorbed in jejunum

33
Q

causes of folate deficiency

A

diet (alcoholics)
malabsorption (coeliac, crohns)
excess utilisation- pregnancy, malignancy, exfoliating dermatitis, haemolysis
drugs (anticonvulsants)

34
Q

causes of non-megaloblastic macrocytosis

A

alcohol excess
liver disease
hypothyroidism (may not be associated with anaemia)
marrow failure (myelodysplasia, myeloma, anaplastic anaemia)

35
Q

indications for a blood transfusion

A

symptomatic anaemia where Hb <70

36
Q

examples of false macrocytosis

A

reticulocytosis in response to acute blood loss or red cell breakdown- reticulocytes are bigger than mature red cells
cold-agglutinins- cause RBCs to clump at temperatures lower than core body temp

Haematology (19 decks)

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