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Phase 2A > Full Blood Count Interpretation > Flashcards

Full Blood Count Interpretation Flashcards

1
Q

What do you use in the red cell count to classify anaemia?

A

Main method is by using the mean cell volume

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2
Q

If the reticulocyte count is raised in a patient with anaemia what is the likely cause?

A

blood loss

haemolytic anaemia

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3
Q

what is sideroblastic anaemia?

A

when the body has enough iron but is unable to use it to make haemoglobin

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4
Q

What does Hb show on a red cell count?

A

conc. of Hb within the blood.

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5
Q

What does MCV mean?

A

Mean cell volume of the red blood cells.

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6
Q

What is the reticulocyte count?

A

conc. of immature red blood cells

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7
Q

what is the haematocrit?

A

volume percentage of red blood cells in the blood

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8
Q

What is mean corpuscular haemoglobin

A

mean haemoglobin quantity within the blood cells - affects the colour of the cells.
Most normocytic and macrocytic anaemias are normochromic
Most microcytic anaemias are hypo chromic

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9
Q

If patient has anaemia and an abnormal WCC and platelets, what does this suggest?

A

Bone marrow cause is likely

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10
Q

Name three causes of Microcytic anaemia?

A 
SIT 
Sideroblastic
Iron deficiency
Thalassaemia
Chronic disease
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11
Q

Name three causes of normocytic anaemia

A 
Acute blood loss
Haemolytic anaemia 
Sickle cell 
Chronic disease
Hypothyroidism 
Bone marrow failure
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12
Q

Name two causes of megaloblastic macrocytic anaemia?

A

Decreased B12

Decreased Folate

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13
Q

Name 4 causes of non-megaloblastic macrocytic anaemia?

A

Alcohol
Reticulocytosis
Liver disease
Pregnancy

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14
Q

What tests could you do to find specific causes of anaemia?

A
  1. Haematinics : B12, folate, ferritin
  2. Iron studies
  3. TFTs
  4. Blood film +/- bone marrow biopsy
  5. Hb electrophoresis (if sickle cell or thalassaemia suspected)
  6. Billirubin (raised in haemolysis)
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15
Q

Causes of iron deficient anaemia

A
  1. Chronic blood loss
    - Menstrual bleeding
    - GI tract loss (malignancy, ulcers, varices
    - Urinary tract loss
  2. Increased demand
    - Pregnancy
    - Growth
  3. Decreased absorption
    - Coeliacs
    - gastrectomy
  4. Poor intake
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16
Q

Investigations for iron deficient anaemia if there is no clear cause?

A

Upper GI endoscopy + colonoscopy
Coeliac screen
Urine dipstick

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17
Q

Treatment for iron deficient anaemia

A

Treat the cause
Ferrous sulfate tablets
Transfusion if Hb < 70

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18
Q

What is a common side effect of ferrous sulphate tablets

A

Constipation

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19
Q

what is the physiology of B12

A

vitamin B12 is found in meat and dairy products. The stomach produces intrinsic factor which binds to B12, allowing it to be absorbed in the terminal ileum.

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20
Q

Causes of B12 deficient anaemia?

A

Pernicious anaemia

Malabsorption (e.g after gastrectomy or terminal ileum disease/resection)

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21
Q

Investigations for pernicious anaemia

A

parietal cell antibodies
intrinsic factor antibodies
Schilling’s test (purpose of the test is to determine how well the patient is able to absorb B12 from their intestinal tract.)

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22
Q

What is the treatment for B12 deficient anaemia?

A

treat the cause

hydroxocobalamin injections 3 monthly

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23
Q

Causes of folate deficient anaemia

A

Dietary (alcoholism, neglect)

Increased requirements (pregnancy, haematopoiesis)

Malabsorption (coeliacs, pancreatic insufficiency, gastrectomy, Crohn’s)

Drugs that interfere with metabolism (phenytoin, methotrexate, trimethoprim)

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24
Q

What is classically shown on a FBC of someone with anaemia of chronic disease?

A

Low iron
Low TIBC (total iron binding capacity)
normal ferritin

25
Q

Name three inherited causes of haemolytic anaemia

A
  1. Haemoglobinopathies
    - sickle cell
    - thalassaemia
  2. Membrane defects
    - hereditary spherocytosis, elliptocytosis
  3. Enzyme defects
    - G6PD deficiency, pyruvate kinase deficiency
26
Q

Name three acquired causes of haemolytic anaemia

A
  1. Immune mediated
    - autoimmune haemolytic anaemia
    - drug-induced haemolytic anaemia
  2. Non-immune
    - DIC
    - TTP
    - physical damage (heart valves, toxins e.g lead, malaria)
27
Q

Investigations to confirm haemolytic anaemia

A
  1. Increased Hb breakdown
    - increased unconjugated bilirubin
    - increased LDH
    - increased urinary urobilinogen (on urine dipstick)
  2. Increased Hb production
    - increased reticulocytes
  3. Intravascular haemolysis
    - decreased free haptoglobin
    - haemoglobinuria
28
Q

Investigations to find cause of haemolytic anaemia

A
  1. Blood film
    - sickle cells
    - schistocytes
    - inclusion bodies (malaria)
    - spherocytes/elliptocytes (hereditary spherocytosis/elliptocytosis)
    - Heinz bodies, bite / blister cells (G6PD)
    - prickle cells (pyruvate kinase deficiency)
  2. Coombs’ test
    - autoimmune haemolytic anaemia
  3. Hb electrophoresis
  4. Enzyme assays
29
Q

what is polycythaemia

A

increased concentration of red blood cells within the blood

30
Q

what are the causes of polycythaemia

A

Relative polycythaemia (i.e decreased plasma volume)

  • acute dehydration
  • chronic (obesity, HTN, alcohol excess, smoking associated)

Absolute (i.e increased RBC mass)

  • Primary : polycythaemia ruba vera
  • Secondary : due to increased EPO (renal cell carcinoma) or chronic hypoxia (COPD, high altitudes, congenital cyanotic heart disease)
31
Q

What mutation is associated with polycythaemia ruba vera?

A

JAK2 mutation

32
Q

what causes polycythaemia ruba vera

A

malignant proliferation of a clone derived from 1 pluripotent stem cell

33
Q

what is a complication of polycythaemia ruba vera

A

increased risk of thrombosis/bleeding

34
Q

what is the presentation of polycythaemia ruba vera

A

may be asymptomatic and picked up on routine blood count

May present with vague symptoms related to hyper viscosity e.g headache, dizziness, tinnitus, erythromelalgia)

35
Q

Investigations for polycythaemia

A
  1. WCC and platelets
    - both raised in primary absolute polycythaemia (polycythaemia ruba vera), but not in secondary absolute polycythaemia
  2. 51Cr Red Cell Mass study
    - normal red cell mass in relative polycythaemia
    - raised red cell mass in absolute polycythaemia
  3. EPO level
  4. If polycythaemia ruba vera suspected : bone marrow biopsy
36
Q

Treatment options for polycythaemia ruba vera

A

Venesection

Hydroxycarbamide (don’t take if pregnant or planning pregnancy)
Interferon

Aspirin daily to reduce blood clots

37
Q

Why may neutrophils be high?

A
  • Bacterial infection
  • Inflammation
  • Necrosis
  • Corticosteroids
  • Malignancy / myeloproliferative disorder
  • Stress (trauma, surgery, burns)
38
Q

Why may neutrophils be low?

A
  • Post-chemotherapy
  • Agranulocytosis causing drugs (carbamazepine, clozapine, colchicine, carjimazole)
  • viral infection
  • hypersplenism
  • bone marrow failure (e.g leukaemia)
39
Q

Why may lymphocytes be high?

A
  • Viral infection
  • chronic infections
  • CLL/lymphoma
40
Q

Why may lymphocytes be low?

A
  • viral infection
  • HIV
  • post-chemotherapy
  • bone marrow failure (e.g in leukaemia)
  • whole body radiation
41
Q

Why may monocytes be high?

A
  • bacterial infection
  • autoimmune disease
  • leukaemia/Hodgkin’s
42
Q

Why may monocyte count be low

A

acute infections
corticosteroids
leukaemia

43
Q

why may eosinophils be high?

A 
allergy (eczema) 
parasite infection
drug reaction
skin diseases 
malignancy e.g Hodgkin's
44
Q

Why may basophils be high?

A 
Some leukaemia/lymphomas
IgE mediated hypersensitivity 
Inflammatory disorders
Myeloproliferative disorders 
Viral infection
45
Q

on what is thrombocytopenia?

A

decreased platelets

46
Q

causes of thrombocytopenia (decreased production) ?

A

bone marrow failure
aplastic anaemia
megaloblastic anaemia
myelosuppresion

47
Q

what is aplastic anaemia

A

Aplastic anaemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets.

48
Q

what is megaloblastic anaemia

A

Megaloblastic anemia is a condition in which the bone marrow produces unusually large, structurally abnormal, immature red blood cells

49
Q

Causes of thrombocytopenia (increased destruction/consumption)

A

Non immune

  • DIC
  • TTP
  • HUS
  • sequestration in hypersplensim

Primary immune
- ITP

Secondary immune

  • SLE
  • CLL
  • viruses
  • drugs
  • alloimmune
50
Q

possible Ix for thrombocytopenia

A
  • Blood film +/- bone marrow biopsy
  • Infection screen (e.g HIV)
  • LFTs
  • LDH
  • Serum B12 and folate
  • Coagulation screen - fibrinogen and D-dimer
  • Acute phase reactants
51
Q

Treatment of thrombocytopenia

A

Treat the cause

  • immunosuppressants if autoimmune e.g prednisolone, azathioprine
  • plasmapheresis for TTP / HUS

Platelet concentrate transfusion

Splenectomy

52
Q

What is HUS?

A

Hemolytic–uremic syndrome (HUS) is a group of blood disorders characterized by low red blood cells, acute kidney failure, and low platelets

53
Q

What is thrombocythemia

A

increased platelets

54
Q

Causes of thrombocythemia

A

Primary : essential thrombocythemia

Secondary : bleeding, inflammation, infection, malignancy, post-splenectomy

55
Q

Investigations for thrombocythemia

A
  • Blood film +/- bone marrow biopsy
  • Acute phase reactants
  • JAK2 mutation
56
Q

Treatment of essential thrombocythemia

A

aspirin

hydroxycarbamide

57
Q

Presentation of essential thrombocythemia

A

bleeding
arterial and venous thrombosis
microvascular occlusion (headache, atypical chest pain, light-headedness)

58
Q

what happens to the urea in a GI bleed?

A

increased in upper GI bleeding

Phase 2A (11 decks)

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