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Human diseases stage 3 > Haem > Flashcards

Haem Flashcards

1
Q

What cells are produced in the myeloid and lymphoid lines

A
  1. Myeloid= basophil, neutrophil, eosinophils, monocyte, macrophage, platelets erythrocytes, mast cells.
  2. Lymphoid = natural killers, T and B lymphocytes
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2
Q

What anaemia is angular stomatitis seen in

A

iron deficiency - microcytic hypochromic anaemia

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3
Q

What is the normal range of Hb for men and women

A

o 110-180g/L women
o 130-180g/L men

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4
Q

What is anaemia. causes

A

Low Hb due to decreased RBC mass. Due to blood loss, lack of red blood cell production, or high rates of red blood cell destruction.

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5
Q

Cause of microcytic hypochromic anaemia

A

-small and pale RBCs
-due to iron deficiency. Due to, diet deficiency, malabsorption, low vitamin C as this helps iron absorption, blood loss
-spooned nails is a symptom of iron deficiency

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6
Q

Cause of normocytic anaemia

A

-it is a chronic disease caused by chronic diseases such as kidney disease, rheumatoid arthritis, lupus, obesity., cancer, infection, vasculitis, heart failure
-acute blood loss

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7
Q

Cause of macrocytic anaemia. who are at risk

A

-Extenive lobulated neutrophils and large RBCs
-Low Hb, high MCV
-B12 or folate deficiency

-People at risk of these deficiencies are elderly, pregnant women, vegans and vegetarians, coeliac disease, abnormal terminal ileum, low gastric acid, alcoholism, liver disease, drugs (septrin, methotrexate)

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8
Q

Are neutrophils increased or decreases in viral or bacterial infections

A

-increased in bacterial, trauma, surgery
-decreased in viral

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9
Q

What is the magic number of platelets for dental surgical safety

A

100,000 per micro litre

<100 x 10^9 per litre avoid extraction
-if needed, refer to secondary care
<50 delay elective procedures

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10
Q

What does increased and decreased lymphocyte level indicate

A
  • Increase – viral infections, (if massively increased, something like chronic lymphatic leukaemia)
  • Decrease – steroid treatment, (if massively decreased, something like systemic lupus erythematous)
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11
Q

What is pernicious anaemia. What is decreased. What autoimmune disease associated with it

A

-a type of macrocytic anaemia
-malabsoprtion of B12 due to decreased intrinsic factor
-associated with thyroid, vitiligo, Addison’s, gastric surgery

[everyone with pernicious anaemia will have B12 deficiency, but not everyone with B12 deficiency has pernicious anaemia. (eg. Alcoholic)]

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12
Q

What is sickle cell anaemia

A

an inherited disease
More common in Africans
the hemoglobin is abnormal, which causes the RBCs to become hard and sticky and sickle shaped. The sickle cells die early, which causes a constant shortage of red blood cells
can lead to infarction

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13
Q

What are thalassaemias

A

group of disorders
common amongst Greeks
Decreased production of one or more Hb globin chains
-alpha thalassaemias = decreased a chain
-beta thalassamias = decreased b chain

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14
Q

Which anaemias do you need to take care with under sedation

A

For sickle cell anaemia and Thalassaemias – care with decreased oxygen tension – in particular IV sedation and GA – send to specialist seditionist in secondary care

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15
Q

Causes of thrombocytopenia. Name other platelet abnormality disease.

A

-thrombocytopoenia =reduced number.(<100,000)
- Caused by leukaemia, alcohol, HIV, Hep C, liver disease, abnormal bone marrow
-von willerbrand’s disease =low vWD factor so reduces clotting. Inherited
-thrombocytosis= too many. rare. secondary to other disease
-aspirin induced anti-platelet effects
-renal function induced (inhibits aggregation)

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16
Q

What are the vitamin K clotting factors. when these will be low

A

2,7,9,10
low if have liver problems as these are produced in the liver. Liver is important for clotting. Liver disease will also affect PT

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17
Q

If someone has bleeding gums but good OH, what could this be a sign of

A

-hamephilia, thrombocytopenia, von willerbrand’s disease, leukaemia, lymphoma (may present as neck Lump), chemotherapy

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18
Q

Causes of aplastic anaemia

A
  • body stops producing enough new blood cells
    -due to bone marrow failure, due to leukaemia, immune disorders, viral infection (hep, HHV4, HIV)
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19
Q

Name diseases that bone marrow failure can lead to

A

-Pancytopaenia -Hb, platelets, WBC etc. decreased. Increased infection.
-Myeloma- plasma cell neoplasm leading to marrow infiltration & osteolytic deposits
-aplastic anaemia
-leukaemia

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20
Q

Wha is erythrocyte sedimentation rate

A
  • Non-specific indicator of the presence of disease – (a cold can also raise this)
  • Measures the amount of time it takes an RBC to fall from the top of the tube to the bottom
  • If the ESR is increased – suggests there is a disease, some sort of organic problem
  • Age dependent: Men = age divided by 2, women age +10 divided by 2
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21
Q

What anaemia is smooth tongue and macroglossia seen in

A

-macrocytic anaemia, due to B12 or folate deficiency
-macroglossia may occur in B12 deficiency

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22
Q

Vitamin B12 and folate: food source, absorption, supply in body

A

-Folate= found in leafy veg, fruit and liver. Absorbed in small bowel. Only 4 month supply in body
-B12= animal protein. Absorbed terminal ileum. 2-6 year supply in body

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23
Q

Diagnosis and treatment of B12 and folate deficiency

A

Low RBC folate levels, low serum, B12 levels
Intrinsic factor antibodies
-oral folate replacement or lifelong injections of Vit B12 (3 MONTHLY)

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24
Q

What is petechiae. cause

A

-pinpoint non-blanching small red spots on the skin and mucous membranes. Seen on hard palate or bruises on legs
-due to reduced platelets, glandular fever, acute leukaemia, bone marrow failure syndromes (aplastic anaemia)
-before doing an invasive procedure (RCT, extraction, RSI) get a blood test first, then give replacement

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25
Q

Name a primary bone marrow disorder and its oral manifestations

A

acute leukaemia
gingival hyperplasia, lymphadenopathy, easy bruising and infection, skin rash

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26
Q

What do bisphosphonates do. Major oral side effect

A

-treat osteopenia or osteoporosis, conditions associated with thin or fragile bones that are at increased risk for fracture. The drugs prevent loss of bone density and slow down bone thinning
-also used for myeloma patients
-can cause osteonecrosis of the jaw - necrosis due to ishameia

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27
Q

which bisphosphonates are highly linked with MRONJ

A

Nitrogen-containing are worse: pamidronate and zoledronate

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28
Q

What to do with a patient on bisphosphantes when they require dental treatment

A

-avoid extraction where possible and do RCT required
-but can do low risk procedures: discuss risks and benefits and proceed. review healing at 8 weeks

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29
Q

What type of drug is zolendronic acid. how long it lingers in the body

A

bisphosphonate
lingers in bone for 3-6 months, so best to see dentists before starting this treatment

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30
Q

Symptoms of myeloma bone cancer. what anaemia it is associated with

A

-bone pain, infection, constipation, stomach upsets secondary to hypercalcameia, myeloma skull with bare punched holes on radiograph
-normochromic normocytic anamia

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31
Q

Symptoms of lymphoma

A

-cancer of the lymphatic system
-lymphomatous lesion (grows in nose then penetrates hard palate), parotid swelling, lymphadenopathy, fatigue, SOB, unexplained weight loss, itching

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32
Q

Difference between Non-hodgkin and Hodgkin lymphoma

A

-Hodgkin = Reed-Sternberg lymphocytes.
-tends to progress in a more predictable way making it easier to recognize and treat.
- Hodgkin lymphoma typically begins in the upper body, such as the neck, chest or armpits

-NHL more common
-Arises in lymph nodes anywhere in the body.

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33
Q

What is mucostitis. oral manifestations. common cause

A

-Inflammation of the mucosal surfaces throughout the body
-oral toxicity scale grades severity from 1-4
-Red sores on the mucosa and tongue.
-erythema, inflammation, ulceration, and hemorrhage in the mouth and throat. If severe, unable to swallow food
-Frequently seen post chemotherapy and radiotherapy
-Can get some relief with mouthwashes and anti-inflammatories

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34
Q

What drug is used to treat oral candidiasis and severe cases

A

Nystatin
Fluconazole for severe cases
Miconazole for fungal angular chelitis

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35
Q

What are the 4 blood components that can be transfused. Which are frozen

A

-RBCs
-Platelets
-Plasma (frozen)
-Cryoprecipitate (frozen)

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36
Q

When a RBC transfusion is given. What components are in the bag and what is added to improve shelf life

A

-RBCs, anticoagulant and clotting factors
-OAS solution to increase shelf life, of 5 weeks
-for those following a haemorrhage with Hb <70

37
Q

What is in platelet transfusion bag. when it is given. what is added to keep the platelets alive

A

-platelets, anticoagulants, additive sugar solution (keeps platelets alive), some plasma
-used for those with thrombocytopenia - low platelets <50 x109

38
Q

What is normal platelet count

A

150,000 to 450,000 platelets per microliter of blood.
<100 = thrombocytopenia

39
Q

When fresh frozen plasma is transfused. what is contained in the bag

A

-plasma, clotting factors, fibrinogen
-used in liver disease patients (high risk of bleeding) or after a major bleed

40
Q

When is cryoprecipitate transfused. What is in the bag

A
  • a portion of plasma (frozen and repeatedly thawed), full of concentrated clotting factors & fibrinogen
    -used for haemophilia A, von wilerbrand disease
41
Q

What is the universal donor blood type and recipient

A

-donor=O blood group
-recipient= AB

42
Q

What are the main causes of transfusion deaths

A

-wrong blood type given- human error (1/3 of cases)
-delays
-infection
-allergic reaction- fever, seizure, hives
-excess volume = circulatory overload= pulmonary oedema=acute respiratory stress

43
Q

What is alloimmunisation, 2 scenarios when it occurs

A

-a response by an individual’s immune system to foreign human antigens that most frequently occurs during pregnancy or blood transfusions.
-antibody against foreign antigen on RBC, as won’t be able to match with all antigens on RBCs. Next time if need a transfusion, cannot give same blood that expresses that antigen.
-Those child-bearing age, if develop antibody, if become pregnant in future, IgG antibody can cross placenta and cause hemolytic disease of fetus

44
Q

What is the process of homeostasis/ thrombosis. What is the difference between the 2

A

-stopping blood flow by vasoconstriction, platelet aggregation (plug) and coagulation:
1-Constriction reduces blood flow and pressure
2-Plug forms when collagen is exposed. Platelets adhere to collagen on endothelial surface by binding to vWF
3-Plug converted to clot when fibrin is made from fibrinogen in the blood clotting cascade. Fibrinolysis prevents occlusion of the vessel

-Haemostasis is a normal process for wound healing and to limit damage. However thrombosis is the unwanted formation of a thrombus (eg. in atherosclerosis) It occludes the arteries and can lead to a heart attack or pulmonary embolism.

45
Q

What are the intrinsic, extrinsic and common clotting factors. when the pathways are initiated

A

-Extrinsic pathway is initiated by damaged tissue. Factors 3 & 7.
-Intrinsic pathway initiated by exposed collagen. Factors 12, 11, 9.
-Common pathway includes factor 10. It converts prothrombin to thrombin (2). Thrombin converts fibrinogen to fibrin.
-Factor 13 cross links the fibrin
-Fibrin is the clotting agent which forms next to platelets to form the clot.

46
Q

What inhibits and aggregates platelets

A

-Induced by ADP, thromboxane A2, platelet activating factor
- Inhibited by Nitric oxide and prostacyclin
-serotonin increases vasoconstriction

47
Q

function of von willerbrands factor. what factor does it carry

A

-binds directly to collagen and forms a link between the damaged endothelium and platelets
-a main carrier of factor 8

48
Q

What is haemophilia

A

-inherited bleeding disorder where blood does not clot properly leading to spontaneous bleeding. Mutation in genes on X chromosome responsible for clotting factors
-males are affected, females are carriers

49
Q

Haemophilia A and B: which factor is deficient, which is more common, which is known as christmas disease,

A

A= 8 deficiency, more common
B= 9 deficiency, Christmas disease

50
Q

Treatment of haemophilia

A

-cryoprecipitate infusion
-gene therapy
-Factor 8/9 replacement for prophylaxis before surgery
-antifibrinolytic drugs- tranexamic acid

51
Q

Symptoms of haemophilia

A

-swelling of joints due to excessive bleeding, muscle wasting, fusion of joints, severe bleeding after minor trauma or spontaneous

52
Q

What is the normal concentration (%) of coagulation factor. what are the values for spontaneous bleeds and severe bleeding after minor trauma

A

normal = 25-50
<50 = bleeding after trauma
<25 = severe bleeding after surgery, bleeding after minor trauma
<5=severe bleeding after minor trauma
<1= spontaneous bleeding episodes

53
Q

what is vonwillebrand type I, II, and III

A

-Inherited. wide spectrum of severity. Bruising, mucosal bleeding (nose, GI), heavy bleeding after surgery
-Type I= mild deficiency in VWD
-Type II= normal level, but VWD not doing it job properly. Qualitative problem
-Type III= severe deficiency

54
Q

Name anti platelet drugs

A

aspirin, clopidogrel, dipyridamole

55
Q

what is the main indication for anticoagulant therapy

A

atrial fibrillation

56
Q

How heparin works. how is an overdose treated

A

-binds to antithrombin (III) which inactivates prothrombin (II) and clotting factors, so no clot forms.
-given IV or subcutaneous
-Overdose causes bleeding which is treated by heparin antagonist (protamine) to dissociate the heparin-antithrombin complex

57
Q

How warfarin works. how overdose is treated. why there is a lag period

A

-It is a vitamin K antagonist. It degrades clotting factors dependant on vitamin K as they cannot be carboxylated and activated. (2,7,9,10)
-Taken orally
-1 to 2 day lag period as highly plasma bound, so takes time to have full effect
-Overdose causes bleeding. Treated by taking vitamin K
- heparin used to cover the lag period as it is fast acting. It can then be withdrawn

58
Q

What is a normal INR. what we aim for in those taking warfarin

A

Normal <1.5
Warfarin we aim for 2-3
Too high= increased bleeding risk

59
Q

How dentists should approach patients who need surgery taking warfarin. how to minimise bleeding

A

-check they are not over coagulated by checking INR 72 hrs prior to surgery
-oral anticoagulants should not be discontinued, provided INR 2-4
-extractions, scaling are safe without altering.
-Limit extraction to 3-4 a visit, assessing extent of bleeding after the first before continuing.
-minimise bleeding using suture, tranexamic acid mouthwash 4x daily for 2 days, oxidised cellulose (surgicel) or collagen sponges
-don’t prescribe NSAIDs as anti-platelet

60
Q

What factor does rivaroxban, apixaban and edoxaban inhibit (new oral anticoagulants)

A

factor Xa

61
Q

What clotting factor does dibigatran inhibit (a new oral anti-coagulant)

A

thrombin (factor IIa)

62
Q

Do intrinsic or extrinsic factor defects prolong the APTT or PT. Name examples of diseases

A

-extrinsic= prolonged PT. Liver disease, use of warfarin, alcoholism, activated in tooth extraction
-intrinsic and common= prolonged APTT. Haemophilia, use of heparin

63
Q

name a congenital and acquired vascular bleeding disorder

A

-ehlers danlos: inherited, collagen not produced properly, prone to bruising, hyper mobility, increased jaw dislocation, no clinically relevant bleeding changes
-scurvy

64
Q

presentations of platelet (vWB disorder, thrombocytopenia) and coagulation disorders (haemophilia) Which is associated with purpura, which with ecchymosis

A

-Epistaxis (nose bleed)
-mennorhagia (heavy periods)
-haematemesis (coughing up blood)
-melaena (blood in stool)

-purpura (big superficial bruises seen in platelet disorders)
-ecchymosis (large spreading bruising at a deeper level seen in coagulation disorders)

65
Q

what blood disorder can chronic kidney failure present with

A

-impaired platelet function. long-term dialysis can cause bone marrow fibrosis, causing thrombocytopenia
-normocytic anaemia. Kidney is involved in making erythropoietin

66
Q

what is thrombophillia

A

-more likely to clot
-factor 5, antithrombin III deficiency
-on anti-coagulants so increased bleeding risk. GA may induce DVT due to being motionless

67
Q

Name anticoagulants

A

warfarin, heparin, tinzaparin, enoxaparin, dabigatran, rivaroxaban, apixaban, edoxaban

68
Q

What does methotrexate treat. what is it co-prescibed with. what antibiotic should you never give with it

A

myelosupressive drug used to suppress the bone marrow. inhibits formation of DNA. co-prescribed with folic acid to dampen its effects
-never give penicillins

69
Q

What are the small, medium and large spontaneous bleeds. what bleeds/bruising are seen in elderly

A
  • Petechiae purpura = small (1-3 mm) Don’t disappear on pressure. Disappear after 3-4 days. Signify abnormal capillary fragility. Can occur on palate
  • Purpura=medium (3mm-1cm) Pools of blood in epidermis.
  • Ecchymoses =large, Bleeding into subcutaneous tissues, causes bruising. usually due to trauma
  • Senile purpura =if in elderly (old people getting bruises) 2cm in diameter, dark red, takes weeks to fade
70
Q

Causes of purpura

A

Vasculitis, infection, deficiency, allergy, connective tissue disease, ageing, heredity haemorrhage telangiectasia, thrombocytopenia, Ehlers danlos

71
Q

Causes off thrombocytopenia

A

-Impaired platelet production due to bone marrow failure - leukaemia, aplastic anaemia, myeloma.
-Reduced megakaryocytes, so reduced platelets due to alcohol or co-trimoxazole
-excessive platelet destruction due to autoimmune problems, HIV, Hep C, liver disease
-removal of platelets in spleen
-dilutional loss of platelets following massive transfusions

72
Q

What is Telangiectasia

A

-a vascular abnormality. spider nevi
-early sign of liver disease
-disappear on pressure then refill

73
Q

What is Haemangioma

A

-a vascular abnormality. strawberry birth mark

74
Q

Features of liver disease

A

-spider nevi
-increase PT
-petichiae purpura
-portal venous hypertension - vomitting blood, ascites (abdominal swelling)
-jaundice due to high bilirubin due to blocked bile duct
-dupuytrens
-steatorhorrea - pale poo as no bilirubin getting into GI tract to darken it
-sialosis: swelling of salivary glands
-encephalitis (build up of toxins)
-flapping tremor

75
Q

Explain the main functions of the liver

A
  1. Synthetic function: clotting factors, bilirubin excretion, makes albumin
  2. Metabolic function: metabolising drugs
76
Q

Bilirubin production in body

A

-RBC breakdown to form unconjugated (fat soluble) bilirubin. Liver converts it into conjugated bilirubin so it is water soluble
-Bilirubin excreted into bile by liver

77
Q

List pre hepatic, hepatic and post hepatic causes of hepatitis

A

-pre: increased RBC turnover
-heptatic: hepatitis, paracetamol overdose, alcohol, heart attack, thrombos
-post: blocked hepatic duct

78
Q

What is ascites and what it is a sign of

A

excessive fluid in abdominal cavity due to imbalanced oncotic pressure. due to portal venous hypertension in liver disease

79
Q

What liver function test will show for liver disease

A

-raised AST and ALT (if AST>ALT then alcohol cause), AP, bilirubin
-raised gamma GT in alcoholic liver disease
-decreased albumin, coagulation factors

80
Q

What LA should be used in liver disease patients

A

-esters, as metabolised in blood
-or limit to 2 cartridges of:
-prilocaine as metabolised in lungs
-articiane as partly metabolised in blood

81
Q

Local measures for excess bleeding after extraction.

A

-ABCDE
-apply pressure with gauze
-more LA for vasonconstriction (lasts 1-2 hours)
-ensure airways clear -plenty aspiration
-aspirate out the unstable clot
-suture
-pac with dressings
-fibrin glue
-tranexamic acid
-chemical or electrical burning

82
Q

Resorptive and non-resorptive dressings to help with bleeding. how they work and name examples.

A

1-Resorptive dressing: creates a matrix to increase surface area for platelets to bind to. Reduced pH to reduce bacteria
 Oxidised cellulose (surgicel) – synthetic so can be used on anyone
 Gelatin eg Gelfoam (porcine product – for non-vegetarian)
 Haemostatic collagen eg Collaplug (bovine product)
2-Non-resorptive dressing (for bone)
 Bone wax – good if bleeding from certain part of bone (carbamide wax) – press it down with damp gauze (damp as a dry one would pull the clot away)

83
Q

What can be used to chemically and electrically burning if excess bleeding

A

-Chemical – silver nitrate sticks
-Electrical – Bipolar (forceps applied to either side of the lesion and a current passes through the forceps and out of the patient), or monopolar (gingival cautering machine goes through the patient, pad put behind the patients shoulder. More invasive. Cannot be used for those with pacemakers)

84
Q

What to give if INR or PT increase

A

vitamin K 10mg IV or PO

85
Q

What pain killers to give for managing coagulopathies

A

paracetamol, codeine
never NSAIDs as anti-platelet

86
Q

ANAEMIA COMMON IN THE ELDERLY REQUIRING AUTOLOGOUS HAEMOPOIETIC STEM CELL TRANSPLANTATION?

A

MYELODYSPLASIA

87
Q

What is haemolytic anaemia. Causes. Symptoms. What type of hypersensitivity the autoimmune disease is

A

-reduced RBCs
-SOB, tired, palpitations, headache, pale

-autoimmune destruction of RBCS (type II sensitivity)
-bone marrow failure
-viral infection, immunodeficiency, rheumatoid arthritis, UC,

88
Q

What is seen in alcoholics due to increased portal pressure

A

HAEMOATEMESIS (vomitting of blood)
SPLENOMEGALY
THROMBOCYTOPOENIA

Human diseases stage 3 (9 decks)

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