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haem Flashcards

1
Q

what is in serum

A

glucose
electrolytes
protein

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2
Q

where is bone marrow

A

pelvis
vertebrae
ribs
sternum

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3
Q

where do blood cells develop

A

bone marrow

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4
Q

what does the pluripotent haematopoietic stem cell form

A

myeloid stem cell
lymphoid stem cell

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5
Q

what do megakaryocytes form

A

platelets

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6
Q

what does the myeloid stem cell form

A

->reticulocytes->RBC
->promyelocytes->monocytes->macrophages, neutrophils, eosinophils, mast cells, basophils

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7
Q

what do lymphoid stem cells form

A

-> B cell (plasma or memory)
-> T cell (CD4, CD8, NK)

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8
Q

lifespan RBC

A

3m

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9
Q

anisocytosis

A

variation size RBC
myelodysplasic syndrome

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10
Q

what are target cells found in

A

iron deficiency anaemia
post splenectomy

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11
Q

when are heinz bodies found

A

G6PD deficiency
alpha thalassaemia

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12
Q

heinz bodies

A

blob in RBC

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13
Q

howell jolly bodies

A

blobs DNA in RBC

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14
Q

when are howell jolly bodies found

A

post splenectomy
severe anaemia

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15
Q

reticulocytes

A

larger than RBC
mesh like

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16
Q

when are reticulocytes found

A

haemolytic anaemia

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17
Q

schistocytes

A

RBC fragments

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18
Q

when are schistocytes found

A

HUS
DIC
thrombotic thrombocytopenic purpura

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19
Q

sideroblasts

A

blobs iron in immature RBC

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20
Q

when are sideroblasts found

A

myelodysplasic syndrome

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21
Q

smudge clls

A

ruptured WBC (fragile)

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22
Q

when are smudge cells found

A

CLL

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23
Q

spherocytes

A

spherical RBC

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24
Q

when are spherocytes found

A

AI haemolytic anaemia
hereditary spherocytosis

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25
normal Hb
F: 120-165 M: 130-180
26
normal MCV
80-100
27
causes microcytic anaemia
thalassaemia chronic disease iron deficiency lead poisoning sideroblastic
28
causes normocytic anaemia
acute blood loss chronic disease aplastic haemolytic hypothyroid
29
causes macrocytic anaemia
megaloblastic: B12/folate deficeincy normoblastic: alcohol, reticulocytosis, hypothyroid, liver disease, azathoprine
30
sx anaemia
tired SOB headache dizzy palpitations pallor increased HR and RR
31
features iron deficiency anaemia
picca hair loss koilonychia angular chelitis atrophic glossitis brittle hair and nails
32
features haemolytic anaemia
jaundice
33
ix anaemia
Hb MCV B12 Folate ferritin blood film OGD colonoscopy BM biopsy
34
where is iron absorbed
duodenum and jejunum
35
transferrin saturation
= serum iron / total iron binding capacity
36
mx iron deficiency anaemua
if no cause: OGD and colonoscopy oral ferrous suphate, iron infusion, blood transfusion
37
SE oral ferrous sulphate
constipation black stool
38
cause pernicious anaemia
AI Ab against parietal cells/intrinsic factor therefore B12 not absorbed
39
sx pernicious anaemia
peripheral neuropathy - numbness, paraesthesia loss vibration sense visual change mood change
40
ix pernicious anaema
auto ab- intrinsic factor ab, gastric parietal cell ab
41
mx pernicious anaemia
1g IM hydroxycobalamin 3/wk for 2wk then every 3m
42
inherited causes haemolytic anaemia
hereditary spherocytosis hereditary elliptocytosis thalassaemia SC anaemia G6PD deficiency
43
acquired causes haemolytic anaemia
AI alloimmune paroxysmal nocturnal haemoglobinuria microangiopathic prosthetic valve related
44
features hereditary spherocytosis
AD jaundice gallstones splenomegaly and aplastic crisis with parvovirus increased MCHC and reticulocytes
45
mx hereditary spherocytosis
folate splenectomy
46
features hereditary elliptocytosis
AD jaundice gallstones splenomegaly and aplastic crisis with parvovirus increased MCHC and reticulocytes
47
mx hereditary elliptocytosis
folate splenectomy
48
inheritance G6PD deficiency
X linked recessive mediteranean/african
49
triggers of crises in G6PD defeicny
infection meds: primaquine, ciprofloxacin, sulfonylureas, sulfasalazine broad beans
50
sx G6PD deficiency
jaundice gallstones anaemia splenomegaly
51
types AI haemolytic anaemia
warm: at normal/above temp = idopathic cold (<10 degrees): agglutination = secondary to lymphoma, leukaemia, SLE, EBV, CMV, HIV
52
mx AI haemolytic anaemia
blood transfusion pred rituximab splenectomy
53
cause alloimmune haemolytic anaemia
transfusion rxn haemolytic disease newborb
54
cause paroxysmal nocturnal haemoglobinuria
gene mutation in life results in activation complement cascade
55
features paroxysmal nocturnal haemoglobinuria
red urine in morning risk VTE smooth muscle dystoniam
56
mx paoxysmal nocturnal haemoglobinuria
eculizimab BM transplant
57
cause microangiopathic haemolytic anaemia
vessel abnormality damages RBC secondary to HUS, DIC, TTP, SLE, cancer
58
cause prosthetic valve haemolysis
valve churns up RBC
59
mx prosthetic valve haemolyssi
oral iron transfusion revision surgery
60
inheritance thalassaemia
AR
61
features thalassaemia
microcytic anaemia fatigue pallor jaundice gallstones splenomegaly poor growth pronounced forehead and malar eminences
62
ix thalassaemia
FBC Hb electrophoresis DNA
63
why is there iron overload in thalassaemia
faulty RBC transfusions
64
features iron overload
fatigue liver cirrhosus impotence HF arrhythmia DM osteoporosis
65
mx iron overload
iron chelation
66
alpha thalassaemia mutation
chrom 16
67
mx alpha thalssaemia
transfusion splenectomy BM transplant
68
beta thalassaemia mutation
chrom 11
69
types beta thalassaemia
minor: 1 normal and 1 abnormal gene intermedia: 2 abnormal beta globin major: homozygous for deletion
70
mx intermediate beta thalassaemia
transfusion
71
mx major beta thalassaemia
regular transfusion BM transplant splenecomy
72
what is HbF replaced by
HbA at 6w
73
inheritance SC anaemia
AR abnormal gene for beta globin on chrom 11
74
SC trait genes
1 copy faultygene
75
complications SC disease
anaemia increased risk infection stroke avsascular necrosis pulmonary HTN priapism CKD SC crisis vaso-occlusive/painful crisis splenic sequestration crisis aplastic crisis acute chest syndrome
76
triggers SC crisis
infection dehydration cold
77
cause vaso-occlusive crisis SC
sickle cells block capillaries
78
features splenic sequestration crisis SC
severe anaemia hypovolaemic shock
79
mx splenic sequestration crisis SC
blood transfusion fluid
80
what happens in aplastic crisis SC
triggered by parvovirus B19 no new RBC made ->anaemia
81
causes acute chest syndrome SC
infective or non infective (vaso-occlusive, fat emboli)
82
features acute chest syndrome SC
fever resp sx new infiltrates on CXR
83
mx SC disease
avoid dehydration vaccinations abx prophylaxis - penicillin V hydroxycarbamide - increaes HbF blood transfusion BM transplant
84
what is leukaemia
cancer BM mutation results in overproliferation of 1 cell type
85
sx leukaemia
fatigue fever FTT pallor petechiae/bruising abnormal bleeding lymphadenopathy hepatosplenomegaly
86
ix leukaemia
FBC blood film increased LDH BM biopsy CT/MRI/CXR
87
associattions ALL
<5 or >45 down syndrome philadelphia chromosome
88
most common leukaemia adults
CLL
89
features CLL
warm haemolytic anaemia richters transformation to lymphoma smudge/smear cells
90
phases CML
chronic: asx - 5y accelerated blast
91
chromosome CML
philadelphia
92
what can cause AML
transformation from myeloproloiferative disorder
93
Blood film AML
auer rods
94
mx leukaemia
chemo steroids BM transplant
95
SE chemo
reduced growth infection neurotoxicity inferitlity seconadry maligancy cardiotoxixity tumour lysis syndrome (release uric acid ->AKI)
96
lymphoma
cancers of lymphocytes
97
RF hodgkins lymphoma
20y or 75y HIV EBV RA fhx
98
features hodgkins lymphoma
lymphadenopathy: rubbery, pain with alcohol B sx: fever, wt loss, night sweats
99
ix findings hodgkins lymphoma
increased LDH lymph node biopsy=reed sternburg ells
100
mx hodgkins lymphoma
chemo and radio
101
staging for lymphomas
ANN ARBOR 1. 1 region of lymph nodes 2. >/= 1 region same side of diaphragm 3. lymph nodes above and below diaphragm 4. non lymph organs e.g. lungs
102
e.g. non hodgkins lymphoma
burkitt MALT - mucosa associated lymphoid tissue diffuse large B cell
103
RF burkitt lymphoma
EBV malaria HIV
104
RF MALT lymphoma
H.pylori
105
features diffuse large B cell lymphoma
>65y painless
106
myeloma
cancer of plasma cells
107
sx myeloma
CRAB increased calcium renal failure anaemia bone lesions and pain
108
RF myeloma
age M african Fhx
109
ix myeloma
bloods: reduced WCC, increased Ca, increased ESR increased plasma viscocity urine elctrophoresis serum free light chain assay serum Ig serum protein electrophoresis BM biopsy XR CT/MRI/bone scan
110
finding urine electrophoresis myeloma
bence jones protein
111
XR findings myeloma
punched out lytic lesions pepperpot skull
112
mx myeloma
chemo stem cell transplant VTE mx bisphosphonates
113
what are myeloproliferative disorders
proliferation 1 stem cell
114
genes associated with myeloproliferative disorders
JAK2 MPL CACR
115
features myeloproliferative disorders
systemic sx anaemia splenomegaly portal HTN
116
ix myeloproliferative disorders
FBC blood film BM biopsy
117
what can myeloproliferative disorders lead to
myelofibrosis - therefore haematopoesis in liver and spleen istead
118
types myeloproliferative disorders
primary myelofibrosis polycythaemia rubra vera essential thromocytopenia
119
features primary myelofibrosis
haematopoetic stem cell anaemia teardrop RBC anisocytosis blasts
120
mx primary myelofibrosis
chemo allogenic stem cell transplant
121
Ix findings polycytheamiea rubra vera
erythroid cells increased Hb
122
mx polycythaemia rubra vera
venesection aspirin chemo
123
features essential thrombocytopenia
megakaryocyte increased plateleyts
124
mx essential thrombocytopenia
aspirin chemo
125
myelodysplastic syndrome
myeloid BM cells dont mature properly -> anaemia, neutropenia, thrombocytopenia
126
RF myelodysplastic syndrome
>60 prev chemo/radio
127
thrombocytopenia
low platelets
128
causes thrombocytopenia
production: sepsis, reduced B12/folate, liver failure, leukaemia, myelodysplastic syndrome destruction: meds (valproate, methotrexate, isotretinoin, antihistamines, PPI), alcohol, ITP, thrombottic thrombocytopenic purpura, herparin induced thrombocytopenia, HUS
129
what is ITP
Ab against platelets
130
mx ITP
pred IVIg rituximab splenectomy
131
what is thrombotic thrombocytopenix purpura
clots in small vessels
132
mx thrombotic thrombocytopenic purpura
plasma exchange steroids rituximab
133
features heparin induced thrombocytopenia
HIT Ab
134
how does thrombocytopenia present
bleeding bruising
135
cause von wilebrand diseae
AD inheritance defective VWF
136
types von willebrand disease
1-3 3 most sev
137
sx von willebrand disease
bleeding gums epistaxis menorrhagia fhx
138
mx von willebrand disease
desmopressin (stimulates VWF) factor VII/VWF infusion usually dont need daily mx, only whe surgery
139
inheritance haemophilia
X-linked recessive so males
140
types haemophilia
A: reduced VIII B: reduced: IX
141
sx haemophilia
bleeding-major haemorhage (intracranial, joints, muscles)
142
mx haemophilia
IV infusion factor VIII/IX desmopressin tranexamic acid
143
what do thrombophilias predispose patient to
blood clots
144
e.g. thrombophilias
antiphospholipid syndrome antithrombus deficiency protein C or S deficiency factor V leiden hyperhomocysteinaemia prothrombin gene variant
145
RF VTE
immobile surgery long haul flights pregnancy oestrogen HRT/COCP malignancy polycythaemia SLE thrombophilia
146
DVT sx
unilateral leg swelling (>3cm compared to the other side 10cm below tibial tuberisty) dilated superficial veins tender
147
VTE ix
wells score d-dimer doppler CTPA
148
mx VTE
LMWH (dalteparin) then warfarin or NOAC (apixaban, rivaroxaban)
149
ix unprovoked DVT
CXR FBC Ca LFTs urine dip CT abdo pelvis mammogram antiphospholipd Ab
150
budd chiari syndrome
clot in hepatic vein -> hepatitis
151
sx budd chiari syndrome
abdo pain hepatomegaly ascites
152
mx budd chiari syndrome
heparin/warfarin
153
pancytopenia
anaemia, thrombocytopenia, and leukopenia
154
agranulocytosis FBC
depleted levels of basophils and eosinophils
155
universal donors
In adults, group O red cells can be universally donated (due to lack of A or B antigens on their surface) and group AB plasma can be universally donated (due to lack of anti-A or anti-B antibodies)
156
vit k deficiency/warfarin use coag screen
PT/INR: increased APTT: increased bleeding time: norm platelet count: norm
157
haemophilia coag screen
PT/INR: norm APTT: increased bleeding time: norm platelet count:norm
158
von willebrands coag screen
PT/INR: norm APTT: norm/increased bleeding time: increased platelet count: norm
159
DIC coag screen
PT/INR: norm APTT: norm bleeding time: increased platelet count: decreased
160
ITP coag screen
PT/INR: norm APTT: norm bleeding time: increased platelet count: decreased
161
TTP coag screen
PT/INR: norm APTT: norm bleeding time: increased platelet count: decreased
162
HUS coag screen
PT/INR: norm APTT: norm bleeding time: increased platelet count: decreased
163
how do ITP, HUS and TTP differentiate on coag screen
THEY DONT PT/INR: norm APTT: norm bleeding time: increased platelet count: decreased
164
Common causes of acute leukocytosis
Reactive: infection, inflammation, post-surgery Steroids: stress response (i.e. endogenous steroids) or medication (i.e. exogenous steroids) Haematological: acute leukaemias
165
Common causes of chronic leukocytosis:
Reactive: chronic infection, smoking Haematological: leukaemia, certain subtypes of lymphoma Hyposplenism: typically mild Pregnancy
166
Common causes of leukopenia
Infection: can be seen as a transient phenomenon in viral illness or as a result of consumption in sepsis Medications: antibiotics, immunosuppressants, anti-epileptics, cytotoxic agents (e.g. chemotherapy) B12/folate deficiency Autoimmune disease Iron deficiency HIV (any cytopenia could be due to HIV) Racial variation: middle eastern and black patients can have lower baseline neutrophil counts which are not pathological Bone marrow failure: often this will be seen alongside low platelets and low haemoglobin
167
Causes of lymphocytosis include:
Viral infection Smoking Hyposplenism/post-splenectomy Malignancy: leukaemia and certain types of lymphoma Pertussis: rates are increasing in the U.K. with decreased vaccination rates
168
Causes of lymphopenia
infection Infection Older age (rarely clinically significant in this context) Alcohol excess HIV Autoimmune disease Bone marrow disease Medications: cytotoxic agents, immunosuppressants Renal failure Congenital immunodeficiency disorders (e.g. Wiskott-Aldrich syndrome)
169
Common causes of monocytosis
Bacterial infection Autoimmune disease Steroids
170
Causes of a very low monocyte count
Acute infection Steroids Bone marrow failure Cytotoxic agents (e.g. chemotherapy) Hairy cell leukaemia
171
Causes of eosinophilia
Allergies/atopy Parasitic infection Autoimmune disease (e.g. vasculitis) Medications (e.g. antibiotics, anti-epileptics, allopurinol) Gastrointestinal disease (e.g. eosinophilic oesophagitis) Respiratory disease (e.g. asthma) Malignancy (any solid organ or haematological)
172
Causes of basophilia
Allergic reactions/atopy Iron deficiency Chronic inflammation Hypothyroidism Infection Haematological malignancies (myeloproliferative disorders)
173
Causes of an elevated blast count
Acute leukaemia Myeloproliferative disorders Reactive (severe infection or treatment with G-CSF) Cytotoxic agents (chemotherapy)
174
Causes of acute thrombocytopenia
Consumption (e.g. infection, bleeding) Acute viral infection Medications (e.g. antibiotics, anti-epileptics, cytotoxic agents) Disseminated intravascular coagulation/microangiopathic haemolytic anaemia (e.g. TTP, HUS) Heparin-induced thrombocytopenia (HIT) Immune thrombocytopenic purpura (ITP) Pregnancy: pre-eclampsia/HELLP syndrome
175
Causes of chronic thrombocytopenia:
Hypersplenism Cirrhosis Alcohol excess Medications (e.g. anti-epileptics, cytotoxic agents) ITP Autoimmune disease B12/folate deficiency Iron deficiency HIV Hepatitis B/C Haematological disease Bone marrow failure
176
Causes of thrombocytosis
Reactive: inflammation/infection Myeloproliferative disorders: typically essential thrombocythaemia although any myeloproliferative disorder can elevate platelet counts Iron deficiency Hypospenlism/post-splenectomy Underlying malignancy: likely secondary to underlying inflammatory processes
177
indications poor prognosis in hodkins lymphoma
lymphopenia leukpcytosis rasied ESR raised LDH low alubmin == aggressive cancer
178
sx non haemolytic febrile transfusion rxn
shivering fever headache nausea flushing tachycardia 30-60m after start PATIENT IS HOT BUT WELL MOST COMMON RXN
179
cause non-haemolytic febrile transfusion rxn
alluimunised recipitant produces cytokines due to donor lukocytes/HCA antigens
180
mx non-haemolytic febrile transfusion rxn
slow transfusion monitor regularly paracetamol
181
what is acute haemolytic transfusion rxn also known as
ABO incompatability
182
cause acute haemolytic transfusion rxn
IgM mediated
183
sx acute haemolytic transfusion rxn
PATIENT IS SICK fever hypotension agitation flushing chest/abdo pain bleeding/DIC AKI within mins of starting
184
mx acute haemolytic transfusion rxn
STOP TRANSFUSION A-E supportive
185
features bacterial contaamination blood transfusion
fever hypotension rigors=septic shcok
186
features delayed haemolytic transfusion rxn
anaemia jaundice haemoglobinuria usually 4-8d after but up to 4w
187
mx bacterial contamination blood products
stop transfusion broad spectrum abx sepsis 6
188
mx delayed haemolytic transfusion rxn
ix monitor renal funt
189
features transfusion related acute lung injury
acute resp distress syndrome dyspnoea cough CXR=white out occurs <6h - usually 2h after start
190
mx transfusion related acute lung injury
stop transfusion oxygen supportive care - may need ICU
191
features transfusion associated circulatory overload
dyspnoea hypoxaemia tachycardia increased JVP basal creps
192
mx transfusion associated circulatory overload
stop transfusion treat as acute LVF: furosemide, oxygen
193
cause non anaphylactic allergic transfusion rxn
plasma protein incompatability
194
sx non anaphylactic allergic transfusion rxn
urticaria and itch
195
mx non anaphylactic allergic transfusion rxn
stop or slow transfusion depending on severity chlorpheniramine
196
sx anaphylactic transfusion rxn
bronchospasm cyanosis hypotension soft tissue swelling

finals (31 decks)

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