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Haem Flashcards

1
Q

Mnemonic for macrocytosis?

A

FAT RBC

Fetus 
Alcohol
Thyroid (hypo)
Reticulocytosis
B12/Folate 
Cirrhosis
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2
Q

Cells that have granules of iron accumulated in the mitochondria surrounding the nucleus

A

Sideroblasts - they can be called ring sideroblasts if the mitochondria form a ring around the nucleus.

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3
Q

Perls’ Prussian blue stain turns blueish purple. What does it indicate the presence of?

A

Iron

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4
Q

How can the causes of sideroblastic anaemia be categorised?

A

Congenital
Acquired
Acquired reversible

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5
Q

What are causes of acquired reversible sideroblastic anaemia?

A

Excess alcohol
Pyidoxine (B6) deficiency
Lead poisoning
Copper deficiency

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6
Q

How can you treat sideroblastic anaemia?

A 
Remove the cause
Consider Pyridoxine (B6) to promote RBC production
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7
Q

What is the general mechanism in Anaemia of chronic disease?

A

IL-6 production

  • -> promote hepcidin production by liver
  • -> reduces ferroportin activity
  • -> reduces transfer of iron to circulation
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8
Q

What are the Iron, TIBC and Ferritin levels like in Anaemia of Chronic Disease?

A

Iron: Low
TIBC: Low
Ferritin: High

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9
Q

What is the most common antibody involved with warm autoimmune haemolytic anaemia?

A

IgG

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10
Q

What type of antibody is usually involved in cold autoimmune haemolytic anaemia?

A

IgM

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11
Q

Is it the indirect or direct Coombs test that is used when testing for autoimmune haemolytic anaemia?

A

direct

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12
Q

Is it the indirect or direct Coombs test that is used when testing blood for transfusion?

A

indirect

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13
Q

Basic steps in a direct Coombs test?

A
  • patient blood sample
  • wash it
  • add Coombs reagent (antihuman antibodies)
  • agglutination = positive result
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14
Q

Basic steps in an indirect Coombs test?

A
  • recipient serum
  • add donor blood
  • add Coombs reagent (antihuman antibodies)
  • agglutination = positive
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15
Q

What is the inheritance pattern of beta-thalassaemia?

A

autosomal recessive

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16
Q

What impact does beta-thalassaemia have on chain synthesis and haemoglobin types?

A

Reduced beta-chain synthesis, excess alpha-chains.

Under production of haemoglobin A

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17
Q

What is the chain composition of haemoglobin A?

A

two alpha

two beta

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18
Q

What is the chain composition of haemoglobin A2?

A

two alpha

two delta

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19
Q

What is the chain composition of haemoglobin F?

A

two alpha

two gamma

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20
Q 
dysphagia
iron deficiency anaemia 
cheilosis
glossitis
oesophageal webs
A

Plummer-Vinson syndrome

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21
Q

Role of ferritin in the body?

A

store/deposit iron in a safe form (i.e. in cells away from invading pathogens)

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22
Q

Low iron
High TIBC
Low ferritin

A

Iron deficiency

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23
Q

Low iron
Low TIBC
High ferritin

A

Anaemia of chronic disease

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24
Q

High iron
Low TIBC
High ferritin

A

Chronic haemolysis

Haemachromatosis (could also have normal TIBC)

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25
Q

High iron
High TIBC
Normal ferritin

A

Pregnancy

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26
Q

High iron
Normal TIBC
High ferritin

A

Sideroblastic anaemia

Haemachromatosis

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27
Q

Causes ofa macrocytic megaloblastic anaemia?

A

B12 or folate deficiency

cytotoxic drugs

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28
Q

A type of anaemia due to an inhibition of DNA synthesis during red blood cell production

A

Megaloblastic anaemia (the folate/B12 is needed for the nucleic acid recycling)

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29
Q

Large immature red blood cells
Howell-jolly bodies
hypersegmented polymorphs

A

Megaloblastic anaemia

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30
Q

spectrin or ankyrin defects

A

Hereditary spherocytosis

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31
Q

just spectrin defect

A

Hereditary elliptocytosis

32
Q

Sickle cell patient with parvovirus B19

A

Aplastic crisis

33
Q

E. Coli
impaired renal function
diarrhoea
thrombocytopenia

A

Haemolytic uraemic syndrome

34
Q

ADAMTS13

A

enzyme for cleaving vWF

35
Q

Pathogenesis of TTP?

A
  • enzyme (ADAMTS13) that cleaves vWF is inhibited
  • more vWF
  • more platelet clotting
  • RBCs pass through clots, undergo shear stress –> rupture –> anaemia and schistocyte formation
36
Q 
Anaemia 
Jaundice 
Thrombocytopenia
Schistocytes
Neurological symptoms
Renal impairment
Fever
A

Thrombotic Thrombocytopenic Purpura

37
Q

What releases factor VIII from vWF

A

thrombin

38
Q

gpIb/IX/V

A

on platelets, vWF binds to these

39
Q

What does vWF bind to on the blood vessel?

A

exposed collagen in the endothelial cells

40
Q

Condition with defective/low levels of GpIIb/IIIa?

A

(Glanzmann’s) thrombasthenia

41
Q

gpIIb/IIIa

A

on platelets, form crosslinks between platelets and binds fibrinogen

42
Q

What do platelets secrete once activated?

A

ADP
TXA2

increase gpIIb/IIIa expression on platelets

43
Q

Thrombocytopenia
Bruises and petechiae
Normal bone marrow
No iatrogenic cause

A

Auto-immune thrombocytopenic purpura

44
Q 
Long aPTT
Long Thrombin time 
Long bleeding time
Low platelets
Increased D-dimer
A

DIC

45
Q

Anaemia
Pancytopenia
t(15;17)

A

Acute promyelocytic leukaemia

46
Q

Anaemia
Pancytopenia
Myeloperoxidase and Sudan black stain positive

A

AML

47
Q

Anaemia
Pancytopenia
Myeloperoxidase and Sudan black stain negative

A

ALL

48
Q

t(9;22)
less than 5% blasts
What’s the diagnosis and treatment?

A

CML - chronic phase

Treatment = Tyrosine Kinase inhibitor, e.g. imatinib

49
Q

t(9;22)
greater than 20% blasts
What’s the diagnosis and treatment?

A

CML - Blast phase
Treatment =
- Tyrosine Kinase inhibitor, e.g. imatinib
- induction chemo (as for AML like cytarabine plus a ‘rubicin’)
- all-SCT

50
Q

t(9;22)
between 10 and 20% blasts
What’s the diagnosis and treatment?

A

CML - accelerated phase
Treatment=
- Tyrosine Kinase inhibitor, e.g. imatinib
- consider allo-SCT plus induction chemo like cytarabine with a ‘rubicin’

51
Q

Old person
Lymphocytosis
Smear cells
Flow cytometry demonstrating coexpression of CD5 and CD19

A

CLL

52
Q

Binet staging

A

CLL

53
Q

CD30 positivity

A

Anaplastic large-cell lymphoma

54
Q

t(2;5)

A

Anaplastic large-cell lymphoma

55
Q

HTLV-1 infection

A

Adult T cell leukaemia

56
Q

Lymphoma associated with mycosis fungoides

A

Cutaneous T Cell lymphoma

57
Q

Myelodysplastic syndrome:

Blood:Anaemia
No blasts
BM: Erythroid dysplasia with less than 5% blasts

A

Refractory anaemia

58
Q

Myelodysplastic syndrome:

Blood: Anaemia
No blasts
BM: Erythroid dysplasia with greater than 15% ringed sideroblasts

A

Refractory anaemia with ringed sideroblasts

59
Q

Myelodysplastic syndrome:

Blood: Cytopenia in more than/equal to 2 cell lines
BM: Dysplasia in more than 10% cells in/greater than 2 cell lines

A

Refractory cytopenia with multilineage dysplasia

60
Q

Myelodysplastic syndrome:

Blood: Cytopenia in more than/equal to 2 cell lines

BM: Dysplasia in more than 10% cells in/greater than 2 cell lines with ringed sideroblasts

A

Refractory cytopaenia with multilineage dysplasia and ringed sideroblasts

61
Q

Myelodysplastic syndrome:

Blood: Cytopenia
Less than 5% blasts
No Auer rods
BM: Dysplasia and 5-9% blasts

A

Refractory anaemia with excess blasts - 1

62
Q

Myelodysplastic syndrome:

Blood: Cytopenia or 5-19% blasts or Auer rods
BM: Dysplasias, 10-19% blasts or Auer rods

A

Refractory anaemia with excess blasts - II

63
Q

Myelodysplastic syndrome:

Blood: Anaemia, normal or increased platelets
BM: Megakaryocytes with hypolobated nuclei and

A

MDS with 5q syndrome

64
Q

Myeloproliferative disorder which is Philadelphia chromosome negative

A

Polycythemia vera
Myelofibrosis
Essential thrombocytosis

65
Q 
Blurred vision
headaches
Plethoric - congested with blood 
Gout
Splenomegaly
Raised Hb and HCT
Low EPO
A

Polycythaemia rubra vera

66
Q

Treatment of polycythaemia rubra vera?

A

Venesection
Hydroxycarbamide
Aspirin

67
Q

JAK2 mutation
raised Hb and HCT
Low EPO

A

Polycythaemia rubra vera

68
Q

Megakaryocytes dominate the BM
maybe associated with JAK2
Thrombosis

A

Essential thrombocythaemia

69
Q

Tear drop poikilocytes
Leukoerythroblasts
Bm fibrosis

A

Myelofibrosis

70
Q

Transfusion:

Urticaria

A

Mild allergic reaction

71
Q

Transfusion:

Mild fever only

A

Febrile non-haemolytic transfusion reaction

72
Q

Transfusion:

Bleeding
Dark urine

A

ABO incompatibility

73
Q

Transfusion:

Swelling
Wheeze

A

Severe allergic reaction

74
Q

Transfusion:

high fever
tachycardia

A

Bacterial infection

75
Q

Transfusion:

Fever
Breathless
normal CVP

A

TRALI

76
Q

Transfusion:

Fever
Breathless
Raised CVP

A

TACO/fluid overload

77
Q

Transfusion

leukocyte antibodies in transfused plasma

A

TRALI

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