haem Flashcards
how do you monitor LMWH
anti-Xa assay
how does LMWH work
inactivated factor Xa
how do you monitor unfractionated heparin
APTT
Vitamin K antagonis
warfarin
how do you monitor warfarin
INR
how does dabigratan work
direct thrombin inhibior
monitoring for dabigatran?
none required
how does rivaroxaban work
block Xa
monitoring for rivaroxaban?
none needed
resistance to the natural anticoagulant protein C
factor V leiden
most common inherited thrombophilia
factor V leiden
deficiency of factor VIII
haemophilia A
deficiency of factor IX
Haemophilia B
christmas disease
in a single clotting factor deficiency (haemophlia), what increased
APTT increased
in a multiple clotting factor deficiency, what increases
PT and APTT
causes of multiple clotting factor deficiecny
Vit K deficieincy
Liver disease
Warfarin
DIC- sepsis, obstetric emergencies, malignancy, hypolvolaemic shock
most common inherited bleeding disorder
von willebrand factor deficiency
male with sternal pain, multiple lytic lesions, what invetsigation do you do>
protein electrophoresis
looking for bence jones protein as this is melanoma
bleeding into breast, has haemophilia B, what do you give?
factor 9 precipitate
what happens to calcium in myeloma
hypercalcaemia
dad has haemophilia and wife is pregnant with son, which test?
no test, as X linked so dad cant give it to boy as son receives Y from dad
on warfrain for heart valve, INR is 8 but he isnt bleeding, what do you do
5mg oral vit K
and stop warfarin
on warfarin , having a major bleed, what do you do
IV Vit K and prothrombin complex (or FFP)
and stop warfarin
on warfarin and INR >8 and minor bleeding, what do you do
stop warfarin
IV vit K 1-3mg
INR 5-8 and minor bleeding
what do you do
stop warfrain
Iv vit K 1-.3mg
INR 5-8 with no bleeding what do you do
withhold a couple of warfarin doses
at what INR can you restart warfarin
<5
target INR if AF
2.5
high MCV
macrocytic anaemia
low MCV
microcytic anaemia
how would you look at RBC morphology
blood film
what might cause a high retic count
haemolysis
bleeding
what can cause a normocytic anaemia
chronic diseasee
pregnancy
haemolysis
acute blood loss
what is microcytic anaemia
whennot enough Hb can be made due to lack or glob, lack of iron so small cells get produced with low Hb content
what causes microcytic anaemia
iron deficicney
thalasaemia
structure Hb variants
what kind of mutations do you get in thalassaemia
point mutations
normally autosomal recessive
what is macrocytic anaemia
red cells have a larger volume than nomral
what is a megaloblast
abnormally large nucleated red cell presurosr with an immature nucelus
(remember red cells dont have a nucleus!)
what happens in megaloblastic macrocytic anaemia
defects in DNA synthesis and nuclear maturation,
thinks it has enough Hb so doesnt divide to become smaller
what causes megaloblastic macrocytic anamia
B12 and folate deficiency
pernicious anaemia
what happens in pernicious anaemia
autoimmine destruction of gastric parietal cells so no intrinsic factor to absorb B12
need B12 injections for life
anti- intrinsic factor
anti- gastric parietal cell
pernicous anamia
causes of non megaloblastic anaemia
alcohol
hypothyroidism
liver disease
marrow failure
what can cause a false (spurious) macrocytosis
reticulocytosis
cold agglutinin disease
state of iron in haem
Fe2+
how to test for functional iron
Hb
test for transported iron
transferrin sat %
test for stored iron
ferritin
where is iron absorbed
duodenum
where is folate absorbed
jejunum
where is B12 absorbed
ileum
causes of iron deficiency?
not taking enough in- veggie/ vegna/ pregnant
losing blood- heavy periods, IBD, ulcer, NSAIDS, malignancy
not absorbing- coeliac, IBD
primary iron overload
haemochromatosis
secondary iron overload causes
many many blood transfusions
thalassaemia
sideroblastic anaemias
myelodysplasia
inheritance pattern for sickle cell
autosomal recessive
best test to confirm sickle cell ( HbS)
haemoglobin high performance liquids chromotography test
what is a sideroblast
when iron gets depositied in mitochondria and forms a ring around the nucleus
seen in siderblastic anaemia
most common inherited haemolytic anaemia
hereditary spherocytosis
autosomal dominant
sphere shaped RBC which gets destrpyed by spleen
how to test for hereditary spherecytosis
osmotic fragility test
what is haemolysis
premature red cell destruction
test to confirm haemolysis
coombs test
cold autoimmune haemolysis
IgM
warm autoimmune haemolysis
IgG
name some causes of haemolysis
autoimmune
burns, infection
sickle cell
G6PD deficiency
Heinz bodies
G6PD deficiency
pencil cells
iron deficiency
spherocyres
autoimmune haemolysis
herediatry spherocytosis
tear drops
megaloblastic anaemia
bone marrow fibrosis
fragments
mechanical destruction
seen in haemolysis
leucoertythroblastic blood film
bone marrow infiltration/ fibrosis
hypersegmented neutrophils
B12/folate def
reactive lymphocutes
EBV, glandyalr fever
target cells
liver dysfunction
iron deficiency
howell jolly bodies
hyposplenism
what is leukaemia
cancer of the white blood cells
most common childhood cancer
acute lymphoblastic leukaemia (ALL)
cancer of the lymphoid cells- B and T lineages affected
acute lymphoblastic leukaemia (ALL)
get proloferation of immature blast cells and tehy get released into the blood before they are mature
they are not as effective as the mature white blood cells leaving you more vulnerable for infection
high or low WCC in ALL
high (but its immature cells) (blasts)
auer rod
acute myeloid leukaemia (AML)
how can you tell the difference between acute myeloid and acute lymphoblastic leukaemia
take a bone marrow aspirate and do immunophenotyping
the most common leukaemia
often found incidentally
chronic lymphoblastic (CLL)
accumulation of mature B cells that have escaped cell death
chronic lymphoblastic (CLL)
skye high lymphocytes
chronic lymphoblastic (CLL)
smudge cells
chronic lymphoblatic (CLL)
proliferation of myeloid cells in bone marrow
chronic myeloid leukaemia (CML)
philadelphia chromosome (tyrosine kinase)
chronic myeloid leukaemia (CML)
high WCC, esp neutrophils!!
chronic myeloid leukaemia (CML)
how to you treat chronic myeloid leukaemia
tyrosine kinase inhibitor (imatinib)
what can cause enlarged lymph nodes
lymphoma infectyion connective tissue disease mets leukaemia
alcohol induced pain
hodgkins lymphoma
smooth rubber non tender lymph nodes
lymphoma
proliferation of lymphocytes which accumulate in lymph nodes
lymphoma
reed sternberg cells
mirror image nuclei
hodgkins lymphoma
plasma cell malignancy
myeloma
paraproetin protein produced
myeloma
pepper pot skull
myeloma
most common type of myeloma
IgG
signs of myeloma
lytic bone disease hypercalcaemia thrombocytopenia renal failure anaemia more infections
how to check for paraprotein
electrophoresis
bence jone protein
myeloma
rouleaux formation-stacked red cells
myeloma
deficiency of all blood cells
pancytopenia
what can cause pancytopenia
bone marrow failure ( decreased production)
hypersplenisim (increased destruction)
proliferation of RBC
PRV
increased blood viscosity
headache
itch (after hot bath)
fatigue
PRV
Jak 2 mutation
PRV
uncontrolled production of abnormal platelets
proliferation of megakaryocytes
essential thrombocythaemia
proliferation of fibroblasts
myelofibrosis
tear drop RBC
leucoerythroblastic appearance on film
myelofibrosis
