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year 4 onlines miscellaneous > haem > Flashcards

haem Flashcards

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1
Q

how do you monitor LMWH

A

anti-Xa assay

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2
Q

how does LMWH work

A

inactivated factor Xa

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3
Q

how do you monitor unfractionated heparin

A

APTT

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4
Q

Vitamin K antagonis

A

warfarin

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5
Q

how do you monitor warfarin

A

INR

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6
Q

how does dabigratan work

A

direct thrombin inhibior

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7
Q

monitoring for dabigatran?

A

none required

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8
Q

how does rivaroxaban work

A

block Xa

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9
Q

monitoring for rivaroxaban?

A

none needed

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10
Q

resistance to the natural anticoagulant protein C

A

factor V leiden

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11
Q

most common inherited thrombophilia

A

factor V leiden

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12
Q

deficiency of factor VIII

A

haemophilia A

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13
Q

deficiency of factor IX

A

Haemophilia B

christmas disease

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14
Q

in a single clotting factor deficiency (haemophlia), what increased

A

APTT increased

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15
Q

in a multiple clotting factor deficiency, what increases

A

PT and APTT

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16
Q

causes of multiple clotting factor deficiecny

A

Vit K deficieincy
Liver disease
Warfarin
DIC- sepsis, obstetric emergencies, malignancy, hypolvolaemic shock

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17
Q

most common inherited bleeding disorder

A

von willebrand factor deficiency

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18
Q

male with sternal pain, multiple lytic lesions, what invetsigation do you do>

A

protein electrophoresis

looking for bence jones protein as this is melanoma

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19
Q

bleeding into breast, has haemophilia B, what do you give?

A

factor 9 precipitate

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20
Q

what happens to calcium in myeloma

A

hypercalcaemia

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21
Q

dad has haemophilia and wife is pregnant with son, which test?

A

no test, as X linked so dad cant give it to boy as son receives Y from dad

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22
Q

on warfrain for heart valve, INR is 8 but he isnt bleeding, what do you do

A

5mg oral vit K

and stop warfarin

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23
Q

on warfarin , having a major bleed, what do you do

A

IV Vit K and prothrombin complex (or FFP)

and stop warfarin

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24
Q

on warfarin and INR >8 and minor bleeding, what do you do

A

stop warfarin

IV vit K 1-3mg

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25
Q

INR 5-8 and minor bleeding

what do you do

A

stop warfrain

Iv vit K 1-.3mg

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26
Q

INR 5-8 with no bleeding what do you do

A

withhold a couple of warfarin doses

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27
Q

at what INR can you restart warfarin

A

<5

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28
Q

target INR if AF

A

2.5

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29
Q

high MCV

A

macrocytic anaemia

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30
Q

low MCV

A

microcytic anaemia

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31
Q

how would you look at RBC morphology

A

blood film

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32
Q

what might cause a high retic count

A

haemolysis

bleeding

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33
Q

what can cause a normocytic anaemia

A

chronic diseasee
pregnancy
haemolysis
acute blood loss

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34
Q

what is microcytic anaemia

A

whennot enough Hb can be made due to lack or glob, lack of iron so small cells get produced with low Hb content

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35
Q

what causes microcytic anaemia

A

iron deficicney
thalasaemia
structure Hb variants

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36
Q

what kind of mutations do you get in thalassaemia

A

point mutations

normally autosomal recessive

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37
Q

what is macrocytic anaemia

A

red cells have a larger volume than nomral

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38
Q

what is a megaloblast

A

abnormally large nucleated red cell presurosr with an immature nucelus

(remember red cells dont have a nucleus!)

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39
Q

what happens in megaloblastic macrocytic anaemia

A

defects in DNA synthesis and nuclear maturation,

thinks it has enough Hb so doesnt divide to become smaller

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40
Q

what causes megaloblastic macrocytic anamia

A

B12 and folate deficiency

pernicious anaemia

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41
Q

what happens in pernicious anaemia

A

autoimmine destruction of gastric parietal cells so no intrinsic factor to absorb B12

need B12 injections for life

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42
Q

anti- intrinsic factor

anti- gastric parietal cell

A

pernicous anamia

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43
Q

causes of non megaloblastic anaemia

A

alcohol
hypothyroidism
liver disease
marrow failure

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44
Q

what can cause a false (spurious) macrocytosis

A

reticulocytosis

cold agglutinin disease

45
Q

state of iron in haem

A

Fe2+

46
Q

how to test for functional iron

A

Hb

47
Q

test for transported iron

A

transferrin sat %

48
Q

test for stored iron

A

ferritin

49
Q

where is iron absorbed

A

duodenum

50
Q

where is folate absorbed

A

jejunum

51
Q

where is B12 absorbed

A

ileum

52
Q

causes of iron deficiency?

A

not taking enough in- veggie/ vegna/ pregnant

losing blood- heavy periods, IBD, ulcer, NSAIDS, malignancy

not absorbing- coeliac, IBD

53
Q

primary iron overload

A

haemochromatosis

54
Q

secondary iron overload causes

A

many many blood transfusions
thalassaemia
sideroblastic anaemias
myelodysplasia

55
Q

inheritance pattern for sickle cell

A

autosomal recessive

56
Q

best test to confirm sickle cell ( HbS)

A

haemoglobin high performance liquids chromotography test

57
Q

what is a sideroblast

A

when iron gets depositied in mitochondria and forms a ring around the nucleus

seen in siderblastic anaemia

58
Q

most common inherited haemolytic anaemia

A

hereditary spherocytosis

autosomal dominant

sphere shaped RBC which gets destrpyed by spleen

59
Q

how to test for hereditary spherecytosis

A

osmotic fragility test

60
Q

what is haemolysis

A

premature red cell destruction

61
Q

test to confirm haemolysis

A

coombs test

62
Q

cold autoimmune haemolysis

A

IgM

63
Q

warm autoimmune haemolysis

A

IgG

64
Q

name some causes of haemolysis

A

autoimmune
burns, infection
sickle cell
G6PD deficiency

65
Q

Heinz bodies

A

G6PD deficiency

66
Q

pencil cells

A

iron deficiency

67
Q

spherocyres

A

autoimmune haemolysis

herediatry spherocytosis

68
Q

tear drops

A

megaloblastic anaemia

bone marrow fibrosis

69
Q

fragments

A

mechanical destruction

seen in haemolysis

70
Q

leucoertythroblastic blood film

A

bone marrow infiltration/ fibrosis

71
Q

hypersegmented neutrophils

A

B12/folate def

72
Q

reactive lymphocutes

A

EBV, glandyalr fever

73
Q

target cells

A

liver dysfunction

iron deficiency

74
Q

howell jolly bodies

A

hyposplenism

75
Q

what is leukaemia

A

cancer of the white blood cells

76
Q

most common childhood cancer

A

acute lymphoblastic leukaemia (ALL)

77
Q

cancer of the lymphoid cells- B and T lineages affected

A

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

78
Q

high or low WCC in ALL

A

high (but its immature cells) (blasts)

79
Q

auer rod

A

acute myeloid leukaemia (AML)

80
Q

how can you tell the difference between acute myeloid and acute lymphoblastic leukaemia

A

take a bone marrow aspirate and do immunophenotyping

81
Q

the most common leukaemia

often found incidentally

A

chronic lymphoblastic (CLL)

82
Q

accumulation of mature B cells that have escaped cell death

A

chronic lymphoblastic (CLL)

83
Q

skye high lymphocytes

A

chronic lymphoblastic (CLL)

84
Q

smudge cells

A

chronic lymphoblatic (CLL)

85
Q

proliferation of myeloid cells in bone marrow

A

chronic myeloid leukaemia (CML)

86
Q

philadelphia chromosome (tyrosine kinase)

A

chronic myeloid leukaemia (CML)

87
Q

high WCC, esp neutrophils!!

A

chronic myeloid leukaemia (CML)

88
Q

how to you treat chronic myeloid leukaemia

A

tyrosine kinase inhibitor (imatinib)

89
Q

what can cause enlarged lymph nodes

A 
lymphoma
infectyion
connective tissue disease
mets
leukaemia
90
Q

alcohol induced pain

A

hodgkins lymphoma

91
Q

smooth rubber non tender lymph nodes

A

lymphoma

92
Q

proliferation of lymphocytes which accumulate in lymph nodes

A

lymphoma

93
Q

reed sternberg cells

mirror image nuclei

A

hodgkins lymphoma

94
Q

plasma cell malignancy

A

myeloma

95
Q

paraproetin protein produced

A

myeloma

96
Q

pepper pot skull

A

myeloma

97
Q

most common type of myeloma

A

IgG

98
Q

signs of myeloma

A 
lytic bone disease
hypercalcaemia
thrombocytopenia
renal failure
anaemia
more infections
99
Q

how to check for paraprotein

A

electrophoresis

100
Q

bence jone protein

A

myeloma

101
Q

rouleaux formation-stacked red cells

A

myeloma

102
Q

deficiency of all blood cells

A

pancytopenia

103
Q

what can cause pancytopenia

A

bone marrow failure ( decreased production)

hypersplenisim (increased destruction)

104
Q

proliferation of RBC

A

PRV

105
Q

increased blood viscosity
headache
itch (after hot bath)
fatigue

A

PRV

106
Q

Jak 2 mutation

A

PRV

107
Q

uncontrolled production of abnormal platelets

proliferation of megakaryocytes

A

essential thrombocythaemia

108
Q

proliferation of fibroblasts

A

myelofibrosis

109
Q

tear drop RBC

leucoerythroblastic appearance on film

A

myelofibrosis

year 4 onlines miscellaneous (18 decks)

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