Haem

Question 1

Give the signs of iron deficiency anaemia

Answer 1

Koilonychia
Angular stomatitis
Atrophic glossitis
Hair loss

Question 2

What are the SE of ferrous sulphate?

Answer 2

Black stools
Constipation
Vomiting

Question 3

What would you seen on a blood smear in someone with thalassaemia?

Answer 3

Microcytic, target cells with nucleated RBC

Question 4

How would you treat someone with thalassaemia who is symptomatic?

Answer 4

Transfusion + desferrioxamine

Question 5

What does the Coombs test look for?

Answer 5

Looks for antibodies against RBC

Question 6

What’s the difference between the direct and indirect Coombs test?

Answer 6

Direct test is done on RBC to detect abs that are already attached (abs directly on the RBC)
The indirect coombs is done to the serum of the blood to detect abs there - used in prenatal testing to screen for abs that could potentially cause haemolytic anaemia in the newborn

Question 7

What abs are associated with TTP?

Answer 7

Anti-ADAM TS13 abs

Question 8

How do you treat ITP?

Answer 8

Immunosuppression and transfusion
IVIG + prednisolone
Platelet transfusion

Question 9

Explain what Thrombotic thrombocytopenic purpura is

Answer 9

Microangiopathic haemolytic anaemia with thrombocytopenic purpura
It is a very rare disease with a high fatality rate.
Usually presents in adults.
? Due to decreased ADAM TS13 - from Anti-ADAMTS13 abs
Causes lots of clots in the microvasculature –> end organ damage - kidneys, heart, brain + NS

Question 10

How do you treat TTP?

Answer 10

Urgent plasma exchange
+ prednisolone
+ aspirin

Question 11

What are some of the causes of DIC?

Answer 11

Shock, sepsis, obstetric, malignancy, trauma and burns

Question 12

Explain what DIC is

Answer 12

DIC is a complication of an underlying condition.
Initial thrombosis causes an activation of coagulation pathways with fibrin deposition in microvascular circulation.
Consumption of coagulation factors and fibrin
Haemorrhage + organ dynsfunction due to vascular occlusion

Question 13

What would the following blood tests show in DIC?

Plts, fibrinogen, PT, APTT, D dimer

Answer 13

Low platelets and fibrinogen

High PT, APTT and D dimer

Question 14

What are some of the causes of prolonged PT?

Answer 14

Warfarin (extrinsic) 
VK deficiency from malabsorption 
Liver disease (decreased production of clotting factors) 
DIC 
Hypothermia

Question 15

What are some of the causes of elevated APTT

Answer 15

Heparin use (intrinsic)
Lupus anti-coagulant (anti-phospholipid syndrome)
Haemophilia A&B
Factor XII + XI deficiencies

Question 16

How do you treat DIC?

Answer 16

Supportive to stop the bleeding
Platelet transfusion
FFP - for the coagulation factors
Cryoprecipitate

Question 17

What is haemophilia?

Answer 17

AR inherited disease in which people cannot form blood clots - bleeding problem
Haemophilia A = deficient in factor 8
Haemophilia B = deficient in factor 9
No activation of the coagulation cascade via the intrinsic pathway causing no fibrin to be produced via the intrinsic pathway

Question 18

What are some of the complications of haemophilia?

Answer 18

Deep internal joint bleeding
Joint damage
Intracranial haemorrhage

Question 19

What is polycythema ruba vera?

Answer 19

It is a myeloproliferative disorder which is predominantly red cells (but also WBC + Plts)
BM overactivity

Question 20

What is the pathology behind polycythemia ruba vera?

Answer 20

JAK-2 mutation which is an on/off switch for the bone marrow - mutation means the production is on

Question 21

How might someone with Polycythemia ruba vera present?

Answer 21

Hyperviscosity - headaches, flushing, 
Vessel congestion - facial plethora, ruddy look 
VTE - stroke, mi, PE, DVT 
Gout 
Pruritus on bathing 
HSM

Question 22

What is immune thrombocytopenic purpura

Answer 22

It is an AI condition that leads to destruction of platelets
IgG to platelets against GP2b/3a - the spleen then destroys the platelets with these abs on them