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Misc. Notes Year 3 > Haem Docs > Flashcards

Haem Docs Flashcards

1
Q

What condition is a pencil cell seen in

A

Iron deficiency

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2
Q

Name 2 scenarios in which a tear drop poikilocyte would be seen

A

Myelofibrosis

Extra-medullary haumatopoeisis

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3
Q

When would a basket cell be seen in

A

Oxidative damage e.g G6PD deficiency

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4
Q

What condition could Bite cells be seen in

A

G6PD deficiency

or any haemolysis

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5
Q

Name 2 common and 2 rare causes of Microcytic, Hypochromic anaemia

A

Thalassaemia + Iron Deficiency anaemia

Lead poisoning + Sideroblastic anaemia

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6
Q

What kind of anaemia would haemolytic anaemia present with

A

Normochromic, Normocytic

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7
Q

What are the two types of macrocytic anaemia

A

Megaloblastic

Non-megaloblastic

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8
Q

Name the most common cause of Megaloblastic, Macrocytic anaemia

A

Vitamin B12 or folate deficiency

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9
Q

Name 3 causes of Non-Megaloblastic, Macrocytic anaemia

A

Alcohol
Liver disease
Hypothyroidism

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10
Q

What does kolionychia indicate

A

Iron deficiency anaemia

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11
Q

Bone lesions + anaemia suggest which underlying disease process

A

Thalassaemia major

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12
Q

What does a low reticulocyte count indicate and name 2 situations when this might occur

A

Low count = decreased production

Chronic Kidney Disease + Aplastic anaemia

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13
Q

What does a high reticulocyte count indicate and name 2 situations when this might occur

A

High count = increased loss/destruction of RBC’s

e.g. bleeding or haemolysis

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14
Q

A beefy tongue indicates what pathology

A

B12/folate deficiency

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15
Q

Angular stomatitis indicates what pathology

A

Iron deficiency anaemia

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16
Q

How is functional iron status assessed

A

Haemoglobin levels

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17
Q

How is iron transport status assessed

A

Serum iron
Transferrin
Transferrin saturation

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18
Q

What is a normal transferrin saturation level

A

20-50%

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19
Q

What are bound and unbound transferrin molecules called

A

Apotransferrin –> unbound

Holotransferrin –> bound

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20
Q

Name a situation when increased transferrin saturation and decreased transferrin saturation could be seen

A

Increased –> iron overload

Decreased –> iron deficiency

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21
Q

How is storage iron assessed

A

Serum Ferritin

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22
Q

Name the mucosal and serosal iron transporters

A

Mucosal –> DMT-1

Serosal –> Ferroportin

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23
Q

Which substance inhibits Ferroportin and when might this process be faulty

A

Hepcidin

Heriditary Haemochromatosis

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24
Q

What kind of anaemia will Anaemia of Chronic disease most commonly present as

A

Normochromic, Normocytic anaemia

sometimes mildy microcytic

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25
Q

What will serum iron and serum ferritin levels be like in anaemia of chronic disease

A

serum iron reduced

serum ferritin normal or raised

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26
Q

Where are alpha and beta thalassaemia’s more common respectively

A

Alpha –> Far east

Beta –> Mediterranean

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27
Q

What is HbH disease and how would it present

A

only one alpha gene remains so excess beta chains form tetramers called HbH
Presentation –>
Microcytic anaemia + jaundice + splenomegaly

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28
Q

How is HbH disease treated

A

Splenectomy and transfusions

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29
Q

What is Bart’s Hb

A

Gamma tetramers

Seen in Barts Hydrops Fetalis

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30
Q

What is the difference in types of mutations in alpha and beta thalassaemias

A

Alpha –> Deletions

Beta –> Point mutations

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31
Q

Which blood result is diagnostic of Beta thalassaemia trait

A

Raised HbA2

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32
Q

What disease causes a “hair on end” appearance of the skull and why

A

Beta Thalassaemia Major

Extra-medullary haematopoeisis

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33
Q

Name a serious endocrine, cardiac and hepatic consequence of iron overload

A

Cardiac –> hypertrophy
Hepatic –> cirrhosis
Endocrine –> diabetes

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34
Q

How can iron overload be managed

A

Iron chelating drugs such as desferrioxamine

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35
Q

What kind of mutation on which codon causes sickle cell anaemia

A

Point mutation on codon 6

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36
Q

What is hand-foot syndrome and which serious disease can it be the presenting complaint of

A

Redness, swelling, and pain on the palms of the hands and/or the soles of the feet
Sickle cell anaemia

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37
Q

How is sickle cell anaemia treated

A

Folic acid supplementation
Hydroxycarbamide –> induce HbF production
Penicillin + vaccination if hyposplenism

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38
Q

Why might Hyposplenism occur in Sickle cell anaemia

A

Multiple infarcts

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39
Q

If a patient with sickle cell anaemia contracts the Parvovirus B19, what could occur

A

Aplastic crisis

low reticulocytes

40
Q

If someone with sickle cell anaemia presents with abdo pain, hepato-splenomegaly and severe haemolytic anaemia –> what is going on

A

Sequestration crisis: pooling of blood in spleen

41
Q

Which two substances are released by platelets to stimulate aggregation and adhesion

A

Thromboxane A2

ADP

42
Q

How would primary haemostasis failure present

A

Purpura
Easy bruising
Mucosal bleeding –> epistaxis, conjunctival bleeding, menorrhagia, GI bleeds

43
Q

What do platelets bind to each other via

A

Glycoprotein IIb/IIIa

44
Q

Name the 4 vitamin K dependent clotting factors

A

II, VII, IX, X

45
Q

What are the 2 main factors in the extrinsic pathway and how is the pathway tested

A 
Tissue Factor & Factor VII
Prothrombin Time (PTT)
46
Q

What are the 2 main factors in the intrinsic pathway and how is the pathway tested

A

Factors VIII & IX

Activated Partial Thromboplastin Time (APTT)

47
Q

Name a serine protease which controls haemostasis

A

Anti-Thrombin III

48
Q

Name 2 naturally occurring anti-coagulants

A

Protein C and S

49
Q

What is haptoglobin and what does a low level suggest

A

Binds free haemoglobin in the blood to prevent oxidative damage
Low level suggests intravascular damage

50
Q

Which disease is an autoimmune condition in which antibodies are produced against platelets

A

Idiopathic Thrombocytopenic Purpura (ITP)

51
Q

What are Howell-Jolly bodies and when are they seen

A

Basophilic nuclear remnants seen in blood cells

Indicate Hyposplenism

52
Q

Schistocytes on blood film + fever + mucosal bleeds + CNS signs should make you think of which disease

A

Thrombotic thrombocytopenic purpura (TTP)

53
Q

How is Thrombotic thrombocytopenic purpura (TTP) managed

A

Plasmapheresis
Steroids + immunoglobulin
Splenectomy

54
Q

Which disease can you use desmopressin for and how does it work

A

vWF disease

Stimulates vWF release from endothelial cells

55
Q

Which emergency consists of thombosis and haemorrhage together

A

Disseminated Intravascular Coagulation (DIC)

56
Q

How is Disseminated Intravascular Coagulation (DIC) treated

A

Treat underlying cause
Consider RBC + platelet transfusions
Give cryoprecipitate after fresh frozen plasma

57
Q

Which type of heparin only inhibits factor Xa

A

LMWH

e.g. dalteparin

58
Q

Name 2 antibiotics that potentiate the effect of warfarin (increase INR)

A

Erythromycin

Cirprofloxacin

59
Q

When should warfarin be stopped with regards to an upcoming surgery

A

5 days before

60
Q

Name a direct thrombin inhibitor and it’s antidote

A 
Dabigatran 
Idarucizumab (antidote)
61
Q

Which anti-coagulants don’t require monitoring

A

NOACS: Noval Oral Anti-coagulants

62
Q

Name the 3 parts of Virchow’s triad

A

Stasis
Hyper-coagulability
Vessel wall damage

63
Q

What is the age threshold, under which you should consider thrombophilia, if a VTE occurs

A

< 40

64
Q

What is the most common acquired thrombophilia

A

Anti phospholipid syndrome

65
Q

What are the primary sites of haematoiesis in kids

A

Long bones of the limbs

66
Q

What are the primary sites of haematoiesis

A

vertebrae, sternum and ribs

67
Q

At what stage of the red cell development does Hb begin to be produced

A

Polychromatic normoblast

68
Q

At what stage of the red cell development does the nucleus shrink

A

Orthochromatic normoblast

69
Q

What process do red blood cells rely on for energy

A

glycolysis

70
Q

What does a red cell use NADH for and why

A

maintain iron in the Fe2+ (ferrous) state as it needs to be in this state to bind oxygen

71
Q

What is the precursor cell of platelets

A

Megakaryocytes

72
Q

Which cells have a segmented nucleus

A

Neutrophils

73
Q

Name 2 conditions in which neutropenia may be present

A

Aplastic anaemia

Pancytopenia

74
Q

Eosinophilia may be present in which blood cancer

A

Hodgkin’s lymphoma

CML

75
Q

Which granulocyte is least common

A

Basophils

76
Q

When might you find a basophilia

A

CML

Polycythaemia Rubra Vera

77
Q

Where is iron absorbed and how much is needed per day

A

Duodenum

1mg

78
Q

How is iron overload defined

A

Total iron stores > 5g

79
Q

If a woman has symptoms of iron deficiency anaemia and webs in her throat, what syndrome should you suspect

A

Plummer Vinson syndrome

80
Q

What are heinz bodies and when are they seen

A

Clumps of denatured Hb

Seen in Intravascular Haemolysis

81
Q

What are Pappenheimer bodies

A

abnormal basophilic granules of iron found inside red blood cells

82
Q

What disease might Pappenheimer bodies be seen in

A

Beta Thalassaemia major

83
Q

What are the two antibodies that may be present in Pernicious Anaemia and which one is more specific

A

Anti-gastric parietal cell

Anti-intrinsic factor (more specific)

84
Q

What is MAHA (microangiopathic heamolytic anemia )

A

Intra vascular heamolysis due to mechanical disruption of red cells leading to their fibrosis and release of intracellular components

85
Q

Donath Landsteiner antibodies = what

A

Paroxysmal cold heamoglobinuria

86
Q

What does cigar shaped RBC’s suggest

A

Heredity Epliptocytosis

87
Q

What are the two main causes of cytopenia

A

Hypersplenism

Reduced production

88
Q

Which blood cancer is Fanconi Anaemia associated with

A

Increased risk of AML

89
Q

Which chains are produced slightly more than the other, light or heavy

A

Light chain

90
Q

Which immunoglobulins are most myelomas

A

IgG

IgA

91
Q

Which paraprotein disease has excess IgM production

A

Waldenstrom’s Macroglobulinaemia

92
Q

What appearance can someone’s skull have on X-ray if they have myeloma

A

Pepper-pot skull

93
Q 
What will be seen on :
Blood film 
Serum Electrophoresis 
Urine electrophoresis 
of someone with myeloma
A

Blood –> Rouleaux formation
Serum –> Paraprotein
Urine –> Bence- Jones protein

94
Q

Which effect of myeloma can cause strokes

A

Hyper-viscosity syndrome

95
Q

What are the parameters of Paraprotein (g/l) and bone marrow plasma cells (%) under which you would diagnose Monoclonal Gammopathy of Unknown Significance (MGUS)

A

< 30g/l paraprotein

Bone marrow plasma cells <10%

96
Q

Lymphoplasmacytoid Lymphoma describes which disease

A

Waldenstrom’s Macroglobulinaemia

97
Q

What are the 3 B symptoms of lymphoma

A

Night sweats
Fever
Weight loss

Misc. Notes Year 3 (25 decks)

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