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Pathology Data Interpretation > Haematinics, coagulation studies > Flashcards

Haematinics, coagulation studies Flashcards

0
Q 
Iron studies for Iron deficiency anemia:
sFe:
sTIBC:
sFerratin:
Transferrin saturation:
sTfR:
A 
sFe: Dec
sTIBC: inc
sFerratin: Dec
Transferrin saturation: dec
sTfR: Inc
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1
Q 
Iron studies for Anaemia of chronic disease:
sFe:
sTIBC:
sFerratin:
Transferrin saturation:
sTfR:
A 
sFe: N or dec
sTIBC: dec
sFerratin: N or inc (APR)
Transferrin saturation: dec
sTfR: N
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2
Q

What is the most common cause of congenital bleeding?

Name FIVE other congenital causes of bleeding.

A 
VWD
Haemophilia A & B
Factor XI deficiency
Collagen vascular disorders (Ehlers Danlos Syndrome)
Platelet function disorders
Hypo/dysfibrinogenamia
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3
Q

What is the most common acquired cause of bleeding?

Name FIVE other acquired causes of bleeding.

A 
Medications
Liver or renal disease
ITP (immune thrombocytopenic purpura)
BM disorders
Cushing's syndrome
Coagulation factors deficiencies (factor VIII, vWfactor)
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4
Q

Name FIVE key investigations for bleeding:

A 
FBE (including differential & film)
PT/INR & APTT
Thrombin time
Fibrinogen
LFT & CrCl
Ferratin
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5
Q

Name FIVE key investigations for bleeding:

A 
FBE (including differential & film)
PT/INR & APTT
Thrombin time
Fibrinogen
LFT & CrCl
Ferritin
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6
Q

What factors are involved in the EXTRINSIC coagulation pathway?

A

7 & tissue factor

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7
Q

What factors are involved in the COMMON coagulation pathway?

A

10, 5, 2, 1

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8
Q 
What pathway(s) are tested via the INR?
What drug is managed via INR
A

Common & Extrinsic

Warfarin

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9
Q

What pathway(s) are tested via the PT

A

Extrinsic

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10
Q

What pathway(s) are tested via the APTT

A

Common & Intrinsic

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11
Q

What is RDW?

What is the significance of an increased RDW?

A

Red cell distribution width = variation in size of the RBCs.
Increased ‘width’ reflects anisocytosis (not the same size RBCs) - meaning cells are in different states of maturity and of size.
Could be a mixed MICRO & MACRO cytic anaemia: where there are TWO RBC populations.

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12
Q 
In MICROCYTIC anaemia, describe:
Hb
MCV
PCV
RDW
WCC
Plts
Reticulocytes
A 
Hb - low
MCV - low
PCV - N
RDW - N
WCC - N
Plts - N
Reticulocytes - N
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13
Q

Name FOUR common causes of MICROcytic anaemia:

A

Iron deficiency
Haemoglobinopathies (thalassemia)
Sideroblastic anaemia
Chronic disease

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14
Q

Name FOUR common causes of NORMOcytic anaemia:

A

Bleeding - acute
Haemolytic anaemia
Chronic disease
BM infiltration

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15
Q

Name SIX common causes of MACROcytic anaemia:

A 
B12 deficiency (pernicious anaemia)
Folate deficiency
Alcoholism
Aplastic anaemia
Hypothyroidism
Multiple myeloma
BM proliferation
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16
Q

Describe the order in which FBE is reviewed when making a Dx about anaemia:

A
  1. Hb [low Hb = anaemia]
  2. Check ALL cell types:
    2a. If only RBCs - an anaemia
    2b. If all cells (R&W&P) - BM issue
  3. Reticulocytes [raised during bleeding or haemolysis when immature RBCs are in the film
  4. MCV [micro, normo, macro]
  5. RDW [to ensure a single population of RBCs]
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17
Q

For each nutrient deficiency, name the type of anaemia:
Iron
Folate
B12

A

Iron - microcytic
Folate - macrocytic
B12 - macrocytic

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18
Q

Where is each nutrient absorbed?
Iron
Folate
B12

A

Iron - Duodenum & jejunum
B12 - Terminal ileum
Folate - Small intestine

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19
Q

What substance is required to assist with the absorption of B12?
What cells in what organ produce this substance?
What disease most commonly causes B12 deficiency?

A

Intrinsic factor
Parietal cells of the stomach
Pernicious anaemia

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20
Q

What is the most common deficiency causing anaemia?

What condition is this typically associated with?

A

Iron deficiency

Bleeding (menstrual or GI)

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21
Q

Regarding iron, what is?
Ferritin
Transferrin

A

Ferritin is the iron storage molecule

Transferrin is the transport molecule that moves Fe from blood to BM

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22
Q

In what substances is iron stored?

A

Hb
Ferritin
Heamosiderin

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23
Q

Which substance measured in haematinics is also an acute phase reactant that is increased by inflammation - such as that in chronic disease?

A

Ferritin

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24
Q

In anaemia of chronic disease, what would you expect Ferritin levels to be?

A

N or raised (because of its role as an acute phase reactant.

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25
Q

What THREE substances/tests can be measured/tested to reflect a state of active inflammation?

A

ESR
CRP (C-reactive protein)
Ferritin

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26
Q

Describe pernicious anaemia

A

autoimmune
defective intrinsic factor production
associated with antibodies against gastric parietal cells and intrinsic factor

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27
Q

What test is used to distinguish between causes of pernicious anaemia?
Apart from pernicious anaemia, what other conditions cause B12 deficiency

A

Schilling test

Bacterial overgrowth

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28
Q

What test detects folate deficiency?

A

serum folate levels

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29
Q

What tests show haemolysis (haemolytic anaemia)?

A

Hb (low)
BR - bilirubin (high)
BR is conjugated in the liver
(cBR) & converted to urobilinogen in the bowel & excreted in urine.
uBR in plasma will rise
UroBil in urine will rise
LDH (lactate dehydrogenase) rises when cell lysis occurs - LDH will rise too

30
Q

What is a HAPTOGLOBIN?

A

Haptoglobins bind with Hb released from lysed RBCs and tpt it to the liver

31
Q

During bleeding, haptoglobins can become saturated resulting in what substances being excreted in urine?
What substance can be found in the blood?

A

Hb - haemoglobinuria
Haemosiderinuria
Methaemalbumin(aemia)

32
Q

What test detects methaemalbumin?

A

Schumm test

33
Q

What test(s) detect autoimmune haemolysis [haemolytic anaemia]

A

Coomb’s test(s)
DAT = direct antiglobulin test
Indirect test

34
Q

Compare the DAT and indirect Coomb’s test.

A

DAT tests for antibodies on the RBC surface

Indirect tests for antibodies in the plasma

35
Q

What are the TWO main types of haemolytic anaemia?

A

Congenital (inherited)

Acquired

36
Q

Name the THREE Inherited haemolytic anaemia mechanisms.

For each, name TWO relevant conditions.

A
  1. Abnormal RBC membrane:
    1a. spherocytes
    1b. elliptocytes
  2. Abnormal Hb:
    2a. Thalassemia
    2b. Sickle cell anaemia
  3. Abnormal RBC metabolism:
    3a. Pyruvate kinase
    3b. Glucose 6 PO4 dehydrogenase deficiency
37
Q

Name the TWO types of acquired haemolytic anaemia:

A

Immune

Non-immune

38
Q

Name FIVE immune acquired haemolytic anaemias:

A 
AI warm
AI cold
Transfusion reaction
HDN
Adverse drug event
39
Q

Name SIX non-immune acquired haemolytic anaemias:

A 
malaria
microangiopathic anaemia
hypersplenism
mechanical heart valve
paroxysmal nocturnal haemoglobinuria
burns
40
Q

What is polycythaemia?
It can be apparent or true.
What causes ‘apparent’

A

Too many RBCs

Dehydration or stress erythrocytosis

41
Q

What other name is given to primary polycythaemia?

A

polycythaemia rubra vera

42
Q

Secondary polycythaemia arises from what TWO mechanisms?

A

Hypoxia

Excess EPO

43
Q

What FOUR situations/conditions cause the hypoxia that gives rise to secondary polycythaemia?

A

lung disease
smoking
high altitude
cyanotic cardiac disease

44
Q

What FIVE situations/conditions cause the excess EPO that gives rise to secondary polycythaemia?

A 
adrenal tumour
hepatocellular carcinoma
cerebellar haemangioblastoma
renal cell carcinoma
polycystic kidneys
45
Q

Name SEVEN common causes of neutrophilia (high neutrophils)

A 
Bacterial infection
Inflammation
Necrosis (eg, post AMI)
Steroid Rx
Malignancy
Metabolic disorders (RF)
Myeloproliferative disorders
46
Q

Name FIVE common causes of neutropenia (low neutrophils)

A

Chemotherapy
Radiotherapy
Adverse drug reaction (clozapine, carbimazole)
Viral infection
Felty syndrome [RA, splenomegaly & neutropenia]

47
Q

Name FOUR common causes of lymphocytosis.

A

Viral infection
Chronic infections (TB)
Chronic Lymphocytic Leukaemia (CLL)
Lymphomas

48
Q

Name SIX common causes of eosinophilia

A 
Allergic disorders
Parasite infection
Skin diseases (Eczema)
Malignancy (Hodgkin's)
Allergic bronchopulmonary aspergillosis
Hypereosinophilic syndrome
49
Q

Name THREE causes of primary thrombocytosis.

A

Myelodysplasia
Chronic myeloid leukaemia (CML)
Essential thrombocythaemia

50
Q

Name SIX causes of secondary thrombocytosis.

A 
Infection
Inflammation 
Malignancy
Bleeding
Pregnancy
Post-splenectomy
51
Q

Name the TWO mechanisms for thrombocytopenia:

A

Increased destruction

Decreased production - BM failure

52
Q

Name EIGHT causes of BM failure causing thrombocytopenia.

A 
Infection (esp viral - mononucleosis)
Drugs (eg penicillamine)
Leukaemia
Aplastic anaemia
Myelofibrosis
BM replacment with tumour (myeloma or metastases)
Myelodysplasia
Megaloblastic anaemia
53
Q

Name SEVEN situations where platelet destruction may occur:

A

After massive transfusion
DIC (diffuse intravascular coagulopathy)
TTP (thrombotic thrombocytopenic purpura)
HUS (haemolytic uremic syndrome)
Hypersplenism
Immune mediated: AITP (autoimmune thrombocytopenic purpura)
HIT (heparin induced thrombocytopenia)

54
Q

What test should be done when a low platelet count is thought to be due to clumping?

A

Citrate test
Use a coagulation (blue) tube
Request ‘DO NOT SPIN’
so that the platelets can be counted

55
Q

What is pancytopenia?

A

LOW levels of RBC, WBC & Plts

56
Q

Name SIX common causes of pancytopenia:

A 
Aplastic anaemia
BM infiltration (by a tumour)
Hypersplenism
Megaloblastic anaemia
Sepsis
SLE (systemic lupus erythromatosis)
57
Q

What is ESR?
What does it measure?
How does ESR change with age?
What is ESR a marker for?

A

Erythrocyte sedimentation rate
How rapidly RBCs sediment in 1 hour
ESR increases with age
ESR is a non-specific marker for inflammation

58
Q

Name FIVE common causes of raised ESR

A 
Infectious disease
Neoplasia (esp MM)
CT disease (esp GCA & PMR)
Anaemia
Renal disease
59
Q

What condition is characterised by Auer rods in the WBCs

A

AML - acute myeloid leukaemia

60
Q

What clotting factor is NOT reflected in APTT?

What drug is monitored using APTT?

A

VII

Heparin

61
Q

What drug is monitored using INR?

What else is the INR an indication of?

A

Warfarin

Liver protein synthesis/function

62
Q

What clotting factors are measured in PT?

A

Common [10, 5, 2, 1] &

Extrinsic [7]

63
Q

What is DIC? (name & pathophys)

A

Disseminated Intravascular Coagulopathy

Both clotting & bleeding occur concurrently

64
Q

What are the typical findings in DIC?

A 
PT & APTT raised (clotting factors are reduced)
Fibrinogen low (fibrin clots are forming)
D-dimer raised (body attempting to break down excess fibrin deposits)
65
Q

What does the D-dimer test measure?

A

Fibrinogen/fibrin degeneration as the body attempts to break down clots formed in the vasculature.

66
Q

When is a negative D-dimer test useful?

A

To exclude PE or DVT

67
Q

Consider PT, APTT & fibrinogen in DIC. What would each be respectively?

A

PT - increased (bleeding)
APTT - increased (bleeding)
Fibrinogen - reduced (clotting)

68
Q

Consider PT, APTT & fibrinogen in LIVER DISEASE. What would each be respectively?

A

PT - increased (making fewer clotting factors)
APTT - increased (making fewer clotting factors)
Fibrinogen - normal (not clotting)

69
Q

Consider PT, APTT & fibrinogen in WARFARIN treatment. What would each be respectively?

A

PT - increased
APTT - normal (or increased)
Fibrinogen - normal

70
Q

Consider PT, APTT & fibrinogen in HEPARIN treatment. What would each be respectively?

A

PT - normal (or increased)
APTT - increased
Fibrinogen - normal

71
Q

Consider PT, APTT & fibrinogen in HAEMOPHILIA A or B. What would each be respectively?

A

PT - normal
APTT - increased
Fibrinogen - normal

72
Q

What happens in plasma cell dyscrasias?
What is the most common plasma cell dyscrasia?
What is the most important plasma cell dyscrasia?

A

M protein is produced in excess
MGUS - monoclonal gammopathy of unknown significance is most common
Multiple myeloma is most significant

Pathology Data Interpretation (10 decks)

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