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YR3 HUD > Haematology 1 > Flashcards

Haematology 1 Flashcards

1
Q

What is haematopoiesis?

A

A process through which all blood cells are derived.

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2
Q

What is the haematopoietic system composed of?

A

Bone marrow, spleen, liver, lymph nodes and thymus.

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3
Q

Why do all cells in blood start as?

What does this cell then differentiate into (2 options)?

A

Haemopoietic stem cell

Lymphoid progenitor cells and myeloid progenitor cell

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4
Q

What normal haemoglobin level does an adult male have?

A

130-170mg

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5
Q

What normal haemoglobin level does an adult female have?

A

120-155mg

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6
Q

What happens to red blood cells in anemia?

A

They have a reduction level in haemoglobin below normal.

less oxygen to body

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7
Q

What are the symptoms and what are the signs for anemia?

A

Symptoms:

  • Fatigue
  • Dizziness
  • Palpitations
  • Headaches
  • Chest pain

Signs

  • Pale appearance
  • Tachycardia
  • Wide pulse pressures
  • Systolic flow murmors
  • Congestive cardiac failure
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8
Q

What are the 4 reasons why anemia can develop?

A

1) Reduced red blood cell production
2) Increased red blood cell destruction (haemolytic anaemia)
3) Loss of red blood cells from the circulation
4) Dilutional effect from increased blood plasma

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9
Q

What are the 3 classifications of anemia cells?

A

1) Microcytic
2) Normocytic
3) Macrocytic

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10
Q

What is microcytic anaemia mainly caused by and how do we manage this?

A
  • IRON DEFICIENCY

3 ways:

  • Poor intake in diet
  • Malabsorption
  • Increased loss (through peptic ulceration, inflammatory bowel disease)

Management:

  • Treat underlying cause
  • Oral supplementation
  • Blood transfusion if severe
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11
Q

What is normocytic anemia and how it is caused?

A

Abnormal RBC due to other diseases

  • Chronic inflammatory condition (arthritis)
  • Chronic infections e.g. TB
  • Chronic renal disease
  • Malignancies
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12
Q

What is macrocytic anemia and what are the two types?

A

Enlarged RBC.

  • Megaloblastic erythopoiesis
  • Normoblastic erythropoisis
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13
Q

What is megaloblastic anaemia?

folate cause

A
  • Associated with folate deficiencies
  • Derived from many food sources

CAUSES OF DEFICIENCY:

  • Inadequate intake (elderly, alcoholism)
  • Malabsorption (Coeliac disease, Crohn’s disease, resection)
  • Increased requirement (pregnancy)
  • Increased loss (dialysis, liver disease, congestive heart failure)
  • Drugs (methotrexate, phenytoin, trimethoprism)
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14
Q

Explain megaloblastic anaemia in terms of Vitamin B12

A

Vitamin B deficiency:

Can be due to…

  • Inadequate intake
  • Inadequate section of intrinsic factor
  • Inadequate release from food
  • Diversion of dietary B12
  • Malabsorption
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15
Q

What are clinical features of folate and B12 deficiencies in megaloblastic anaemia?

A

Folate and Vitamin B12

  • Generic symptoms of anemia
  • Occasionally mild jaundice
  • Glossitis
  • Oral ulceration

Vitamin B12

  • Periphery neuropathy
  • Demyelination with subacute combined degeneration of spinal cord
  • Dementia
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16
Q

What is the management for megaloblastic anemia (folate and B12 deficiency)?

A
  • Address underlying cause
  • Oral supplementation (for B12 and folate)
  • Parenteral vitamin B12
17
Q

What are normoblastic macrocytosis anaemia causes?

A
  • Alcohol excess
  • Liver dysfunction
  • Hypothyroidism
  • Drugs
18
Q

What are the two types of haemolytic anaemia (due to decreased RBC lifespan) ?

A
  • Congenital

- Acquired

19
Q

In terms of congenital haemolytic anaemia, what are the 3 types?

A

1) Membrane defects - problems with RBC membrane integrity. Mutation leads to increases fragility
2) Enzyme defects - deficiency in glucose-6-phosphate dehydrogenase - leading to reduced glucose metabolism
3) Globin defects

20
Q

For acquired hemolytic anemia, what are the two classifications?

A
  • Immune
    (IgG coated red cells interacting with macrophages leading to phagocytosis)
    (Autoimmune processes with antibodies against RBC)
    (Autoimmune results from transfusion and production of antibodies)
  • Non-immune
    (Mechanical trauma, burns, infections or drugs)
21
Q

Explain the structure of haemoglobin

A
  • 2 alpha and 2 beta chains

- Each globin group is associated with a haem group

22
Q

Why does haemoglobin have high oxygen affinity in high oxygen tension areas?

A

Oxygen does not need to be released as the surroundings already has enough oxygen.

23
Q

What is the name of congenital haemolytic anaemia - globin disorder?

A

Thalassaemia

Either alpha or beta thalassemia (depending on what globin chain is affected).

  • Excess chains precipitate in the pre-cursor blood cells leading to premature death of cell
  • Precipitated in the pre-cursor blood cells leading to premature death
24
Q

What is the difference between the alpha and beta thalassemia in terms of what happens to the globin chains when in disease?

A

Alpha = deletion of genes

Beta = mutation of genes

25
Q

What is the clinical presentation of thalasseamia?

A
  • Bony deformities
  • Growth retardation
  • Enlargement of maxilla
  • Spacing and migration of upper teeth
26
Q

What happens in sickle cell anaemia?

A

Mutation in the B-globin gene leading to interaction of sickle-B globin chinas with normal A globin chains.

Leads to a variant of haemoglobin called HbS.

Results in deformation of the cell into a sickle shape.

27
Q

What are the clinical manifestations of sickle cell anaemia?

A
  • Chronic haemolytic anaemia
  • Hyposplenism
  • Acute chest syndrome
  • Stokes
  • Bone infarction
  • Chronic leg ulcers
  • Chronic renal disease
28
Q

What is the management of sickle cells anaemia?

A
  • Give transfusions when necessary
  • Avoid vaccinations to prevent hyposplenism
  • Prophylactic penicillin
29
Q

Is it safe to treat patients with sickle cell anemia dental?

A

Yes!

Can be treated under LA.

30
Q

What is the ABO system?

A

This released to the antigen on the RBC cell membrane.
A or B allele leads to antigen modification but O leads to no modifications.

O = universal doner

AB = universal receiver

31
Q

What is the Rh system of classifying RBC?

A
  • Encoded by 2 genetic loci on one chromosome
  • D antigens are relevant here
  • Rhd NEGATIVE person is at risk of developing anti-D antibodies after transfusion of Rhd POSITIVE blood
  • Main relevance is to Rhd negative mothers as the fetus may be rhd + and have an adverse reaction (need to give mother anti-D drugs)
32
Q

What are the two types of transfusion reactions that can occur?

A

1) Acute (within 24h)
Includes:
- Allergy
- Acute haemolytic reaction (destruction of all RBC - fatal)
2) Delayed (days to weeks)
- Delayed haemolytic transfusion reactions
- Transfusion associated graft vs host disease

33
Q

How do we manage any reactions to a transfusion?

A
  • Stop transfusion!
  • Paracetamol
  • IV fluids
  • Look for signs of anaphylaxis
34
Q

What is the dental relevance of anaemia?

A

Oral features of anaemia

  • Angular cheilitis
  • Glossitis
  • Oral ulceration
  • Peripheral neuropathies

Can sometimes complicate treatment

Sickle cell anemia can also lead to oral pain, osteomyelitis, trigeminal neuropathy.

35
Q

How can anemia complicate dental treatment?

A

1) Bleeding - risk may be increased esp if the patient has liver disease

2) Anesthesia
- Avoid prilocaine
- Avoid GA with thalassemia and sickle cell disease

YR3 HUD (23 decks)

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