Haematology

Question 1

What is hct (haematocrit)?

Answer 1

Percentage volume of blood that is red blood cells.

Question 2

What is RBC (Red blood cell count)?

Answer 2

Number of red blood cells in a given volume of blood.

Question 3

What is Hb?

Answer 3

Haemoglobin concentration.

Question 4

What is MCV?

Answer 4

Average number of red blood cells in volume of blood.

Question 5

What is MCH?

Answer 5

Average amount of haemoglobin in each red blood cell.

Question 6

What is MCHC?

Answer 6

Average amount of haemoglobin compared to size of the cell.

Question 7

What is anaemia?

Answer 7

Anaemia is a reduction in the amount of haemoglobin
in a given volume of blood

Question 8

What are the two mechanisms that drive anaemia?

Answer 8

RBC failure of production or RBC excess loss/destruction

Question 9

If microcytic anaemia is present what colour are the red blood cells?

Answer 9

Hypochromic (pale).

Question 10

If macrocytic anaemia is present what colour are the red blood cells?

Answer 10

Normochromic (normal).

Question 11

What proportion of normal red blood cells are pale?

Answer 11

A third of the diameter.

Question 12

Why is the centre of the red blood cell pale?

Answer 12

Red blood cell have a disc shape. The centre has less haemoglobin and therefore is paler.

Question 13

Why are hypo-chromic cells pale?

Answer 13

Less haemoglobin and flatter cell.

Question 14

What are the three causes of iron deficiency anaemia?

Answer 14

Increased loss (blood loss), insufficient intake, increased requirement.

Question 15

What are common causes of a loss of iron?

Answer 15

Hookworm, gastrointestinal bleeding, heavy menstrual bleeding.

Question 16

What are common causes of an insufficient intake of iron?

Answer 16

Vegetarian diet, Coeliac disease (malabsorption).

Question 17

What are common causes of an increased requirement of iron?

Answer 17

Pregnancy and infancy.

Question 18

What are symptoms of iron deficiency anaemia?

Answer 18

Fatigue, Shortness of breath.

Question 19

Why are iron deficiency anaemia symptoms caused?

Answer 19

Low amounts of haemoglobin means less oxygen to tissues. Reduced rate of respiration causes fatigue.

Question 20

What should iron deficiency show in the blood test?

Answer 20

Increased transferrin and reduced serum ferritin.

Question 21

What do iron deficiency anaemia and thalassaemia trait cause?

Answer 21

Micryocytic red cells.

Question 22

How can you differentiate iron deficiency anaemia and thalassaemia trait?

Answer 22

Electrophoresis of haemoglobin and iron studies.

Question 23

What do you see in β
thalassemia electrophoresis and why?

Answer 23

Raised Haemoglobin A2 is found where there is a reduction in beta globin chains, caused by β
thalassemia (or trait). Allows more delta chains to be incorporated into hemoglobin and so raised HbA2.

Question 24

Important markers of thalassaemia trait.

Answer 24

Raised RBC and normal mchc.

Question 25

Why do people with anaemia from chronic disease not benefit from iron supplementation?

Answer 25

They have high amounts of iron storage. (high ferritin levels).

Question 26

What causes a reduction in haem?

Answer 26

IRON DEFICIENCY ANAEMIA OF INFLAMMATION/CHRONIC DISEASE

Question 27

What caused a reduction in globin?

Answer 27

THALASSAEMIA

Question 28

What happens to hepcidin in response to iron deficiency anaemia?

Answer 28

Downregulated.

Question 29

What happens to hepcidin in response to anaemia of chronic disease?

Answer 29

Hepcidin is produced.

Question 30

Explain the process of the absorption of vitamin b12?

Answer 30

B12 combines with Intrinsic factor (IF) made in the gastric parietal cells. B12-IF binds to receptors in the ileum.

Question 31

Deficiency in vitamin b12 can be caused by what?

Answer 31

inadequate intake (veganism), inadequate secretion of IF (pernicious anaemia), Malabsorption (coeliac disease), lack of acid in stomach.

Question 32

Lack of vitamin B12 or folic acid causes what?

Answer 32

Megaloblastic anaemia.

Question 33

What else can cause macrocytic anaemia?

Answer 33

Liver disease and ethanol toxicity.

Question 34

What is haemolytic anaemia

Answer 34

Premature destruction of red blood cells.

Question 35

Normal erythrocyte life span?

Answer 35

120 days.

Question 36

An increased blue tinge to the cytoplasm of a red cell is referred to as what?

Answer 36

Polychromasia.

Question 37

What does polychromasia indicate?

Answer 37

A young red blood cell which tells us that there is an increase in erythropoiesis which is a response to haemolysis.

Question 38

What are Reticulocytes?

Answer 38

Reticulocytes are newly produced, relatively immature red blood cells.

Question 39

What does Reticulocytosis indicate?

Answer 39

Reticulocytosis may occur as a response to bleeding or red cell destruction (haemolysis)

Question 40

What will be raised in full blood count is patient has reticulocytosis?

Answer 40

Reticulocytes and MCV. Young red cells are about 20% larger than mature red cells so if there is an increased proportion of young red cells (polychromasia/reticulocytes) in the circulation, the average cell size (MCV) will be increased

Question 41

What are the consequences of red blood cell sickling?

Answer 41

Haemolysis and vaso-occlusion.

Question 42

What causes 'sickling' in sickle cell disease?

Answer 42

Polymerization of hemoglobin S that make red blood cells less flexible.

Question 43

What causes symptoms of anaemia in patients with sickle cell disease?

Answer 43

HbS has a lower affinity for oxygen than HbA.

Question 44

What is the spleen involved in?

Answer 44

* Immune defence * Breakdown and removal of old, malformed or damaged red blood cells.

Question 45

What causes the spleen to no longer work in sickle cell patients?

Answer 45

Repeated splenic vaso-occlusion.

Question 46

What is it called when the spleen no longer works?

Answer 46

Functional hypospleenism.

Question 47

What might you recommend to someone with hypospleenism?

Answer 47

Antibiotics. Might also recommend immunisations.

Question 48

Why does polycythaemia happen?

Answer 48

Too little plasma. Blood becomes too thick.

Question 49

What does polycythaemia increase the risk of?

Answer 49

Thrombosis.

Question 50

What are raised in a patient with polycythaemia?

Answer 50

Hb, Hct and RBC.

Question 51

What is infectious mononucleosis?

Answer 51

Swollen lymph glands, fever, sore throat. Resulting from Epstein‒Barr virus infection.

Question 52

What is seen on the blood film of a patient with Infectious Mononucleosis?

Answer 52

Scalloped margins and ‘hugging’ of the surrounding red blood cells. Lymphocytes that have intensely basophilic (blue) cytoplasm.

Question 53

What do we see on the blood film of a patient with CLL?

Answer 53

Smear cells. Lymphocytes.

Question 54

What helps confirm diagnosis of CLL?

Answer 54

Flow cytometry. Profile of cell surface markers expressed by lymphocytes.

Question 55

How can blast cells be recognised?

Answer 55

Large size, high nucleus/cytoplasmic ratio.

Question 56

Why does the philadelphia chromosome leads to CML?

Answer 56

BCR::ABL1 gene on philadelphia chromosome encodes a protein with uncontrolled tyrosine kinase activity, which gives rise to leukaemic clone.

Question 57

How can you treat CML?

Answer 57

Tyrosine kinase inhibitors. These block tyrosine kinase and so there is no signal for cell to divide.

Question 58

CML key symptom?

Answer 58

Splenomegaly.

Question 59

How do you differentiate acute lymphoblastic leukaemia and acute myeloid leukaemia on a blood film?

Answer 59

Cytoplasm in blasts of AML contain granules. Very irregular shape of the nuclei seen in acute lymphoblastic leukaemia.

Question 60

What is pancytopenia?

Answer 60

Deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

Question 61

What kind of cells do you see on blood film of acute myeloid leukaemia?

Answer 61

Myeloblasts, Nucleated red blood cell

Question 62

What kind of cells do you see on blood film of chronic myeloid leukaemia?

Answer 62

Increased granulocyte precursors: myelocytes and metamyelocytes (‘left shift’).

Question 63

Test for infectious mononucleosis?

Answer 63

Monospot test or looking for IgM antibodies to Epstein-Barr Virus (EBV).

Question 64

Metabolic effects of leukaemia?

Answer 64

High levels of uric acid and renal failure

Question 65

What is a specific indicator of bacterial infection seen in neutrophils on blood film?

Answer 65

Presence of clear vacuoles within the cytoplasm of the neutrophils.

Question 66

How to optimise image when using a light microscope?

Answer 66

Step 1: Focus the image. Step 2: Focus the condenser. Step 3: Adjust the field iris. Step 4: Adjust the condenser iris.