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Haematology Flashcards

1
Q

What is flow cytometry?

A

Tests for types of proteins on surface of the cell, size + complexity ie type of cell

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2
Q

What’s the difference between serum and plasma

A

Plasma = coag factors and protein rich
Serum = no coag factors and proteins (clot using them up)

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3
Q

What does haematocrit refer to

A

The % of RBC’s column over total

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4
Q

Causes of low reticulocyte count

A

Iron def
Marrow diseases
Lack of erythropoietin
Decreased O2 consumption
Ineffective erythropoeisis
Chronic inflam or malig disease

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5
Q

Causes of neutropenia

A

> increased destruction = hyperspace sim, immune mediated destruction
decreased production = bone marrow failure (aplastic anaemia, chemo, acute leukaemia), specific neutrophil dysfunction (congenital/ drug induced)

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6
Q

Causes of neutrophil leukocytosis

A

> bacterial infection
tissue necrosis
pregnancy
acute haemorrhage
drugs
asplenia

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7
Q

What is a leukaemoid reaction

A

When mature and immature leukocytes are found in the peripheral blood in response to a severe infection

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8
Q

Causes of leukoerythroblastic blood film (nuclei in RBC’s)

A

> acute/chronic myeloid leukaemia
severe megaloblastic anaemia
myeloma/lymphoma
Severe haemolysis
primary myelofibrosis

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9
Q

Causes of eosinophilia NB

A

> allergic disease
parasitic disease
recovery from acute infection
certain skin diseases eg psoriasis
drug sensitivity
metastatic malignancy

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10
Q

What’s the difference between chronic and acute leukaemia

A

Acute - immature cells proliferate (aggressive)
Chronic - mature cells don’t die

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11
Q

What pattern of bleeding does thrombocytopenia give you

A

Mucocutaeous bleed (gums, nose etc)

Joint/muscle bleed = coag factor deficiency

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12
Q

Causes of deranged platelet counts

A

Thrombocytopenia
> decreased production
>increased destruction
>hypersplenism
>dilutional

Thrombocytosis
>reactive (acute haemorrhage, chronic infections, post splenectomy
>endogenous (myeloproliferative disorders)

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13
Q

Indications for bone marrow aspiration NB

A

> unexplained cytopenias
lymphoma staging
suspecting infiltration by TB or malignancy
leukaemia follow ups

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14
Q

Risk factors for thrombosis

A

Increased age
Pregnancy
Surgery

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15
Q

Arterial thrombosis risk factors

A
  • male
  • hyperlipidaemia
  • family history
  • diabetes
    -hypertension
  • gout
  • smoking
  • polycytaemia
  • lupus
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16
Q

Venous thrombosis risk factors

A

VIRCHOWS TRIAD
- age
- obesity
- lupus
- immobility
- lupus
- trauma
- surgery
- hormone replacement therapy
- previous thrombosis

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17
Q

What’s ironic about antiphospholipid syndrome

A

High PTT when tested in the lab, but the patient thrombosis

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18
Q

What are the symptoms of paroxysmal nocturnal haemaglobinuria

A

> dark urine in the morning from haemolysis
fatigue, dizziness, blood clots
can lead to aplastic anaemia

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19
Q

What tests would you run for a thrombophilia screen?

A

> FBC (platelets), diff and smear (fragments)
Clotting profile
Vit K
aPTT and PT (lupus antibody)
ESR (inflammation)
APS = antiphospholipid screen
thrombin time
Fribrinogen
antithrombin, protein C and s
PNH screen (paroxysmal nocturnal haemaglobinuria)

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20
Q

How long do you treat a patient who has clotted?

A

Provoked =3 months
Unprovoked = lifelong

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21
Q

Who do you test and who do you not test for thrombophilia?

A

TEST
>VTE in unusual location, unprovoked
>DVT/PE high risk of recurrence

CONSIDER
>VTE pt request
>family of strong thrombophilia in index pt
>arterial thrombosis in young, unexplained

NO TEST
>pregnancy loss (UNLESS >2 MISCARRIAGES >15 WEEKS →antiphospholipid)

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22
Q

What are the strong thrombophilia?

A

APLS
Protein C def
Protein S def
Antithrombin def

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23
Q

What do you do before you test for thrombophilia?

A

Wells score probability of having a PE or DVT

> 4 = high probability

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24
Q

What’s the difference between therapeutic and prophylactic anticoagulant treatment?

A

Therapeutic dose is higher

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25
How do you treat thrombophilia?
Initiate LMWH parenteral and VitKA (warfarin) = bridging therapy Warfarin also inhibits natural anticoagulants When INR>2 then you can stop LMWH
26
What is a complication of not using bridging therapy?
Warfarin induced Skin necrosis
27
High INR indicates
Longer time to clot (pt bleeds)
28
What are the advantages of direct oral inhibitors?
Fixed dose Few drug/food interactions No monitoring No need for bridging
29
What are disadvantages of direct oral inhibitors?
No reversal agents Can’t miss a dose as short acting Hepatic and renal effects Less experience
30
What are the advantages of warfarin?
Long acting Reversible Long experience Monitoring encourages compliance Safe in renal failure
31
Disadvantages of warfarin
Monitoring frequency Food and drug interactions Variable dose Narrow therapeutic range Slow onset
32
What is heparin induced coagulopathy and treatment
Heparin binds to platelet factor and forms complex (removes platelets from plasma) Antibodies attack complex and activate platelets to form throng = thrombocytopenia with clots If this happens, stop heparin and find alternative.
33
Indications for ordering haemostasis tests?
>to ID pts who are acutely bleeding who have a correctable bleeding tendency >to ID pts with acute clots who have a correctable clotting tendency >monitoring anticoagulant medication >prognostication of liver failure pts >screening for DIC
34
Why do you need to fill the citrate tube to the top?
So that the ratio of plasma to anticoagulant is 1:9
35
What are the conventional tests for haemostasis?
Platelet count PTT PT/INR Fibronogen D-dimer
36
What may cause pseudothrombocytopenia?
Platelet trapping clots in tube from not mixing properly EDTA dependent agglutinates
37
Causes of thrombocytosis? NB
Reactive: infection, post-surgery, post-splenectomy,malignancy, acute blood loss Myeloproliferative
38
Causes of thrombocytopenia?
Decreased production: bone marrow disease, nutritional deficiencies Increased destruction: autoimmune disease, DIC, medications, alcohol, HIV Hypersplenism
39
Isolated increased PT/INR indicates…
VII deficiency
40
Increased INR + other coagulation abnormalities could be …
Vit K deficiency Vit K antagonist Malabsorption Liver disease Dilutional coagulopathy High conc unfractionated heparin
41
How to prepare sample for PT measurement
>centrifuge >discard RBC’s >add calcium, thromboplastin (phospholipid and tissue factor) >fibrin clot
42
How to conduct aPTT test in lab?
>centrifuge >remove RBC’s >add calcium, partial thromboplastin (phospholipid with no tissue factor) and silica =activating agent >fibrin clot
43
Causes for isolated elevated aPTT
Factor XII, XI, IX and VII deficiency Contact factor deficiency Acquired clotting factor inhibitors
44
Prolonged aPTT and PT
Vit K deficiency Liver disease due to malabsorption, decreased synthesis of clotting factors, DIC Multiple clotting factor deficiencies Direct thrombin inhibitors Dilutional coagulopathy
45
Causes of increased PTT +- increased PT
UFH Antiphospholipid antibodies Acquired clotting factor inhibitors
46
What causes high fibrin levels?
Acute phase reactant Pregnancy
47
What causes low fibrin levels?
Liver failure (synthesised in the liver) DIC
48
What is mixing studies and how does it help?
Take pt plasma and normal pt plasma and mix them. If clotting corrects then factor deficiency. If it doesn’t correct then there is a factor inhibitor. Helps decide treatment
49
What is D-dimer?
A fibrin degradation product.
50
Causes of high D-dimer
PE DVT Arterial clot Severe sepsis Malignancy Recent surgery or trauma Liver disease Pregnancy DIC
51
Reasons for an artefactual abnormal result?
Pts haematocrit Pt fasting state Time between sample collection and test Concentrate of citrate in tube
52
Define blood transfusion
Safe transfer of blood components from a donor to a recepient
53
What is acute normovolaemic haemodilution?
Remove blood from pt once under anaesthesia and replace with acellular fluid. Return as detected by intracellular loss.
54
How is platelet rich plasma formed?
4 huffy coat units and 1 plasma unit
55
Pre-transfusion tests of recipient?
Crosshatch ABO and are blood ground Antibody screen
56
Red cell concentrate indications
Acute blood loss Anaemia symptomatic Obs haemorrhage Surgery
57
Platelet transfusion indications
Bone marrow failure Massive transfusion Acute DIC Congenital disorders of platelets
58
Contraindications of platelet transfusion
Immune thrombocytopenia unless bleeding Thrombotic thrombocytopenia purpura Heparin induced thrombocytopenia
59
FFP indications
Replacement of inherited single factor deficiencies Multiple coag deficiency Thrombotic thrombocytopenia purpura Reversal of warfarin if active bleeding Vit K deficiency Haemolytic disease of the newborn
60
What is leukodepletion?
Removal of majority of WBC’s from transfused blood products
61
Indications for leukodepletion
Pts on chronic transfusion regimens Risk of CMV infection (intracellular) Organ and stem cell transplant patients Infant <1y Pts undergoing cardiac surgery
62
What is gamma-irradiation
Kills off T lymphocytes to prevent graft vs host disease
63
Indications for gamma irradiation
Transfusion from relatives HLA matched platelets Intrauterine transfusions Exchange transfusion Congenital immunodeficiency states Post allogenic transplants Hodgkin lymphoma Pts treated with purine analogue
64
Early complications of blood transfusions
Haemolytic reaction Anaphylaxis bacterial contamination Allergic reaction Febrile non-haemolytic transfusion Electrolyte imbalances Transfusion related acute lung injury
65
Late complications of blood transfusion
Graft vs host disease Purpura Alloimmunisation Transmission of infection
66
Clinical features of haemolytic anaemia
Anaemia Jaundice Splenomegaly Ankle ulcers(sickle cell) Pigment gallstones Bone expansion in children due to marrow expansion
67
Lab features of haemolytic anaemia
→/↑ Hb ↑ unconjugated bilirubin ↓ Haptoglobin ↑ LDH ↑reticulocytes Increased urin + plasma Hb
68
How can you measure lifespan of RBC’s
Radioactive chromium labelling
69
Causes of intravascular haemolysis
Mismatched blood transfusion Red cell fragmentation syndromes Autoimmune haemolytic anaemia Drug/infection induced G6PD deficiency
70
Hereditary spherocytosis
Abnormal RBC membrane proteins = lipid bilateral unsupported = dehydration and K loss
71
Clinical features of hereditary spherocytosis
Increased haemolysis during infection Splenomegaly, mild anaemia, mild jaundice,gallstones, iron overload, lower leg ulcers
72
Lab features hereditary spherocytosis
Hb varies MCHC increased Microspherocytes Polychronasia Osmotic fragility
73
Treatment of hereditary spherocytosis
Folic acid Blood transfusion Splenectomy Cholecystectomy
74
G6PD enzyme deficiency clinical picture
Haemolysis 1-3 days after drug exposure Dark urine, backache Neonatal jaundice Heinz bodies appear and Hb decreases rapidly
75
Lab features G6DP deficiency
Polychromatic Acute ingravascular haemolysis Heinz bodies on supravital staining
76
Management of G6DP deficiency
Stop offending drug Treat infection Transfuse red cells Consider splenectomy
77
What is thalassaemia
Reduced synthesis of alpha or beta glob in chain subunit of Hb
78
Clinical features of thalassaemia
Anaemia Failure to thrive, inter current infection, mild jaundice Iron overload
79
Lab findings thalassaemia
Hypochromic microcytic anaemia Raised RCC Hyper cellular bone marrow
80
Management of thalassaemia
Keep Hb >9-10 Iron chelation therapy Immunise for hep B Splenectomy Bone marrow transplant
81
What is iron stored as in the body?
Haemosiderin and ferritin
82
Iron deficiency vs iron deficiency anaemia
In the latter, there is depletion of the iron stores in the presence of anaemia
83
What is functional iron deficiency?
Insufficient mobilisation of iron for the purpose of erythropoiesis.
84
Iron restricted erthropoiesis
Reduced iron supply for the purpose of erythropoiesis, regardless of the level of iron stores.
85
Symptoms of iron deficiency anaemia
Pallor Fatigue Dizziness Headache Dyspnoea Dry and damaged hair Cardiac murmur Tachycardia Dry and rough skin
86
Lab features of iron deficiency anaemia
Microcytic hypochromic RBC’s Reticulocytopenia Pencil shaped poikilocytes Target cells
87
What does S-ferritin levels tell us
Decreased in iron and Vit C deficiency Increased in chronic disease from haemolysis after organ damage and inflammation
88
What does s-transferrin receptor levels tell us
Increased in iron deficiency anaemia (but not in chronic disease) Influenced by change in rate of erythropoiesis
89
How does reticulocyte haemaglobin content help us?
Decreased in iron deficiency anaemia <27,2 But also in thalassaemia
90
Causes of iron tx failure
Non compliance Continuing haemorrhage Mixed deficiency Another cause Malabsorption Wrong diagnosis
91
Expected response to iron supplements
Increase in Hb by 2g/dl every 3 weeks
92
What is iron refractive iron deficiency anaemia
Inherited disorder of both absorption and utilisation of iron Partially responsive to parenteral, nonresponsive to oral
93
Causes for macrocytosis
Pregnancy Reticulocytosis Alcohol Smoking Liver disease Myxoedema Myeloma Cytotoxic drugs
94
What are the effects of VitB12 deficiency and folate deficiency?
Megaloblastic anaemia Macrocytosis of epithelial cell Neuropathy Sterility Decreased osteoblast activity Neural tube defects in fetus
95
Causes of ViB12 deficiency
Malabsorption >pernicious anaemia >gastrectomy Abuse of nitric oxide Inherited metabolic >impaired ability to transport VitB12 Dietary deficiency
96
Pathophysiology of pernicious anaemia
Autoimmune gastritis = gastric atrophy = reduced acid and intrinsic factor
97
Clinical features of pernicious anaemia
Gradual onset with features of anaemia Mild jaundice Glossitis Angular stomatitis Purpura Reversible melanin pigmentation Progressive neuropathy
98
Lab findings of pernicious anaemia
Low reticulocyte count Oval macrocytes Hypersegmented neutrophils Decreased leukocyte and platelet count
99
Treatment for Vit B12 deficiency
IM hydroxocobalamin 1000micrograms 6 doses over 2-3 weeks and then 1 dose every 3 months
100
Treatment for folate deficiency
5mg oral folic acid daily for 4 months (if chronic condition = lifelong tx)

Chemical Pathology (8 decks)

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