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Paediatrics > Haematology > Flashcards

Haematology Flashcards

1
Q

Screening tests for bleeding disorder?

A

Bleeding time bt(normal 3-7 min) / PFA platelet function assay ( mostly preferred )

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2
Q

Screening tests for thrombocytopenia?

A

Platelet count

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3
Q

Screening tests to assess bm function? (3)

A

-Hb
-Wcc
- smear

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4
Q

Screening tests for extrinsic pathway?

A

Prothrombin time pt (vitamin K )
Factors tissue factor, VII, vit K dependent factors ( 2,7, (9), 10)

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5
Q

Screening tests for intrinsic pathway?

A

Aptt

Factors 8, 9, 11, 12

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6
Q

Screening tests for platelet function?

A

Platelet aggregation test

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7
Q

Diagnostic tests for haemophilia?

A

Factor viii /ix levels

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8
Q

What does it mean if large platelets in patient presenting with bleeding?

A

Peripheral destruction

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9
Q

Name 4 causes increased bleeding time (>7 minutes)

A

• Thrombocytopenia,
• platelet dysfunction (qualitative platelet disorder)
• Von willebrand disease
. Aspirin

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10
Q

Name 6 causes prolonged pt (<12 sec, neonate 12 -18 sec)

A

Defect Vit K dependent factors
• haemorrhagic disease of newborn
. Malabsorption Vit K deficiency
. Liver disease
• DIC
. Oral anticoagulants eg warfarin
• rat poison

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11
Q

Name 4 causes prolonged APTT activated partial thromboplastin time

A

Test intrinsic and common pathway
• haemophilia A and B (factors 8 and 9)
• Von willebrand disease (carrier protein for factor 8, and glue to keep platelets together)
• heparin
• DIC

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12
Q

Name 4 causes prolonged tt thrombin time

A

Test fibrinogen to fibrin conversion
- DIC
- hypofibrinogenemia
- heparin
- uremia

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13
Q

Name 6 vascular/non-haem causes bleeding

A
  • Child abuse
  • vasculilits
  • other trauma
  • ulcer
  • varices
  • polyps/tumours
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14
Q

How classify haematologic causes bleeding?

A

Thrombocytopenia vs coagulopathy

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15
Q

Name 4 causes primary thrombocytopenia

A

Increased peripheral destruction (large platelets)
• ITP (most common!)
• neonatal isoimmune
• wiscott - Aldrich syndrome

decreased platelet production (small platelets)
• tar syndrome (, absent radii)

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16
Q

Name 10 causes secondary thrombocytopenia

A

Decreased production
• Bone marrow failure: aplastic anaemia
• INFECTION: CMV, EBV, HCV, HIV, mumps, parvovirus B19, rickettsia, rubella, VZV
• Malignancy
- bone marrow suppression: chemo, radiation, meds
- nutritional deficiency: B12, folate

Increased peripheral destruction (large platelets)
• DIC/ severe sepsis
. HUS (haemolytic uraemic syndrome), TTP (thrombotic thrombocytopenic purpura)
- Drug induced
• HIV, CMV, EBV, HCV, Mumps, parvovirus b19, rickettsia, rubella, VZV
- Autoimmune eg SLE, anti phospholipid syndrome, sarcoidosis
• mechanical: artificial veins, aortic valve, mechanical valve, extracorporeal bypass

Sequestration (abnormal distribution)/other
. Hypersplenism eg distributional thrombocytopenia
. Haemangioma (kassabach merrit)
- chronic alcohol abuse
- dilutional thrombocytopenia: haemorrhage, excessive crystalloids
- liver disease: cirrhosis, fibrosis, PHT
- PHT

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17
Q

Name 3 causes primary coagulopathy

A
  • Von willebrand disease
  • haemophilia
  • platelet function defect
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18
Q

Name 7 causes secondary coagulopathy

A
  • DIC
  • anticoagulant
  • vit K deficiency (neonate)
  • hepatic failure
  • renal failure
  • maternal anticonvulsants
  • rat poison
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19
Q

Usual symptom thrombocytopenia?

A

Mucocutaneous bleeding

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20
Q

Usual findings peripheral blood smear in thrombocytopenia due to decreased platelet production? (2)

A

Small platelets, high MCV

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21
Q

Name 3 types microcytic (mcv < 80 ) anaemias and how to diagnose

A

DO serum iron studies
• iron deficiency anaemia.: low iron and ferritin (stores iron), high TIBC (total iron binding capacity) (rdw high)
• thalassaemia minor: Mentzer index MCV: RBC <13 ( abnormal hb) (rdw normal )
• anemia of chronic disease component plus iron deficiency: low-normal iron, low- normal ferritin, low tibc (rdw normal )
• lead poisoning (rdw normal )

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22
Q

Define anaemia

A

Not enough healthy red cells to carry oxygen to organs
Or
Reduced hb per unit volumeof blood

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23
Q

Name 7 types normocytic (mcv 80 - 100 ) anaemias and how to diagnose

A

Do reticulocyte count.

Low <2%
→ hypoproliferative
• aplastic anaemia
• pure red cell aplasia
• other marrow failure syndromes: ineffective haematopaesis eg myelodysplastic syndrome
• infections
• protein-calorie malnutrition (rdw normal )
• inflammatory disorders
→ infiltrative
• leukaemias

High 2% (hyperproliferative)
→ haemorrhage: parasites, git abnormalities (rdw normal )
→ haemolysis
• Acquired: rh/abo, autoimmune (rdw high )
• Hereditary: spherocytosis (rdw normal ), enzyme defects, haemoglobinopathies (rdw high )

Anaemia of chronic disease: chronic inflammation, ckD, malignancy, endocrine deficiency, liver disease, malnutrition with early iron/folate deficiency (rdw high )

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24
Q

Name 7 types macrocytic (mcv > 100 ) anaemias and how to diagnose

A

Do blood smear and look at macrocytes

Megaloblastic oval macrocytes and segmented neutrophils
• vit b12 deficiency (pernicious anaemia, ileal disease, poor intake). (rdw high )
• Folate deficiency (dietary, alcoholics, coeliac disease, increased cell turnover, phenytoin, methotrexate, sulfasalazine) (rdw high )

Non-megaloblastic round macrocytes: ALARMS
• physiological anaemia of the newborn (rdw normal )
• haemolysis (rdw high )
• myelodysplastic syndrome, myeloproliferative disease (rdw normal )
• Liver disease: cirrhosis (rdw normal )
• congenital bone marrow failure syndromes: Aplastic anaemia of bone marrow infiltration (rdw normal )
• hypothyroidism, reticulocytosis (haemolysis, haemorrhage) (rdw normal )

25
Q

Name 4 important factors needed for normal erythropoeisis

A

• DNA synthesis: require B 12, folate (megakaryocyte erythroid progenitor MEP → proerythroblast → early erythroblast)
• erythropoietin (proerythroblast → early erythroblast)
• hormonal influence: thyroid, androgens (intermediate → late erythroblast → nuclear extrusion)
• iron incorporation: require copper, pyridoxine B6 (late erythroblast → nuclear extrusion →reticulocyte)

26
Q

Cause low RDW?

A

RBC uniform in size
Eg thalassemia

27
Q

Cause high RDW?

A

High variation in size of RBC: nutritional cause

28
Q

What is Mentzer index and how interpret?

A

MCV / RBC
Use if microcytic anaemia to determine cause
>13 Iron deficient
<13 thalassaemia trait

29
Q

What is in cryoprecipitate

A

FFP but rich in fibrinogen

30
Q

Name 8 common indications blood transfusion

A

• Trauma/surgery
• oncology
• severe symptomatic acute anaemia
• thrombocytopenia and platelet disorders, symptomatic and bleeding
• exchange transfusions (neonates, very high bilirubin)
• DIC → FFP
• haemoglobinopathies eg thalassemia major every 3 weeks, symptomatic sickle cell disease
• hypofibrinogenemia → cryoprecipitate

31
Q

Name 7 acute complications blood transfusion

A

Non infections
. Acute haemolytic reactions
- allergic /anaphylactic reactions
- metabolic derangements
- transfusion related ALI

Infections
-HIV
- hep B
- hep C

32
Q

Name 3 delayed complications blood transfusion

A
  • Iron overload
  • delayed haemolytic reaction
  • transfusion associated graft vs host disease
33
Q

Name 3 broad causes anemia

A

• Impaired production by bone marrow
• Blood loss
• Haemolysis

34
Q

Name 3 causes of anemia due to impaired production by bone marrow in the newborn

A
  • Infections: torch, HIV
  • red cell aplasia
  • congenital leukemia
35
Q

Name 8 causes of anemia due to impaired production by bone marrow in infancy and pre -school

A

• Iron deficiency
• PEM
• folate deficiency
An infection
• acquired (infection, idiopathic, drugs)
• Fanconi’s
. Acute leukaemia
• solid tumours

36
Q

Name 10 causes of anemia due to impaired production by bone marrow in late childhood

A
  • Iron deficiency
  • folate deficiency
  • vitamin B 12 deficiency!
    -Infection
  • systemic disease!
  • acquired (infection, idiopathic, drugs)
  • Fanconi’s
  • acute leukaemia
  • lymphoma!
  • solid tumours
37
Q

Name 4 causes of anemia due to blood loss in the newborn

A

Feto-maternal
- twin-twin

Cord
- cephalhaematoma
- haemorrhagic disease

Blood sampling

38
Q

Name 2 causes of anemia due to blood loss in infancy and preschool

A
  • Gastrointestinal: malformations, polyps, parasites
  • platelet / coagulation abnormalities
39
Q

Name 3 causes of anemia due to blood loss in later childhood

A
  • Gastrointestinal: ulcer!, malformations, parasites
  • urogenital eg bilharzia!
  • platelet/coagulation abnormalities
40
Q

Name 4 causes of anemia due to haemolysis in the newborn

A
  • Rh/abo!
  • infection
  • hereditary
    →Spherocytosis
    → G6PD deficiency
41
Q

Name 4 causes of anemia due to haemolysis in infancy and preschool

A

-Infection: malaria!
- autoimmune!
- hereditary
→ spherocytosis
→ G6PD deficiency

42
Q

Name 6 causes of anemia due to haemolysis in later childhood

A
  • infection: malaria
  • autoimmune
  • hereditary
    → spherocytosis
    → G6PD deficiency
    → hb- pathies!
    → thalassaemia!
43
Q

Approach to anaemia in newborn? (8)

A

Do reticulocytes

  • high >5%
    → blood loss
    > acute: placenta, internal organs, DIC
    > chronic: felo-maternal, twin-twin, cephalhaematoma, hereditary bleeding disorder
    → haemolysis: do direct Coombs test
    > positive: Rh /abo
    > negative: infections (bacterial, torches, HIV), hereditary haemolytic anemia, spherocytosis, G6PD
  • low <%
    → hypoplastic anemia
    > acquired: infection/drug related
    > congenital: red cell aplasia
44
Q

Which blood component is raised in iron deficiency anaemia?

A

Transferrin (tibc)
Serum iron and ferritin low

45
Q

Which blood component is raised in anaemia of infection?

A

Ferritin
Serum iron and transferrin low

46
Q

Name 5 nb causes high neutrophils

A
  • Physiological: newborns
  • infections: bacterial, fungal
  • drugs: steroids
  • Haematological /neoplastic: haemolytic anaemias
  • miscellaneous: diabetic acidosis
47
Q

Name 5 nb causes high monocytes

A
  • Physiological: recovery phase acute infections
  • infections:
    → Tb
    → subacute bacterial endocarditis, congenital syphilis
    -Haematological/neoplastic: Hodgkin’s lymphoma
  • miscellaneous: connective tissue disorder
48
Q

Name 5 nb causes high lymphocytes

A
  • Physiological: early childhood 1 month - 4 years
  • infections: viral! (Eg infectious mononucleosis, CMV, whooping cough…)
  • haem/neoplastic:
    → lymphomas
    → neutropenia’s
  • Miscellaneous: thyrotoxicosis
49
Q

Name 5 nb causes high eosinophils

A
  • Physiological: recovery from shock/infection
  • infections: parasitic! ( eg ascariasis, strongyloidiasis, ankylostomiasis, trichinosis…)
  • drugs: hypersensitivity reaction eg penicillin
  • Haem /neoplastic: metastatic tumours
  • misc: allergic disorders!
50
Q

Expected level of disorder and clinical diagnosis in pt presenting with pelechiae, superficial ecchymosis, mucous membrane bleeding? (4)

A

platelets and blood vessels

  • Platelet quantitative defect eg ITP
  • platelet qualitative defect eg drugs
  • scurvy, vasculitis etc
51
Q

Expected level of disorder and clinical diagnosis in pt presenting with palpable purpura? (3)

A

Blood vessels

  • Hypersensitivity
  • vasculitis eg Henoch - schonlein purpura
52
Q

Expected level of disorder and clinical diagnosis in pt presenting with haemarthrosis, deep ecchymosis, with or without mucous membrane? (3)

A
  • Coagulation factors (viii, ix )
  • haemophilia A and B
  • Von Willebrand’s disease
53
Q

How should pancytopenia be further investigated?

A

Bone marrow aspiration

54
Q

What type of anaemia is iron deficiency?

A

Microcytic hypochromic

55
Q

Identify and define picture 19

A

Petechia
Non blanching lesions <2mm

56
Q

Identify and define picture 20

A

Left: petechiae - non blanching lesion < 2 mm
Right: purpura - group of adjoining petechia

57
Q

Identify and define picture 21

A

Left: echymosis - isolated lesions larger than petechia
Right: haematoma - raised echymosis

58
Q

Identify picture 22 and name cause

A

Left: Osler node (pulp of fingers and toes, painful, immune mediated)
Right: janeway lesion

Infective endocarditis

Paediatrics (15 decks)

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