Haematology Flashcards
Screening tests for bleeding disorder?
Bleeding time bt(normal 3-7 min) / PFA platelet function assay ( mostly preferred )
Screening tests for thrombocytopenia?
Platelet count
Screening tests to assess bm function? (3)
-Hb
-Wcc
- smear
Screening tests for extrinsic pathway?
Prothrombin time pt (vitamin K )
Factors tissue factor, VII, vit K dependent factors ( 2,7, (9), 10)
Screening tests for intrinsic pathway?
Aptt
Factors 8, 9, 11, 12
Screening tests for platelet function?
Platelet aggregation test
Diagnostic tests for haemophilia?
Factor viii /ix levels
What does it mean if large platelets in patient presenting with bleeding?
Peripheral destruction
Name 4 causes increased bleeding time (>7 minutes)
• Thrombocytopenia,
• platelet dysfunction (qualitative platelet disorder)
• Von willebrand disease
. Aspirin
Name 6 causes prolonged pt (<12 sec, neonate 12 -18 sec)
Defect Vit K dependent factors
• haemorrhagic disease of newborn
. Malabsorption Vit K deficiency
. Liver disease
• DIC
. Oral anticoagulants eg warfarin
• rat poison
Name 4 causes prolonged APTT activated partial thromboplastin time
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
Name 4 causes prolonged tt thrombin time
Test fibrinogen to fibrin conversion
- DIC
- hypofibrinogenemia
- heparin
- uremia
Name 6 vascular/non-haem causes bleeding
- Child abuse
- vasculilits
- other trauma
- ulcer
- varices
- polyps/tumours
How classify haematologic causes bleeding?
Thrombocytopenia vs coagulopathy
Name 4 causes primary thrombocytopenia
Increased peripheral destruction (large platelets)
• ITP (most common!)
• neonatal isoimmune
• wiscott - Aldrich syndrome
decreased platelet production (small platelets)
• tar syndrome (, absent radii)
Name 10 causes secondary thrombocytopenia
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
Name 3 causes primary coagulopathy
- Von willebrand disease
- haemophilia
- platelet function defect
Name 7 causes secondary coagulopathy
- DIC
- anticoagulant
- vit K deficiency (neonate)
- hepatic failure
- renal failure
- maternal anticonvulsants
- rat poison
Usual symptom thrombocytopenia?
Mucocutaneous bleeding
Usual findings peripheral blood smear in thrombocytopenia due to decreased platelet production? (2)
Small platelets, high MCV
Name 3 types microcytic (mcv < 80 ) anaemias and how to diagnose
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 )
Define anaemia
Not enough healthy red cells to carry oxygen to organs
Or
Reduced hb per unit volumeof blood
Name 7 types normocytic (mcv 80 - 100 ) anaemias and how to diagnose
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 )
Name 7 types macrocytic (mcv > 100 ) anaemias and how to diagnose
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 )
Name 4 important factors needed for normal erythropoeisis
• 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)
Cause low RDW?
RBC uniform in size
Eg thalassemia
Cause high RDW?
High variation in size of RBC: nutritional cause
What is Mentzer index and how interpret?
MCV / RBC
Use if microcytic anaemia to determine cause
>13 Iron deficient
<13 thalassaemia trait
What is in cryoprecipitate
FFP but rich in fibrinogen
Name 8 common indications blood transfusion
• 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
Name 7 acute complications blood transfusion
Non infections
. Acute haemolytic reactions
- allergic /anaphylactic reactions
- metabolic derangements
- transfusion related ALI
Infections
-HIV
- hep B
- hep C
Name 3 delayed complications blood transfusion
- Iron overload
- delayed haemolytic reaction
- transfusion associated graft vs host disease
Name 3 broad causes anemia
• Impaired production by bone marrow
• Blood loss
• Haemolysis
Name 3 causes of anemia due to impaired production by bone marrow in the newborn
- Infections: torch, HIV
- red cell aplasia
- congenital leukemia
Name 8 causes of anemia due to impaired production by bone marrow in infancy and pre -school
• Iron deficiency
• PEM
• folate deficiency
An infection
• acquired (infection, idiopathic, drugs)
• Fanconi’s
. Acute leukaemia
• solid tumours
Name 10 causes of anemia due to impaired production by bone marrow in late childhood
- Iron deficiency
- folate deficiency
- vitamin B 12 deficiency!
-Infection - systemic disease!
- acquired (infection, idiopathic, drugs)
- Fanconi’s
- acute leukaemia
- lymphoma!
- solid tumours
Name 4 causes of anemia due to blood loss in the newborn
Feto-maternal
- twin-twin
Cord
- cephalhaematoma
- haemorrhagic disease
Blood sampling
Name 2 causes of anemia due to blood loss in infancy and preschool
- Gastrointestinal: malformations, polyps, parasites
- platelet / coagulation abnormalities
Name 3 causes of anemia due to blood loss in later childhood
- Gastrointestinal: ulcer!, malformations, parasites
- urogenital eg bilharzia!
- platelet/coagulation abnormalities
Name 4 causes of anemia due to haemolysis in the newborn
- Rh/abo!
- infection
- hereditary
→Spherocytosis
→ G6PD deficiency
Name 4 causes of anemia due to haemolysis in infancy and preschool
-Infection: malaria!
- autoimmune!
- hereditary
→ spherocytosis
→ G6PD deficiency
Name 6 causes of anemia due to haemolysis in later childhood
- infection: malaria
- autoimmune
- hereditary
→ spherocytosis
→ G6PD deficiency
→ hb- pathies!
→ thalassaemia!
Approach to anaemia in newborn? (8)
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
Which blood component is raised in iron deficiency anaemia?
Transferrin (tibc)
Serum iron and ferritin low
Which blood component is raised in anaemia of infection?
Ferritin
Serum iron and transferrin low
Name 5 nb causes high neutrophils
- Physiological: newborns
- infections: bacterial, fungal
- drugs: steroids
- Haematological /neoplastic: haemolytic anaemias
- miscellaneous: diabetic acidosis
Name 5 nb causes high monocytes
- Physiological: recovery phase acute infections
- infections:
→ Tb
→ subacute bacterial endocarditis, congenital syphilis
-Haematological/neoplastic: Hodgkin’s lymphoma - miscellaneous: connective tissue disorder
Name 5 nb causes high lymphocytes
- Physiological: early childhood 1 month - 4 years
- infections: viral! (Eg infectious mononucleosis, CMV, whooping cough…)
- haem/neoplastic:
→ lymphomas
→ neutropenia’s - Miscellaneous: thyrotoxicosis
Name 5 nb causes high eosinophils
- Physiological: recovery from shock/infection
- infections: parasitic! ( eg ascariasis, strongyloidiasis, ankylostomiasis, trichinosis…)
- drugs: hypersensitivity reaction eg penicillin
- Haem /neoplastic: metastatic tumours
- misc: allergic disorders!
Expected level of disorder and clinical diagnosis in pt presenting with pelechiae, superficial ecchymosis, mucous membrane bleeding? (4)
platelets and blood vessels
- Platelet quantitative defect eg ITP
- platelet qualitative defect eg drugs
- scurvy, vasculitis etc
Expected level of disorder and clinical diagnosis in pt presenting with palpable purpura? (3)
Blood vessels
- Hypersensitivity
- vasculitis eg Henoch - schonlein purpura
Expected level of disorder and clinical diagnosis in pt presenting with haemarthrosis, deep ecchymosis, with or without mucous membrane? (3)
- Coagulation factors (viii, ix )
- haemophilia A and B
- Von Willebrand’s disease
How should pancytopenia be further investigated?
Bone marrow aspiration
What type of anaemia is iron deficiency?
Microcytic hypochromic
Identify and define picture 19
Petechia
Non blanching lesions <2mm
Identify and define picture 20
Left: petechiae - non blanching lesion < 2 mm
Right: purpura - group of adjoining petechia
Identify and define picture 21
Left: echymosis - isolated lesions larger than petechia
Right: haematoma - raised echymosis
Identify picture 22 and name cause
Left: Osler node (pulp of fingers and toes, painful, immune mediated)
Right: janeway lesion
Infective endocarditis
