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Haematology Flashcards

0
Q

Types of macrocytic anaemia and tests

A
  • vit B12 deficiency : serum B12 level
  • folic acid deficiency : RBC folate level
  • liver disease : liver function tests
  • drugs (ARVs)
  • hypothyroidism

Vit b12/ folate deficiency - megaloblastic anaemia

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1
Q

Causes of vit B12 deficiency

A
  • lack of animal product in diet (vegans)
  • pernicious anaemia (lack of IF)
  • gastrectomy
  • stagnant loop
  • tropical sprue
  • ileal resection
  • crohns disease
  • congenital metabolic defects
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2
Q

Types of normocytic anaemia and tests

A
  • anaemia of chronic disease : iron studies
  • renal disease : serum urea and creat
  • haemolytic anaemia : blood film morphology, reticulocyte count
  • BM failure
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3
Q

Types of microcytic anaemia and tests

A
  • iron deficiency : iron studies
  • thalassemia : Hb studies
  • sideroblastic anaemia : BM for ring sideroblasts
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4
Q

Clinical features of anaemia

A
  • tiredness
  • fainting
  • pallor
  • tachycardia
  • SOB
  • weakness
  • palpitations
  • headaches
  • intermittent claudication
  • confusion
  • bounding pulse
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5
Q

Causes of folic acid deficiency

A
  • nutritional
  • malabsorption (crohns, jejunal resection)
  • excess utilization (pregnancy, lactation)
  • excess urinary loss
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6
Q

Causes of iron deficiency anaemia

A
  • chronic blood loss (peptic ulcer, heavy menses)
  • increased demand (preg, premature infants)
  • malabsorption (gastrectomy)
  • undernutrition (poverty)
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7
Q

Causes of raised reticulocyte count

A
  • haemorrhage
  • haemolysis
  • response to treatment of anaemia
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8
Q

Types of hereditary haemolytic anaemia a

A
  • membr disorders (HS)
  • haemoglobinopathies (sickle)
  • enzyme defects (G6PD)
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9
Q

Types of acquired haemolytic anaemias

A
  • immune (auto)
  • mechanical (fragmentation syndromes)
  • infections (malaria)
  • drugs (dapsone)
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10
Q

Lab tests for sickle cell anaemia

A
  • Hb electrophoresis

- suckling test

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11
Q

Tests done in iron studies

A
  • serum iron
  • transferrin
  • ferritin
  • % saturation
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12
Q

Definition of anaemia

A

A blood Hb concentration below the normal range for age and sex of patient

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13
Q

Sources of vit B12

A

Meat
Fish
Dairy

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14
Q

Primary haemostasis

A

The formation of the platelet plug at the site of vessel injury

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15
Q

Secondary haemostasis

A

The series of enzymatic reactions in the coag cascade leading to formation of the stable fibrin clot

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16
Q

2 red cell metabolic pathways

A
  • embden-meyerhoff

- hexose mono phosphate shunt

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17
Q

Characteristics of embden-meyerhoff pathway

A
  • anaerobic glycolytic
  • metabolized to lactate and ATP
  • ATP provides energy for maintenance of vol, shape and flexibility
  • pyruvate kinase
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18
Q

Characteristics of hexose mono phosphate shunt

A
  • aerobic glycolytic
  • produces NADPH and reduced glutathione
  • protects red cell against oxidative stress
  • G6PD
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19
Q

Causes for increased EPO production

A
  • anaemia
  • low atmospheric O2
  • defective CVS/pulm function
  • decreased renal circulation
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20
Q

What influences the clinical features of anaemia?

A
  • speed of onset
  • severity
  • age
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21
Q

RBC parameters in FBC

A
  • red cell count
  • Hb
  • haematocrit
  • MCV (mean cellular vol)
  • MCH (mean cellular Hb)
  • MCHC (mean cellular Hb conc)
  • red cell distribution width
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22
Q

Causes of anaemia

A
  • decreased production of red cells
  • increased destruction of red cells
  • loss of red cells due to bleeding
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23
Q

Components of anaemia work up

A
  • onset
  • reticulocytes
  • size of red cells
  • peripheral blood smear
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24
Landsteiner's theory
If A or B antigen is present on a red cell, the opposite antigen will be found in serum
25
Functions of blood
- carry O2 - maintain acid-base equilibrium - transport of nutrients and hormones - transfer of waste products to liver and kidneys - coagulation - immune surveillance - participation in inflam and tissue repair
26
Toti potent stem cells
Trophoblast, placenta and embryo
27
Pluripotent stem cells
Differentiate into all 3 germ layers
28
Multi potent stem cells
Haematopoietic stem cells
29
Functions of the spleen
- pooling - culling - pitting - filtering - immune
30
Types of leukocyte disorders
- myoproliferative - myelodysplastic - lymphoproliferative
31
Haematopoiesis is a complex structure of
- immature and differentiated myeloid and lymphoid lineages - marrow micro environment - biological cell modifiers - myeloid metaplasia into other organs
32
Evidence of Hb breakdown
- jaundice - decreased plasma haptoglobin - increased plasma LDL - haemosiderin in urine
33
How diagnosis of thalassemia is made
- microcytic hypo chromic anaemia - normal iron stores - Hb electrophoresis shows proportional increase in Hb F and A2
34
Therapy for thalassemia
- blood transfusions - iron chelation - stem cell transplantation
35
Components of normal haemostasis
- bvs - platelets - coagulation factors - coagulation inhibitors - fibronolysis
36
Stages of haemostasis
- vessel injury - vasoconstriction - platelets adhere and aggregate - coag system activates and forms fibrin mesh - clot dissolution by fibronolysis - endothelial repair
37
Platelet agonists
- collagen - adrenalin - ADP - thrombin
38
Process of platelet activation
- shape change - release of granules - synthesis of secondary agonist thromboxane A2 - exposure of procoagulant phospholipids - cross linking with fibrin through gp2b3a
39
Natural inhibitors of platelets
- NO - prostacyclin - ecto-ADPase
40
Anti platelet drugs
- asprin - clopidogrel (ADP receptor agonist) - abxicimab - dioryridamole
41
Von willebrands factor binds
- collagen - platelets - factor 8
42
Process of primary haemostasis
- injury of endo exposes subendo - vWF binds subendo and unravels to linear form - exposes binding sites for adhesive glycoproteins of platelets - platelets adhere and firm adhesion - platelets exposed to agonists and activation - further platelets adhere - cross linking with fibrin and fibrinogen - unstable platelet plug
43
Where are pro-enzymes for coag cascade produced
In the liver
44
What happens in post translational modification of enzymes of coag cascade?
- 2nd carboxyl group added to glutamic acid residues
45
Role of co-factors in coag cascade
- facilitate interaction of enzyme and substrate on phospholipid surface - need calcium
46
Structure of fibrinogen
- central globular domain with 2 lateral short tails - short peptide chains extend out of globular domain - fibrin formed when these are cleaved off - expose sticky site for tails of other fibrin mol to stick to
47
Phases of cell based model
- initiation - amplification - propagation
48
Action of warfarin
- inhibits vit K epoxied reductase enzyme | - vit K trapped in inactive for.
49
Action of heparin
- binds anti thrombin and enhances activity | - reversed by protamine sulphate
50
Lifespan of a red blood cell
120 days
51
Process of erythropoiesis
- haemopoietic stem cell - Burst forming unit erythroid - colony forming unit erythroid - pronormoblast - mature in BM and nucleus extrudes - released as reticulocytes
52
Where EPO produced
Peritubular interstitial cells of kidney and 10%liver
53
Clues to sudden onset anaemia
- hemodynamic instability - comparisons with previous FBC results - history of overt blood loss
54
Structure of a reticulocyte
- red cell at stage where lost nucleus but still has residual RNA - stain blue-gray with supravital stain - if many are present, term polychromasia used
55
Why reticulocyte count is usefulness
- normally if Hb is low, EPO drived BM to prod more red blood cells - if reticulocyte count not increased in patients with anaemia, could mean BM not working or EPO synthesis impaired
56
Definition of ansiocytosis
Difference in sizes of RBC
57
Appearance of megaloblastic anaemia
- ansiocytosis - oval macrocytes - hyper segmented neutrophils
58
Purpose of indirect antiglobulin test
Detects free antibodies in serum
59
Process of IAT
- recipient's serum obtained - donor's blood sample added - recipients Igs that target donor's RBCs form antibody/antigen complexes - anti-human Igs (Coombs antibodies) are added - if positive, agglutination of RBCs occurs because human Igs attached to RBCs
60
Genetic change in sickle cell
Substitution of valine for glutamic acid on Hb chain
61
Chromosome affected in thalassemia
Chromosome 11
62
How G6PD deficiency is diagnosed
- bite and blister cells - Heinz bodies - fluorescence spot test - ascorbate cyanide test
63
Pathophysiology of hereditary spherocytosis
- autosomal dominant - defect in protein spectrin - involved in interaction between membrane skeleton and lipid bilayer of RBCs - loss of membrane
64
Causes of spherocytosis
- autoimmune haemolytic anaemia - hereditary spherocytosis - clostridium infection
65
Describe the absorption of vit b12
- dietary vit B12 combines with intrinsic factor | - complex binds with specific receptor in the distal ileum

End Of Year (12 decks)

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