Haematology Flashcards
Acquired risks of VTE? (13)
- Age
- Obesity
- Previous DVT/PE
- Immobilisation
- Major surgery
- Long distance travel
- Mlaignancy
- Pregnancy
- COCP
- HRT
- Anti-phospholipid syndrome
- Polycythaemia
- Thrombocythaemia
Factor V Leiden
- who
- what
caucasian
resistance to Protein C, therefore increased clotting
Inherited risk factors of VTE? (7)
- Antithrombin deficiency
- Protein C deficiency
- Protein S deficiency
- Factor V Leiden
- Prothrombin G20210A
- Lupus anticoagulant
- coag excess - VIII, II, fibrinogen
DVT Prophylaxis
- TED stockings
2. sc LMWH
Treatment of 1st VTE unknown cause?
Warfarin
Action of Heparin?
potentiates antithrombin II
inactivates thrombin
inactivates factors 9, 10, 11
Action of Warfarin?
inhibits reductase enzyme responsible for regenerating Vitamin K
Inhibits synthesis of factors 2, 7, 9, 10
Warfarin side effects?
teratogenicity
Action of Rivaroxiban?
direct inhibitor of factor Xa
Target INR in AF?
2-3
Target INR in recurrent VTE/PE?
2.5 - 3.5
Target INR in mechanical heart valve?
3.5
INR raised >5 no bleeding?
Stop Warfarin, restart when INR
INR raised 5 - 8 and bleeding?
Stop Warfarin, Vit K slowly
Anaemia in men?
Hb
Anaemia in women?
Hb
Symptoms of anaemia? (7)
- fatigue
- dyspnoea
- faintness
- palpitations
- headache
- tinnitus
- anorexia
Leukoerythroblastic anaemia
- what
- morphological features (3)
- causes (4)
- anaemia of white and red cell precursors in the peripheral blood
- marrow infiltration
1. nucleated RBCs
2. myelocytes
3. poikilocytes “tear drop”
Causes
1. haematological malignancies
2. non-haematological malignancies
3. severe infection e.g. miliary TB
4. myelofibrosis
Lab findings of haemolysis (5)
- anaemia
- reticulocytosis
- raised bilirubin
- raised LDH
- reduced haptoglobins
Haemolytic anemia
- what is it?
- types (2)
breakdown of RBCs before their normal lifespan of 120 days
a) inherited
b) acquired 1) immune 2) non-immune
Lab findings auto-immune haemolytic anaemia? (2)
- spherocytes
2. DAT +
Types of non-immune acquire haemolytic anaemia? (2)
- Infection - malaria
2. Micro-angiopathic haemolytic anaemia
Causes of microcytic anaemia? (4)
- IDA
- Anaemia of chronic disease
- Sideroblastic anaemia
- Thalassaemia
Causes of normocytic anaemia? (7)
- acute blood loss
- anaemia of chronic disease
- bone marrow failure
- renal failure
- hypothyroidism
- haemolysis
- pregnancy
Causes of macrocytic anaemia? (7)
- pregnancy
- anti-folates
- hypothyroidism
- reticulocytosis
- B12 or folate deficiency
- cirrhosis
- myelodysplastic syndromes
Causes of neutrophilia (5)
- corticosteroids
- neoplasm
- inflammation
- myeloproliferative disorders
- bacterial infection
Causes of eosinophilia (4)
- parasitic infection
- allergic disease e.g. asthma, RA
- neoplasm
- drug reaction e.g. erythema multiforme
Signs of IDA (5)
- Koilonychia
- atrophic glossitis
- anugular cheilosis
- Plummer-Vinson syndrome
- brittle hair & nails
Features of blood film in IDA? (4)
- microcytic
- hypochromic
- anisocytosis
- poikilocytosis
Causes of IDA? (5)
- blood loss
- increased utilisation e.g. pregnancy
- decreased intake e.g. prematurity, dietary
- decreased absorption e.g. coeliac
- intravascualr haemolysis e.g. MAHA
Pathophysiology of anaemia of chronic disease
- lab findings
- cytokine driven inhibition of RBC production
- cytokines IFNs, TNF, IL1 reduced EPO receptor, and therefore EPO synthesis
- ferritin is HIGH as iron is sequestered in macrophage to deprive invading bacteria of iron
Causes of anaemia of chronic disease (4)
- chronic infection
- vasculitis
- RA
- Malignancy
Sideroblastic anaemia
- what
- causes (4)
- diagnosis
- inability to incorporate iron in to Hb resulting in iron loading
1. myelodysplastic disorders
2. chemotherapy
3. irradiation
4. alcohol excess - ring sideroblasts
Acanthocytes (3)
Abetalipoproteinaemia
liver disease
hyposplenism
Basophilic RBC stippling (3)
accelerated erythropoiesis
- lead poisoning
- liver disease
- haemoglobinopathy
Burr cells (3)
- uraemia
- GI bleeding
- stomach carcinoma
Heinz bodies
Glucose-6-phosphate dehydrogenase deficiency
Howell-Jolly bodies (4)
- post-splenectomy
- hyposplenism
- megaloblastic anaemia
- hereditary spherocytosis
Polychromasia
premature or inappropriate release from bone marrow
High no of reticulocytes
haemolytic anaemia
Low no of reticulocytes
aplastic anaemia
Right shift of white cells (3)
hypermature white cells
megaloblastic anaemia
uraemia
liver disease
Rouleaux formation (3)
paraproteinaemia
myeloma
chronic inflammation
Schistocytes (3)
microangiopathic anaemia
DIC
HUS
Spherocytes (2)
hereditary spherocytosis
autoimmune haemolytic anaemia
Stomacytes (3)
hereditary stomacytosis
high alcohol intake
liver disease
Target cells (4)
IDA
liver disease
hyposplenism
thalassemia
Megaloblastic anaemia
results from inhibition of DNA synthesis during RBC production
Vitamin B12 Deficiency
- causes (2)
- sources
- symptoms (8)
1) dietary
2) malabsorption
- meat, dairy products
- glossitis
- angular chelitis
- irritability
- depression
- psychosis
- dementia
- peripheral neuropathy
- paraesthiasiae
Pernicious anaemia
- what
- test
autoimmune atrophic gastritis with lack of intrinsic factor
Schilling test
Folate deficiency
- causes (4)
- sources
- poor diet
- pregnancy
- malabsorption
- alcohol
green vegetables, nuts
Herditary spherocytosis
- inheritance pattern
- deficiency
- susceptibilities (2)
- Blood film
- Diagnostic test
- Sign
- autosomal dominant
- spectrin deficiency
1) parvovirus B19
2) gallstones - spherocytes
- DAT -ve
- splenomegaly
Hereditary elliptocytosis
- inheritance pattern
- deficiency
- outcome
- autosomal dominant
- spectrin
asymptomatic to hydrops fetalis
G6PD Deficiency
- who
- inheritance pattern
- blood film
- precipitants (3)
- attack
- Mediterranean
- X-linked
- Heinz bodies, bite cells
1) broad beans
2) drugs - anti-malarials, sulphonamides, aspirin
3) acute infection - rapid anaemia and jaundice
Pyruvate kinase deficiency
- inheritance pattern
- clinical features (3)
- autosomal recessive
1. neonatal jaundice
2. splenomegaly
3. haemolytic anaemia
single base mutation in sickle cell anaemia?
GAG - GTG
Glutamine to valine
age of onset of sickle cell anaemia?
3-6 months, coincides with decreasing fetal Hb
features of sickle cell anaemia?
SICKLED MP S - stroke I - infection, Parvovirus B19 C - crises K - kidney necrosis, nephrotic syndrome L - liver, gallstones E - eyes, retinopathy D - dactilitis, impaired growth M - mesenteric ischaemia P - priapism
Clinical features of B thalassemia? (3)
- frontal bossing
- maxillary hypertrophy
- hairs on end skull x-ray
Inherited haemolytic anaemia DAT/Coombs test?
DAT -ve
Acquired haemolytic anaemia DAT/Coombs test?
DAT +ve
Paroxysmal Cold Haemoglobinuria
- what
- cause
- antibodies
autoimmune haemolysis where haemoglobin is present in the urine
virus e.g. measles, syphilis, VZV
Donath-Landsteiner antibodies
Paroxysmal Nocturnal Haemoglobinuria
- what
- pathophysiology
- signs (2)
- test
acquired haemolysis loss of GPI markers of RBCs 1. morning haemoglobinuria 2. thrombosis - Ham's test
Microangiopathic Haemolytic Anaemia
- what
- blood film
- causes (4)
mechanical destruction of RBCs schistocytes 1. HUS 2. TTP 3. DIC 4. pre-eclampsia
Thrombotic Thrombocytopenic Purpura
- what
- pentad of symptoms
- autoimmune platelet activation
1. MAHA
2. fever
3. renal impairment
4. neuro abnormalities
5. thrombocytopenia
Haemolytic Uraemic Syndrome
- cause
- pathophysiology
- who
- symptoms (2)
- E.Coli
- toxin damages endothelial cells
- children & elderly
1. renal impairment
2. diarrhoea
Normal platelet count
150 - 400
Intrinsic pathway of coagulation cascade?
Factor TwelvE EleveN NinE EighT Ten
Extrinsic pathway of coagulation cascade?
Enodthelial damage
Tissue Factor activation
Factor Seven
Ten
Common pathway of coagulation cascade?
Ten
Two
Prothrombin is?
Factor II
Thrombin is?
Factor IIa
Antithrombin
inhibits clotting factors
Phases of clotting cascade? (4)
- initiation
- activation
- propagation and thrombin burst
- stable clot
Inhibitors of clotting cascade? (4)
- Tissue factor pathway inhibitor
- Protein C
- Protein S
- Antithrombin III
Monitoring of intrinsic pathway?
- which drug?
Activated Partial Thromboplastin Time (APTT)
- Heparin
Monitoring of extrinsic pathway?
- which drug?
Prothrombin Time (PT) - Warfarin
Monitoring of common pathway?
Thrombin Time (TT)
Fibrinolysis
- initiated by?
- outcome
- fibrin clot formation
- plasmin lyses fibrin clot in to degradation products
what is TPA?
tissue plasminogen activator
“clot-buster”
Types of bleeding disorders (4)
- vascular defects
- platelet defects
- coagulation disorders
- mixed
Symptoms of vascular and platelet disorders (3)
- superficial bleeding into skin
- bleeding of mucosal membranes
- immediate bleeding after injury
symptoms of coagulation disorders (3)
- prolonged bleeding
- bleeding into deep tissues, muscles, joints
- delayed, severe bleeding after injury
Osler-Weber- Rendu Syndrome
- inheritance pattern
- signs (3)
Hereditary Haemorrhagic Telangiectasia
- autosomal dominant
1. telangiectasia of mucous membranes
2. epistaxis
3. arteriovenous malformations
Ehlers Danlos
- what
- inheritance pattern
- signs
- connective tissue disorder
- autosomal dominant
1. hyper mobility
2. fragile skin
3. arteriovenous malformations
4. valvular heart disease
Acquired vascular defects (4)
- senile purpura
- infection - measles, meningococcal
- steroids
- scurvy - perifollicular haemorrhages
Causes of thrombocytopenia?
- decreased production - Bone marrow failure
2. increased destruction - AITP, drugs
Auto Immune Thrombocytopenia Purpura
- what
- sign and symptoms (2)
antibodies against platelet antigens so platelets are destroyed by splenic macrophages
- petichiae
- menorrhagia