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Haematology Flashcards

1
Q

Summary of Haematology

A 
Blood Cells
Diagnostic tests (4)
Anaemia
Thrombocytopenia
Transfusion
Heritable/Acquired Blood disorders
Haemoglobinopathies
Blood cancers
Obstetric/Paedaitric haematology
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2
Q

What is the term given for the physiological developmental process that gives rise to blood cells?

A

Haematopoiesis

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3
Q

Embyrologically when do the haematopietic cells penetrate aorta –> liver

A

day 27

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4
Q

State the two lineages of blood cells

A

Myeloid

Lymphoid

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5
Q

Which WBC arise from the myeloid lineage

A 
Granulocytes:
Basophil
Eosionophil
Neutrohpil
Macrophage
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6
Q

Broadly, what are the 3 functions of blood cells?

A

02 transport
Immune response
Coaguation (clotting)

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7
Q

What are the 4 diagostic tests which are carried out in Haematology?

A

FBC
Blood film
Coagulation screen
Bone marrow aspirate

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8
Q

The components of the Coagulation screen are…?

A 
Prothrombin Time (PT)
Activated Partial Thromboplastin Time (APTT)
Thrombin Time (TT)
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9
Q

Anaemia = ?

A

Decrease in RBC

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10
Q

How does the body adapt to anaemia?

A

Increase CO/BP/RBC/02 extraction

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11
Q

The 3 classifications of anaemia = ?

A

Microcytic Hypochromic
Normocytic Normochromic
Macrocytic (Megaloblastic)

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12
Q

Which anaemia has low MCV, low MCH and caused by Iron def, thallassaemias, anaemia of chronic D?

A

Microcytic Hypochromic

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13
Q

Which anaemia is caused by haemolysis, acute blood loss, renal D and bone marrow failure?

A

Normocytic Normochromic

Normal MCV, normal pigment but less Hb

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14
Q

Megaloblastic anaemia can be caused by Haematological cancer and what else?

A 
B12/Folate def
Alcohol
Liver D
Drugs
Congenital ab
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15
Q

If Fe2+ def + male, what should you screen for?

A

Bowel Cancer

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16
Q

Haematinic def consist of…?

A

Fe2+ def
Folate def
B12 def

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17
Q

Iron is stored in liver by what protein?

A

Ferritin

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18
Q

List common causes of Fe2+ def in kids, young women etc.

A 
Kids:
Malnutrtion/Malabsorption/Growth
Women:
Menstrual problems
Preg
GI:
Ulcers, Diverticula, Bowel cancer
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19
Q

Veganism, Gastric/SI problems can lead to what type of def?

A

B12 def

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20
Q

What is a complication of B12 def?

How does it present?

A

SACDC
Subacute Combinded degeneration of the Cord

Peripheral neuropathy, numbness/weakness, nsteady walking, Dementia

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21
Q

The clinical presentation of Folate/B12 def is identical. What is it?

What is the treatment if you dont’ know the def yet?

A

Megaloblastic anaemia
Mild jaundice

IM B12 & Folate

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22
Q

How would you investigate Fe2+ def?

A

FBC (low MCV, MCH)
Blood Film
Ferritin (low)

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23
Q

How would you investigate B12/Folate def?

A 
FBC
Blood film
Bilirubin/LDH
[B12] [Folate]
Antibodies
GI investigations
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24
Q

Apart from haematinic def, what are other causes of anaemia?

A

Haemolysis
Anaemia of Chronic D
Alcohol
Renal impairment

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25
Examples of haemolytic anaemia...?
INSIDE CELL: Haemoglobinopathies Enzyme defects CELL MEM: Hereditory spherocyotis/ellip OUTSIDE CELL: Antibodies, Heart valves, Drugs, toxins
26
To treat anaemia of chronic disease, you would treat the underlying cause & give EPO. What sorts of conditions can cause it?
Malignancy Inflammatory Infectious Multiple co-morbities
27
``` Drugs, alcohol, toxins Autoimmune ITP, TTP Liver D Hypersplenism Preg Infections DIC Haematological diseases ..can all cause what? ```
THROMBOCYTOPENIA
28
Is TTP or ITP an autoimmune platelet disorder that often presents in kids, post-viral with bruising/bleeding/petechiae?
ITP Immune Thrombocytopenic Purpura
29
Treatment of ITP?
NONE | Steroids, IV Ig, Thrombopoeitin
30
What does TTP stand for? What is it?
Thrombotic Thrombocytopenia Purpura Micro-clots everywhere due to ab bv RARE BUT EMERGENCY
31
Classic presentation of TTP? Treatment?
Thrombocytopenia + Haemolysis+ Fever + Neurological symptoms FFP, Steroids
32
What products can we transfuse?
RBC Platelets Plasma - FFP, Cryoprecipitate, Factors
33
"GROUP and SCREEN" is referring to what?
Pre-transfusion blood tests
34
State the steps of "GROUP and SCREEN"
1. Determine ABO & Rh group 2. Screen plasma for Ab against other blood antigens 3. Cross-matching
35
List the adverse reaction that can occur after transfusion.
Acute transfusion reactions 24hrs | Acute haemolytic reaction - 15 minutes
36
How does someone present whose had a delayed tranfusion reaction?
JAUNDICE FEVER FATIGUE
37
Fever, rigors, DIC, dark urine, infusion pain, shock, chest pain are all presentations of what?
Acute haemolytic reaction FATAL IN ~30%
38
name the test performed in suspected Delayed haemolytic reaction.
Coomb's test (Anti-human Globin)
39
In coagulation/clotting disorders is bleeding prolonged & often reoccurs?
Yes
40
Describe what bleeding is like in Platelet & vessel wall defects..
``` Immediate & non-recurrent -Petechiae -Nose bleeds -Superficial bruises Mennorhagia ```
41
Aspirin can cause dysfunction in which blood cell?
Platelets
42
The most common heritable bleeding disorder which often acompanies FVIII def is...?
vWD
43
Describe the 3 types of vWD
Type 1: mild, normal structure, decreased [vWF] Type 2: mild, normal [vWF], abornmal structure Type 3: absent vWF, FVIII def, RECESSIVE
44
Treatments for vWD?
Tranexamic acid DDAVP Factor concentrates COCP
45
Which are the most common heritable factor def?
Factor XII def | Factor VIII vWD def
46
What mode of inheritance does Haemophilia display?
X-linked
47
Describe the types of bleeding experienced in Haemophilia A/B.
``` Spontaeous Post-trauma (minor) Haemarthrosis Muscle bleeding Soft tissue - esp surrounding airwas Intracranial (neonates) ```
48
The treatment for Haemophilia is similar to the treatment for...?
vWD minus COCP +Prophylaxis +Supportive
49
Transfusion transmitted infections and Inhibition are complications of treating vWD and Haemophilia. T/F?
T
50
Bleeding disorders can be acquired from..?
``` Vit K def Liver D Massive transfusion syndrome DIC Acquired Inhibitors ```
51
Which factors are Vit K dependant in order to become active?
Factor II, VII, IX, X
52
What is the consequence of Vit K def in neonates?
Haemorrhagic Disease of the newborn
53
Causes of Vit K def in adults
Prolonged nutritional def Obstructive jaundice (fat soluble Vit) Broad spectrum antibioics (gut flora make vit K)
54
Define Massive transfusion syndrome.
Transfusion of RBC equal to patient’s total volume in
55
DIC = microvascular thrombosis when coagulation pathway activated + then platelet depletion --> bleeding. Who does it tend to occur in?
``` Unwell patients Sepsis Infection Cancer End-stage Liver D Retained foetus Acute haemolytic syndrome ```
56
Investigations of DIC?
FBC/Film - thrombocytopenia All Coagulation screen - prolonged D-Dimer - elevated
57
How would you treat DIC?
Treat underlying cause
58
Warfarin is managed using INR as guidance. What drugs interact with it?
Corticosteroids NSAIDs Antibiotics Amiodarone
59
Which haemaglobinopathy has acute complications of vasculo-occlusive crises?
Sickle cell
60
What types of Sickle Cell are there?
Sickle cell trait Sickle cell Disease
61
Which haemoglobinopathy is characterised by severe anaemia, short stature, enlarged spleen/liver, maxilliary hypertrophy/Hair on head x-ray?
B-Thalassaemia Major
62
What is the leading cause of mortality in Sickle Cell disease
Chest syndrome | vasculo-occlusive crisis
63
Iron-rich environment is favourable for bacteria therefore tranfusions in haemoglobinopathies are a risk factor for...?
Infections
64
How would you diagnose haemoglobinopathy?
FBC/Film | HB electrophoresis
65
What haematological state are pregnant women in?
Pro-thrombotic Increased plasma volume --> mild anaemia Thrombocytopenia in late Higher WCC
66
Which Ig crosses the placenta? Where do babies get the rest of the Ig from?
IgG Breast milk
67
Platelets are low by 18 weeks preg in the foetus. T/F?
F Platelets reached adult values
68
Foetus is hyperresponsive to what factor?
vWF prepare for birth
69
When do congenital bleeding disorders tend to be diagnosed?
6-9 months
70
List 4 main ways children can be anaemia from congenital causes.
Haemoglobinopathies Bone marrow failure Blood loss (twin-twin) RBC destruction (ABO/Rh, sphero, G6PD)
71
List 3 congenital causes of bleeding/bruising in childhood.
Platelet problem: ITP, drugs Clotting factor problem Connective Tissue D
72
Trauma, Tumour, infection, ITP, TTP, bone marrow failure and drugs can lead to what in childhood
Bleeding/bruising problems
73
Name the blood cancers
``` Myeloma Lymphoma AML ALL CML CMPD (3) ```
74
Which blood cancer is diagnosed based on CRAB features, MDEs, > 10% plasma cells neoplastic?
Myeloma
75
What are the CRAB features
C - hypercalcaemia R - renal insufficiency A - anaemia B- bone pain/lesion
76
MDEs = Myeloma-defining events, which are..
> 60% plasma cells neoplastic SFLC ratio > 100 1 bone lesion on MRI
77
What is myeloma always preceeded by?
MGUS
78
Myeloma + AKI = ?
MEDICAL EMERGENCY
79
How is myeloma diagnosed?
Protein electrophoresis | Immunofixation
80
Follicular Lymphoma often has chromosomal changes of..?
t(14,18)
81
Treatment for warfarin overdose?
PCC Prothrombic Complex concentrate
82
Which cancer can be precipitated by EBV?
Hodgkin's Lymphoma
83
Diagnostic mutation in myeloproliferative disorders?
JAK2/CALR mutation
84
CML has the t(9,22) abnormality. How does it present?
Abdo discomfort (splenomegaly) Fatigue (anaemia) Venous occlusion Gout
85
Neutropenic sepsis is a complication of intensive chemo in which cancers?
AML, ALL
86
Presentation of AML, ALL?
Anaemia Infections Bruising/Haemorrhage Organomegaly
87
Which condition presents as pancytopenia, splenomegaly, B symptoms?
Idiopathic myelofibrosis
88
Which 3 conditions constitute CMPD?
1" Polycythaemia Vera 1" Thombocytosis Myelofibrosis

Clinical Pathology (13 decks)

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