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Clinical Pathology > Haematology > Flashcards

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
Q

Examples of haemolytic anaemia…?

A

INSIDE CELL:
Haemoglobinopathies
Enzyme defects

CELL MEM:
Hereditory spherocyotis/ellip

OUTSIDE CELL:
Antibodies, Heart valves, Drugs, toxins

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26
Q

To treat anaemia of chronic disease, you would treat the underlying cause & give EPO. What sorts of conditions can cause it?

A

Malignancy
Inflammatory
Infectious
Multiple co-morbities

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27
Q 
Drugs, alcohol, toxins
Autoimmune ITP, TTP
Liver D
Hypersplenism
Preg
Infections
DIC
Haematological diseases
..can all cause what?
A

THROMBOCYTOPENIA

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28
Q

Is TTP or ITP an autoimmune platelet disorder that often presents in kids, post-viral with bruising/bleeding/petechiae?

A

ITP
Immune Thrombocytopenic
Purpura

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29
Q

Treatment of ITP?

A

NONE

Steroids, IV Ig, Thrombopoeitin

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30
Q

What does TTP stand for?

What is it?

A

Thrombotic Thrombocytopenia Purpura

Micro-clots everywhere due to ab bv

RARE BUT EMERGENCY

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31
Q

Classic presentation of TTP?

Treatment?

A

Thrombocytopenia +
Haemolysis+
Fever +
Neurological symptoms

FFP, Steroids

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32
Q

What products can we transfuse?

A

RBC
Platelets
Plasma - FFP, Cryoprecipitate, Factors

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33
Q

“GROUP and SCREEN” is referring to what?

A

Pre-transfusion blood tests

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34
Q

State the steps of “GROUP and SCREEN”

A
  1. Determine ABO & Rh group
  2. Screen plasma for Ab against other blood antigens
  3. Cross-matching
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35
Q

List the adverse reaction that can occur after transfusion.

A

Acute transfusion reactions 24hrs

Acute haemolytic reaction - 15 minutes

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36
Q

How does someone present whose had a delayed tranfusion reaction?

A

JAUNDICE
FEVER
FATIGUE

37
Q

Fever, rigors, DIC, dark urine, infusion pain, shock, chest pain are all presentations of what?

A

Acute haemolytic reaction

FATAL IN ~30%

38
Q

name the test performed in suspected Delayed haemolytic reaction.

A

Coomb’s test (Anti-human Globin)

39
Q

In coagulation/clotting disorders is bleeding prolonged & often reoccurs?

A

Yes

40
Q

Describe what bleeding is like in Platelet & vessel wall defects..

A 
Immediate & non-recurrent
-Petechiae
-Nose bleeds
-Superficial bruises
Mennorhagia
41
Q

Aspirin can cause dysfunction in which blood cell?

A

Platelets

42
Q

The most common heritable bleeding disorder which often acompanies FVIII def is…?

A

vWD

43
Q

Describe the 3 types of vWD

A

Type 1: mild, normal structure, decreased [vWF]
Type 2: mild, normal [vWF], abornmal structure
Type 3: absent vWF, FVIII def, RECESSIVE

44
Q

Treatments for vWD?

A

Tranexamic acid
DDAVP
Factor concentrates
COCP

45
Q

Which are the most common heritable factor def?

A

Factor XII def

Factor VIII vWD def

46
Q

What mode of inheritance does Haemophilia display?

A

X-linked

47
Q

Describe the types of bleeding experienced in Haemophilia A/B.

A 
Spontaeous
Post-trauma (minor)
Haemarthrosis
Muscle bleeding
Soft tissue - esp surrounding airwas
Intracranial (neonates)
48
Q

The treatment for Haemophilia is similar to the treatment for…?

A

vWD

minus COCP
+Prophylaxis
+Supportive

49
Q

Transfusion transmitted infections and Inhibition are complications of treating vWD and Haemophilia. T/F?

A

T

50
Q

Bleeding disorders can be acquired from..?

A 
Vit K def
Liver D
Massive transfusion syndrome
DIC
Acquired Inhibitors
51
Q

Which factors are Vit K dependant in order to become active?

A

Factor II, VII, IX, X

52
Q

What is the consequence of Vit K def in neonates?

A

Haemorrhagic Disease of the newborn

53
Q

Causes of Vit K def in adults

A

Prolonged nutritional def

Obstructive jaundice (fat soluble Vit)

Broad spectrum antibioics (gut flora make vit K)

54
Q

Define Massive transfusion syndrome.

A

Transfusion of RBC equal to patient’s total volume in

55
Q

DIC = microvascular thrombosis when coagulation pathway activated + then platelet depletion –> bleeding.
Who does it tend to occur in?

A 
Unwell patients
Sepsis
Infection 
Cancer
End-stage Liver D
Retained foetus
Acute haemolytic syndrome
56
Q

Investigations of DIC?

A

FBC/Film - thrombocytopenia

All Coagulation screen - prolonged

D-Dimer - elevated

57
Q

How would you treat DIC?

A

Treat underlying cause

58
Q

Warfarin is managed using INR as guidance. What drugs interact with it?

A

Corticosteroids
NSAIDs
Antibiotics
Amiodarone

59
Q

Which haemaglobinopathy has acute complications of vasculo-occlusive crises?

A

Sickle cell

60
Q

What types of Sickle Cell are there?

A

Sickle cell trait

Sickle cell Disease

61
Q

Which haemoglobinopathy is characterised by severe anaemia, short stature, enlarged spleen/liver, maxilliary hypertrophy/Hair on head x-ray?

A

B-Thalassaemia Major

62
Q

What is the leading cause of mortality in Sickle Cell disease

A

Chest syndrome

vasculo-occlusive crisis

63
Q

Iron-rich environment is favourable for bacteria therefore tranfusions in haemoglobinopathies are a risk factor for…?

A

Infections

64
Q

How would you diagnose haemoglobinopathy?

A

FBC/Film

HB electrophoresis

65
Q

What haematological state are pregnant women in?

A

Pro-thrombotic

Increased plasma volume –> mild anaemia
Thrombocytopenia in late
Higher WCC

66
Q

Which Ig crosses the placenta?

Where do babies get the rest of the Ig from?

A

IgG

Breast milk

67
Q

Platelets are low by 18 weeks preg in the foetus. T/F?

A

F

Platelets reached adult values

68
Q

Foetus is hyperresponsive to what factor?

A

vWF

prepare for birth

69
Q

When do congenital bleeding disorders tend to be diagnosed?

A

6-9 months

70
Q

List 4 main ways children can be anaemia from congenital causes.

A

Haemoglobinopathies
Bone marrow failure
Blood loss (twin-twin)
RBC destruction (ABO/Rh, sphero, G6PD)

71
Q

List 3 congenital causes of bleeding/bruising in childhood.

A

Platelet problem: ITP, drugs
Clotting factor problem
Connective Tissue D

72
Q

Trauma, Tumour, infection, ITP, TTP, bone marrow failure and drugs can lead to what in childhood

A

Bleeding/bruising problems

73
Q

Name the blood cancers

A 
Myeloma
Lymphoma
AML
ALL
CML
CMPD (3)
74
Q

Which blood cancer is diagnosed based on CRAB features, MDEs, > 10% plasma cells neoplastic?

A

Myeloma

75
Q

What are the CRAB features

A

C - hypercalcaemia
R - renal insufficiency
A - anaemia
B- bone pain/lesion

76
Q

MDEs = Myeloma-defining events, which are..

A

> 60% plasma cells neoplastic
SFLC ratio > 100
1 bone lesion on MRI

77
Q

What is myeloma always preceeded by?

A

MGUS

78
Q

Myeloma + AKI = ?

A

MEDICAL EMERGENCY

79
Q

How is myeloma diagnosed?

A

Protein electrophoresis

Immunofixation

80
Q

Follicular Lymphoma often has chromosomal changes of..?

A

t(14,18)

81
Q

Treatment for warfarin overdose?

A

PCC

Prothrombic Complex concentrate

82
Q

Which cancer can be precipitated by EBV?

A

Hodgkin’s Lymphoma

83
Q

Diagnostic mutation in myeloproliferative disorders?

A

JAK2/CALR mutation

84
Q

CML has the t(9,22) abnormality. How does it present?

A

Abdo discomfort (splenomegaly)
Fatigue (anaemia)
Venous occlusion
Gout

85
Q

Neutropenic sepsis is a complication of intensive chemo in which cancers?

A

AML, ALL

86
Q

Presentation of AML, ALL?

A

Anaemia
Infections
Bruising/Haemorrhage
Organomegaly

87
Q

Which condition presents as pancytopenia, splenomegaly, B symptoms?

A

Idiopathic myelofibrosis

88
Q

Which 3 conditions constitute CMPD?

A

1” Polycythaemia Vera
1” Thombocytosis
Myelofibrosis

Clinical Pathology (13 decks)

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