Haematology Flashcards
Erythrocytes
120 day lifespan
Granulocytes
Neutrophils, Eosinophils, Basophils
Neutrophils
Lobed nucleus
Lifespan= few hours
Decreased due to drugs, AI, chemo
Eosinophils
Increased due to parasites, allergies and aspirin
Basophils
Rare
Increased in CML
Monocytes
Macrophages in tissue
Increased in TB
Lymphocytes
Increased in CLL+ EBV
Decreased after BM transplant
NK Cells
Recognise non-self
Large and granuler
Plasma Cells
Mature B cells
Make IgG
Increased in infection and myeloma
RBC Transplant
=RBCs, electrolytes, glycose, adenine
Takes 1.5-3 hours
Need if over 30% blood loss
Platelet Transplant
Stored at room temp
30mins/unit
Fresh Frozen Plasma
Needs defrosting
30mins/unit
Used in bleeding
Not warfarin reversal
Platelet Defects
Mucosal and skin bleeding
Less platelets/not working platelets/abnormal interaction
Von Willebrand Disease
vWF can’t make platelets release granules or carry FVIII
AD
Treatment= antifibrinolytics, DDAVP, vWF, COCP
Coag Factor Defects
Prolonged bleeding
Muscle and joint bleeds
Haemophilia
A= FVIII B= FIX Treatment= replacement, DDAVP, factor conc, antifibrinolytic agents
Vit K deficiency
Cofactor of II, VII, IX, X
Causes= obstructive jaundice, nutritional deficiency, broad spectrum abx, neonates, warfarin
Liver Disease
Causes thrombocytopenia, less factors and excessive plasmin
Massive Transfusion
Dilutes platelets and factors
Get DIC, citrate toxicity and hypocalcaemia
DIC
Clot until factors and platelets used up then bleed
Fibrinolysis products inhibit fibrinolysis
Thrombosis in small vessels= tissue ischaemia
Causes= sepsis, obstetrics, trauma, transfusions, cancer, liver disease
Warfarin
INR controls doses
Effect increased by erythromycin, cephalosporins, NSAIDs, steroids and ampicillin
Effect decreased by spiranolactone, vit K, rifampicin, carbamazepine, cholestyramine
Heparin
UF= APTT, bleeding stopped by protamine LMWH= more anti-Xa, once a day, anti-Xa assays
Haem
2 alpha (chr 16) 2 beta/delta (chr 11) Marrow makes beta/delta
Sickle Cell Disease
Polymerises in low O2 making fibrils
Short lifespan as destroyed
Trait= heterozygous (only problem if hypoxic or dehydrated)
Disease= homozygous
Crises cause septicaemia, priaprism and organomegaly
Hydroxycarbamide increases Hb-F
Alpha Thalassaemia
Less alpha chains
Beta Thalassaemia Minor
Carriers only
Small pale RBCs
Beta Thalassaemia Intermedia
Varying genetics+ symps
No transfusions needed
Get pulmonary hypertension, fertility probs and bone changes
Beta Thalassaemia Major
Severe anaemia Nucleated RBCs Increased marrow activity Short stature, increased iron absorption Splenomegaly Maxillary hypertrophy Treatment= tranfusions
Pregnancy
Macrocytic anaemia (more iron and folate)
Neutrophilia
Thrombocytopenia (low folate, pre-eclampsia, DIC, HUS, virus)
Procoaguable
Myeloma
Incurable malignant disease of plasma cells
Preceded by MGUS
Get CRAB features, focal lesions and BM plasma cells
High IgG so renal insufficiency
Therapies of cyclopriming and melphalan
CRAB features
Diagnostic of myeloma C= High calcium R= Renal insufficiency A= Anaemia B= Bone abnormalities
Lymphoma
Neoplastic disease of lymphoid tissue
Hodgkin’s has Reed-Sternberg cells
Often due to t(14,18)
Acute Myeloid Leukaemia
Granulated nuclei in large cells BM fails FAB staging Monosomy 7 bad Induction therapy for remission, then combo chemos
Acute Lymphoid Leukaemia
Small round cells Organ infiltration Peroneal infections Candida Need induction chemo, intensive chemo and meningeal prophylaxis (methotrexate and irradiation) Often due to philadelphia chromosome
Neutropenic Sepsis
Due to intensive chemo
Fever and infections
Need abx
Philadelphia Chromosome
t (9,22)
Creates bcr-abl
Has tyrosine kinase activity
Poor prognosis
Chronic Myeloid Leukaemia
Get leukocytosis, anaemia, gout and splenomegaly
Chronic phase treated with cytotoxins and interferon
Acute transformation needs intensive chemo
Phil chr treated with gleevec/imalinib
Polycythaeemia Vera
More RBCs
Persistant raised Hb
Reduced EPO means JAK2/EXON12 mutations (cytokine signalling)
Need venesections and aspirin
Essential Thrombocytosis
Increased platelets
May be JAK2 or CALR mutations
Need antiplatelets and interferon
Idiopathic Myelofibrosis
Pancytopenia and splenomegaly
JAK2 and CALR mutations
Need JAK2 inhibitors or BM transplant
Splenomegaly Causes
CHICAGO Cancer Haem Infection Congestion Autoimmune Glycogen storage issues Other
Children
Larger and more RBCs Higher WCC Developing Igs at 2 months IgG crosses placenta Platelets larger and hyperresponsive
Thrombosis
Venous thrombi more fibrin
Diagnosed via Well’s score and D-Dimer
Treatment= LMWH, warfarin, NOACs (dabigatron, rivoraxaban)
Factor V Leiden
FV resistant to cleavage so can’t be inactivated
Prothrombin 20210A
Increases prothrombin levels
Antiphospholipid Syndrome
Antiphospholipid Abs
Causes= lupus, anticardiolipin
Microcytic Anaemia
Due to iron deficiency, haemoglobinopathies, chronic disease
Iron Deficiency
Causes= blood loss, increased demand, decreased intake
Tests= FBC, film, ferritin, serum iron, marrow
IV iron best
Macrocytic Anaemia
Causes= B12 deficiency, folate deficiency, marrow damage, haemolytic
B12+Folate Deficiency
Causes= megaloblastic, drugs, alcohol
Can’t make DNA bases
B12
From animal sources
Absorbed by gastric cells, IF and terminal ileum
Deficient due to veganism, gastric or small bowel probs
Pernicious if Abs to IF or gastric cells
Get subacute combined degeneration of the cord
Folate
Absorbed in small intestine
Stores well
Deficient due to malnutrition, malabsoption, increased need, drugs, alcohol
Marrow Damage
Causes=disease, alcohol, drugs
Haemolysis
Causes= haemoglobinopathies, G6PD deficiency, sphercytosis, Abs, drugs, heart valves, vasculitis
Treatment depends on cause
Normocytic Anaemia
Caused by chronic disease
Less RBCs due to abnormal iron metabolism, poor EPO response or poor marrow response
Cytokines released
Normal ferritin but low iron
Thrombocytopenia
Causes= AI, toxins, liver disease, DIC, pregnancy, infections, congenital
Get bruising and bleeding
Need steroids, IV Igs and immunosuppressants
Immune Thrombocytopenic Pupura
Immune disorder
Thrombotic Thrombocytopenic Purpura
Get fever, haemolysis and neuro symps
Need urgent plasma and steroids
Dendritic Cells
Make interferon
Circulate in blood
Make cytokines
