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Haematology Flashcards

1
Q

Hb levels which define anaemia

A

Less than 120g/L in females
And less than 140g/L in males

Or less than 12.5g/dL in adults

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2
Q

Potential causes of low Hb

A

Lack of production
Destruction of RBCs
Dilution
Loss of blood

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3
Q

Causes of iron deficiency anaemia

A 
Increased loss of iron 
Reduced iron absorption
Gynaecological disorders eg menorrhagia 
Hemoglobinuria
Multiple blood donations

Anything in the GIT causing inflammation

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4
Q

Causes of loss of iron

A 
Cancer/polyp - colon, stomach, oesophagus, small bowel 
Peptic ulcer, oesophagitis 
NSAID use 
IBD- ulcerative colitis, chrons 
Intestinal parasites 
Vascular lesions: angiodysplasia
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5
Q

Reduced iron absorption causes

A 
Deficient iron intake 
Coeliac disease 
Gastrectomy and gastric atrophy 
Gut resection or bypass 
Bacterial overgrowth
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6
Q

Weight loss surgery can cause

A

Anaemia

Affects stomach absorption

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7
Q

Anaemia production problems include

A

Iron deficiency
B12 deficiency
Folate deficiency

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8
Q

Causes of b12 deficiency

A 
Low intake (vegans) 
Impaired absorption (stomach - pernicious anaemia, gastrectomy) 
Small bowel (chrons, ileal disease or resection, bacterial overgrowth, tapeworm)

B12 needs the parietal cells of the stomach to be absorbed
Anything competing with it like tapeworms

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9
Q

Causes of folate deficiency

A 
Poor intake (eg alcoholics) 
GIT disease (gastrectomy, coeliac disease, chrons) 
Increased requirement (pregnancy, lactation, malignancy) 
Anti folate drugs (methotrexate, trimethoprim)
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10
Q

What deficiency causes macrocytic RBCs ?

A

Folate?
B12

Cells arrested in G2

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11
Q

Iron deficiency anaemia is

A

Microcytic hypochromic

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12
Q

Causes of anaemia of chronic disease

A

Infection
Malignancy
Autoimmune (RA, SLE, vasculitis, sarcoidosis, IBD)
Chronic kidney disease

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13
Q

Anaemia of chronic disease leads to what type of RBCs

A

Normocytic normochromic

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14
Q

How can renal disease lead to anaemia

A

Lack of EPO

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15
Q

What protein/hormone control iron release/absorption into circulation

A

Hepsidin

Inflammatory effect raises hepsidin ?

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16
Q

Reasons for the bone marrow not making sufficient RBCs

A

Fibrosis
Infiltration
Failure
(Most common cause of acquired bone marrow failure is aplastic anaemia characterised by peripheral pancytopenia and marrow hypoplasia)

Chemo agents can cause failure or fibrosis

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17
Q

Destruction problems leading to anaemia

A

Destruction of normal RBCs eg ABO and Rh incompatibilities (Ab mediated - haemolytic)

Shortened lifespan due to abnormal RBC eg sickle cell anaemia (HbS), thalassemia (alpha or beta protein abnormality in Hb)

High uptake in splenomegaly eg malaria, EBV

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18
Q

EPO is produced by

A

Kidneys 90%

Liver 10%

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19
Q

Shortened lifespan of RBC due to

A

HbS
G6PD deficiency
Thalassemia
Anything causing haemolysis

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20
Q

Haemolytic anaemia causes

A

Inherited - hemoglobinopathy, membranopathy, enzymopathy

Acquired - drugs, transfusion reaction, immune disorders, mechanical heart valve

Rh D haemolytic disease

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21
Q

Clinical signs of haemolytic anaemia

A

Jaundice
Dark urine
Splenomegaly!!

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22
Q

Signs in blood of haemolytic anaemia

A

Reticulocytosis
Unconjugated hyperbilirubinemia
Raised LDH

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23
Q

Tests for haemolytic anaemia

A

Direct antiglobulin test (Coombs)
Blood film
Hb screen

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24
Q

What helps in hereditary spherocytosis

A

Splenectomy

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25
Causes of dilution of Hb
Pregnancy (also causes iron deficiency)
26
Causes of microcytic anaemia
Iron deficiency | Thalassemias
27
Causes of normocytic anaemia
``` Chronic disease Acute blood loss Haemolysis Aplastic anaemia Bone marrow infiltration ``` Combined deficiencies
28
Causes of macrocytic anaemia
``` B12 Folate Alcohol excess Liver diseases Marrow disorders, myelodysplasia Drugs ```
29
MCV
Mean corpuscular volume | Red blood cell size
30
TIBC
Total iron binding capacity
31
High TIBC means
Iron deficiency Pregnancy OCP Means lots of empty transferrin
32
Low TIBC
Anaemia of chronic disease Malnutrition Inflammation Haemochromatosis Can be due to not enough transferrin around or some sort of malnutrition May not be anaemic depending on TIBC as it only shows transferrin saturation!!!!!
33
Ferritin levels reflect
Bone marrow iron stores Decreased = iron deficiency *low normal (up to 100 ug/l) possible if iron deficiency when this co exists with inflammation, liver disease or malignancy (acute phase response)
34
Low reticulocyte indicates
Bone marrow hypoproliferation | Production problems
35
High reticulocyte count indicates
Bone marrow hyperproliferation | Haemolytic anaemia, acute blood loss
36
How many Hb molecules in each RBC
250 million
37
Quantitative changes in globin chains
Thalassemias
38
Qualitative changes in globin changes | Are
Hemoglobinopathies
39
Iron switches to which state when oxygen binds
Fe2+ to fe3+ | Ferrous to ferric state
40
Which two types of chains make up Hb
A2B2
41
What does 2,3-BPG do?
Stabilises the low affinity state of the Hb molecule
42
Where does heme synthesis take place?
Mostly in RBCs in bone marrow | About 15% daily in liver for formation of heme containing enzymes
43
Heme is made from
Glycine and succinyl coA(made from alphaketoglutamate via succinyl Coa dehydrogenase) --> succinate
44
The first main enzyme in heme production
Aminolevulinate synthase | ALA synthase
45
Things that inhibit heme production
Heme Low iron Vitamin b6 deficiency (rare, precursor for ALA synthase) Erythrocyte formation - enhances Liver - drug induced alterations in heme synthesis through p-450 dependent oxidises (p450s are major consumers of hepatic heme) Inhibitory feedback loop affects delta-ALA synthase and first enzymes
46
Heme feedback loop
Inhibits activity of pre existing d ala synthase Diminishes transport of enzyme Repressed production of enzyme Stimulates globin synthesis
47
Symptoms of porphyria
Photosensitive Hypertrichosis Lowered levels of heme Severe blistering and scarring Progressive deforming ears, nose and lips Weakness in wrist and fingers Reddish brown teeth that fluoresce in UV light due to deposition of some types of porphyria Garlic stimulates haem and can exacerbate symptoms
48
What is CEP
Congenital erythropoietic porphyria Deficiency of enzyme uroporphyrinogen III synthase Extreme photosensitive skin blistering scarring and increased skin bacterial infections Lower RBCs feed back to increase production and exacerbate symptoms
49
Epidemic porphyria cutanea tarda
Porphyrinuria appeared early Began with bullous lesions which progress to ulceration and generally healed leaving pigmented scars characterised by presence of microcysts
50
Primary haemostasis in bleeding
Vasoconstriction and platelet activation
51
Secondary haemostasis
Coagulation cascade | Fibrinolysis
52
MCV
Mean corpuscular volume Red cell size Hematocrit/ red cell concentration
53
MCH
Mean corpuscular hemoglobin Hb concentration / red cell conc
54
MCHC
Mean corpuscular hb conc Hb conc / hematocrit
55
Failure to produce reticulocyte response indicates
Bone marrow failure or haematinic deficiency
56
Haematocrit is reduced in
Anaemia
57
Anisocytosis Poikilocytosis
Frequently associated with disease of blood Increased variation in cell size - anisocytosis Presence of abnormal shape - poikolocytosis
58
Aniso-poikolocytosis occurs in
Absences of functioning spleen
59
Leukoerythroblastic blood results from
Gross marrow disturbance such as infiltration by malignancy, or fibrous tissue (myelofibrosis) or in severe anaemia due to deficiency of vitamin b12 or folate (megaloblastic anaemia)
60
Heinz bodies seen in
Certain haemolytic anaemia Such as g6pd deficiency (denatured Hb)
61
Basophils are closely related to
Mast cells Contain heparin or histamine
62
Causes of reative neutrophil leukocytosis include
``` Sepsis Trauma Infarction Chronic inflammatory disease Malignant neoplasms Steroid therapy Acute haemorrhage or haemolysis ```
63
Monocytosis may be reactive to
Sepsis Chronic infections eg tb Malignant neoplasms
64
Eosinophili leukocytosis may be reactive to
Allergy eg asthma Parasites Malignant neoplasms Miscellaneous eg polyarteritis nodosa
65
Causes of pancytopenia
Bone marrow failure Megaloblastic anaemia Hypersplenism
66
Causes of selective neutropenia include
``` Overwhelming sepsis Racial Autoimmune such as RA Drug induced Cyclical - uncommon condition ```
67
Platelets are
Contractile and adhesive
68
Reactive thrombocytosis may be seen in
``` Acute or chronic blood loss Iron deficiency Chronic inflammatory disease eg RA Neo plastic disease Tissue trauma Primary disorders of bone marrow - the myeloproliferative diseases and chronic myeloid leukaemia ```
69
Coagulation pathway?
[image]
70
Where are almost all of the coagulation factors (and inhibitory factors) made?
In the liver
71
Which clotting factors require vitamin k?
2,7,9,10
72
Which clotting factors are serine proteases?
2,7,9,10,11,12 Presence of serine necessary for action in hydrolysing peptide bonds
73
What are the principal clotting inhibitors and what do they require for synthesis?
Protein C and S require vitamin K Tissue factor pathway inhibitor Antithrombin III - serine protease inhibitor (and requires glycosaminoglycan 'heparans' present on vascular endothelial surface) Antiplasmin
74
What clotting factors does protein C inhibit
requires co-factor protein S for full acivity V, VIII
75
What does thrombin do?
Promotes fibrin formation and also has crucial role in negative feedback to inhibit clot formation
76
What does protein C require for activation?
Thrombin bound to endothelial protein, thrombomodulin
77
Plasminogen activators are released from...
endothelial cells Cleave plasminogen --> plasmin which rapidly digests fibrin clot this partially balanced by TAFI (thrombin activated firbinolytic inhibitor)
78
What is the main pathway for coagulation?
Tissue factor pathway (extrinsic pathway)
79
APTT
acitvated partial thromboplastin time invovles all clotting factors other than VII and XIII intrinsic pathway activated
80
PT
prothrombin time assess factors VII, V, X, II and fibrinogen only tissue factor and phospholipid added (extrinsic pathway)
81
INR
International normalised ratio | Pateint's PT/normal mean PT
82
ESR
erythrocyte sedimentation rate increased aggregation and sedimentation occurs in the presence of high concentrations of immunoglobulin and fibrinogen acute phase reactant
83
Where are blood cells produced
Adult - all blood cells produced in red marrow which is restricted to bones of axial skeleton (50% adipocytes and 50% blood cells and precursors) Fatty marrow of other bones capable of hemopoiesis when demand required infant/young child - practically all bones fetal life - liver and spleen (yolk sac before 6 weeks) *extramedullary haemopoiesis typically assoc with progressive fibrosis of BM seen in myelopriliferative disorders
84
growth factors that govern production of leukocytes
eg IL-1, 3, 6 GM-CSF - increases stem cell committment to granulocyte and monocyte production G-CSF - granulocytes M-CSF - monocytes
85
Thrombopoietin
capable of stimulation of platelet production and produced mainly in liver
86
Acute leukemia which cells accumulate?
Blast cells mutations in haemopoietic stem cells - the luekemic clone proliferates but loses ability to mature accumulation of blast cells in bone marrow
87
ALL is common in
children
88
AML is common in
adults
89
hepcidin action
downregulates the plasma membrane transfer protein ferroportin
90
when erythropoiesis is more active -->
increased iron uptake even if stores are high ( can lead to iron overload as seen in thalassemias)
91
deficiency of iron , b12 and folate may have a misleading
normal MCV and MCH
92
increase in TIBC means
iron deficiency with compensatory increase in transferrin concentration
93
in chronic disorders, TIBC is usually
reduced | and serum ferritin is usually raised due to inflamamtion or malignancy
94
chronic anaemia can lead to
``` acute chelitis atrophic glossitis brittle nails koilonychia oesophageal web ```
95
vitamin b12 metabolism
present in foods of animal origin --> becomes bound to intrinsic factor in parietal cells of stomach --> this complex binds to receptors in terminal ileum where only b12 is absorbed --> transported to tissues attached to transcobalamin II deficiency takes a long time to develop
96
neutrophil large and hypersegmented/exaggerated segments in b12 deficiency?
?
97
vitamin b12 deficiency leads to
unconjugates hyperbili and increased LDH due to increased cell breakdown/ineffective erythropoiesis/premature removal lesions of the nervous system: myelin degeneration of posterior and lateral columns often assoc with peripheral neuropathy affecting sensory neurons (subactue combined degeneration of the cord) *demyelination and axonal degeneration optic atrophy and cerebral changes resulting in psychiatric disease less common musosal abnormalities may be present - atrophic glossitis, weight loss due to malabsorption because of mucosal changes, sore mouth chronic hypoxia --> cardiomyopathy (transfusion poorly tolerated due to volume overload) thrombocytopenia (bruising and mucosal haemorrhage)
98
folate is absorbed in
proximal jejunum
99
anticonvulsants that impair folate absorption
phenytoin and phenobarbitone
100
in myelofibrosis the marrow is replaced by
reticulin and collagen
101
what happens to haptoglobin in haemolytic anaemia
absent serum haptoglobin
102
Malaria and pregnancy
First two trimesters Trans placental spread Low birth weight/ premature birth
103
Which genetic blood factors protect against p.falciparum
HbS Thalassemia G-6PD deficiency HbC
104
Which genetic blood factor protects against p. Ovale and vivax?
Duffy blood group negative
105
P.falciparum
``` Tertian (2day) cycle Cyclical fever No relapse Cerebral malaria - fatal Malignant malaria In PNG ``` Multiple thing rings Small RBC Affects all age RBCs
106
P.Vivax
tertian cycle Relapse - hypnozoite liver stage Thick rings Enlarged RBCs Young RBCs
107
P.Ovale
Tertian cycle Relapse Comet trophozoite Oval and large RBCs Smiley face :)
108
P.malariae
In west pacific Nephrotic syndrome ``` Quartan cycle (3day) Chronic malaria ``` Band trophozoites Daisy schizonts Mature RBCs
109
P.knowlesi
Zoonotic Macaques- long pig tailed Low platelets ! 1d cycle Ring and schizont
110
Malaria life cycle
Image
111
Antithrombotic effects of endothelial cells to modulate hemostasis
Inhibit platelet aggregation - NO and prostacyclin (PGI2) Anticoagulant effect - thrombomodulin (activation of protein c and s) and heparin like molecules (--> antithrombin) Fibrinolysis - t-PA
112
Prothrombotic effects of endothelial cells to modulate hemostasis
Platelet adhesion and aggregation - vWF Procoagulant effect - tissue factor Anti-fibrinolytic - PA inhibitor (PAI)

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