haematology Flashcards
1
Q
what is the most common WBC?
A
neutrophil
2
Q
what is the precursor to lymphocytes?
A
lymphoblasts
3
Q
what produces platelets
A
megakaryotes which are formed from megakaryoblasts
4
Q
what are RBCs formed from?
A
reticulocytes
5
Q
when is the neutrophil count raised?
A
inflammation
myeloid leukaemia
steroid therapy
bacterial infection
6
Q
when are neutrophils low?
A
viral infection
bone marrow failure
sepsis
B12 deficiency
7
Q
what causes eosinophils to be high?
A
parasitic infection
allergy
lymphoma
8
Q
what causes basophils to be high?
A
hypersensitivity reactions
chronic inflammation
9
Q
what would cause lymphocytes to be high but neutrophils to be low?
A
viral infection
10
Q
what cells do CD4 cells activate (T helper)
A
cytotoxic CD8
B cells
11
Q
which clotting factor is not synthesised in the liver?
A
5
12
Q
which leukaemia mainly affects children?
A
ALL acute lymphoblastic (remember AML M for mature)
13
Q
which leukaemia is the most common?
A
chronic lymphocytic leukaemia
14
Q
what are the 3 stages of therapy for leukaemia?
A
induction
consolidation
maintenance
CNS prophylaxis
15
Q
what is the difference between leukaemia and lymphoma
A
both abnormal proliferation of WBCs
leukaemia in blood and bone marrow
lymphoma in lymph glands
16
Q
what is the staging system in Hodgkin’s lymphoma
A
Ann Arbour
17
Q
how is multiple myeloma diagnosed?
A
paraproteinaemia/high bone marrow plasma cells+end organ failure (CRAB-hyperCalcaemia, Renal failure, Anaemia, lytic Bone lesions)
18
Q
what might lead to febrile neutropenia?
A
leukaemia or chemotherapy, it is very dangerous
19
Q
give the most common causes of normocytic anaemia
A
haemorrhage
combined haematinic deficiency
chronic disease
20
Q
give some causes of macrocytic anaemia
A
hypothyroidism
pregnancy
alcohol
B12/folate deficiency
21
Q
what drugs might cause macrocytic anaemia?
A
rituximab
trimethoprim
anti epileptic drugs lead to folate deficiency and decreased RBC production
22
Q
where is folate absorbed?
A
the duodenum
23
Q
what is a complication of transfusion?
A
haematochromatosis
24
Q
what infection leads to bone marrow aplasia (failure of erythropoiesis) in sickle cell disease?
A
Parovirus B19
25
where is B12 absorbed?
terminal ileum with intrinsic factor from parietal cells
26
what does prothrombin time measure
the extrinsic pathway 10, 9, 7, 2
27
what does activated partial thromboplastin time measure?
the intrinsic pathway
28
how do you reverse the action of heparin on Xa?
protamine sulfate
29
what is haemophilia A
deficiency of VIII
30
what is haemophilia B
deficiency of IX
31
what will be elevated in haemophilia?
activated partial thromboplastin time (intrinsic), the prothrombin time will be normal
32
what is the most common cause of congenital thrombophilia?
factor V leiden
33
give symptoms of haemophilia
haemoarthosis (arthritis)
spontaneous soft tissue bleeds
GI bleeds
haematuria
34
what should be avoided in a patient with haemophilia?
NSAIDs and IM injections
35
what will give elevated activated thromboplastin time but low INR?
vWF deficiency, it is affecting V-the intrinsic pathway
36
what kind of bleeding will haemophilia lead to?
haemophilia>mucosal bleeding (epistaxis, gingival) and subcutaneous bleeds (haemartoma)
37
give signs of DVT
```
redness
swelling
Homan's sign (pain on dorsiflexion of foot)
erythema
pitting oedema
```
38
what is the Wells criteria
measures the probablility of someone having a DVT, includes: active cancer, paralysis, bedridden, loackised tenderness, whole leg swollen, previous DVT
39
what is the treatment for DVT?
dalteparin and then warfarin or a NOAC
40
what is sickling precipitated by?
cold
hypoxia
dehydration
infection
41
what kind of anaemia does sickle cell disease cause?
normocytic
42
give some long term complications of sickle cell disease
```
pulmonary hypertension
cardiomegaly
MI
priapism
chronic bone infarcts>avascular necrosis
infections
leg ulcers
stunted growth
```
43
what disease may lead macrocytic anaemia?
coeliac or tropical sprue>folate cannot be absorbed in the duodenum.
44
what may malignancy of differentiated B lymphocytes lead to?
monoclonal gammopathy of unknown significance
asymptomatic myeloma
symptomatic myeloma
45
which blood malignancy is AIDS defining
lymphoma
46
which virus has a role in the pathogenesis of both types of lymphoma?
EBV
47
which leukaemias affect adults
AML Mature
CML
(CLL ellllllderly)
48
how do you treat someone who has heparin induced thrombocytopenia?
stop heparin never give heparin again, another anticoagulant (immunity)
49
what does vWF do?
prevents inactivation of VII
50
how is von Willebrand disease inherited?
autosomal dominant
51
possible complication of chemotherapy
AML
52
in which leukaemia is CNS involvement most common?
ALL
53
how do you differentiate between ALL and AML
microscopy and immunophenotyping on bone marrow aspirate
54
what is the most common leukaemia
chronic lymphocytic
55
what characterises chronic lymphocytic leukaemia?
smear cells
56
what leukaemia has blast crises?
chronic myeloid leukaemia
57
in which anaemia is there abdominal discomfort?
chronic myeloid because there is massive splenomegaly
58
what is combined haematinic deficiency?
low iron, low folate, low B12 leads to normochromic normocytic
59
what is pernicious anaemia?
folate deficiency
60
treatment for iron deficiency anaemia
ferrous sulfate
61
symptoms specific to iron deficiency anaemia?
atrophic glossitis
angular stomitis
brittle hair and nails
62
what kind of anaemia does multiple myeloma cause?
normocytic
63
where in the diet does B12 come from?
meat
fish
dairy
64
causes of bleeding
XS destruction GP-tirofiban, heparin, DOAC-apixiban
BM suppression from radiotherapy, leukaemia
DIC
ITP
haemophilia
65
how is haemophilia inherited
the factor VIII or IX deficiency is X linked
66
ITP symptoms
purpura
easy bruising
menorrhagia
epistaxis
67
where is there usually bleeding into with haemophilia
joints>arthropathy
68
how is ITP treated
splenomegaly
steroids
IV Ig
69
when is bleeding treated with heparin?
in DIC
70
what are the free light chains in multiple myeloma restricted to?
kappa or lambda
71
who gets multiple myeloma?
70yo+ and Afro-Carribean men
72
what is MGUS?
monoclonal gammopathy of unknown significance
73
why are there bone lesions in multiple myeloma?
tumour produces growth factors which lead to osteoclast action
74
urine in patient with multiple myeloma
bence jones protein
75
lots of RBCs?
polycythaemia rubra vera
76
treatment for polycythaemia
venesection and aspirin
77
causes of polycythaemia
XS EPO, renal carcinoma
decreased plasma volume
hypoxia
78
what might chemotherapy or bone marrow transplant complicate into?
febrile neutropenia
79
what haematological conditions cause spinal cord compression
malignancy-esp myeloma and lymphoma
80
what will tumour lysis syndrome eventually lead to?
acute renal failure
81
causes of iron deficiency anaemia?
hookworms, blood loss (PUD, menorrhagia), clopidogrel, warfarin, diet, malabsorption (coeliac, surgery, long term PPI), pregnancy, haemolysis
82
causes of normocytic anaemia?
blood loss, anaemia of chronic disease, bone marrow failure, renal failure, hypothyroidism, haemolysis, pregnancy
83
macrocytic anaemia causes?
b12/folate deficiency, liver disease, alcohol XS, reticulocytosis, myeleoplastic syndromes, marrow infiltration
84
what kind of anaemia does alcohol XS cause?
non-megaloblastic macrocytic anaemia
85
when does a patient need transfusion?
Hb<70g/L
86
how does anaemia of chronic disease happen?
poor use of iron in erythropoiesis and cytokine induced shortening of RBC life, reduced EPO, reduced EPO response. Hepcidin plays regulatory role
87
what are causes of megaloblastic anaemias?
B12, folate, cytotoxic drugs
88
where is folate found?
green veg
nuts
yeast
liver
89
where is folate absorbed
duodenum and proximal jejunum
90
causes of folate deficiency
```
poor diet
high demand (pregnancy, haemolysis, malignancy, inflammatory disease, dialysis)
malabsorption (coeliac, tropical sprue)
alcohol
anti epileptics
MTX
trimethoprim
```
91
what is vit B12 in a drug called?
hydroxycolbamin
92
what does b12 help synthesis
thymidine, if low>low RBCs
93
what lasts longer, b12 or folate stores?
b12-4 years
| folate-4 months
94
where is b12 found?
meat
dairy
fish
95
how is b12 absorbed?
intrinsic factor from parietal cells so can be absorbed in terminal ileum
96
what is pernicious anemia
autoimmune destruction of parietal cells
97
what are non pernicious b12 deficiency anaemias?
Crohn's, tropical sprue
bacterial overgrowth
tapeworms
98
how does b12 deficiency affect the nervous system?
degeneration of the spinal cord causing sensory neuropathy with LMN and UMN signs (extensor plantars, absent knee and ankle jerks, pain and temp sensation remains intact)
99
what blood results suggest haemolysis?
anaemia with a normal or increased mean corpuscular volume, high bilirubin (esp unconjugated), high urinary urobilinogen and high serum LDH
100
what suggests high RBC production
increased reticulocytes so high MCV
101
what complications can result from hamolysis
gallstones
| leg ulcers
102
why would you used the coombs test?
direct-sees if there's antigens on RBC surface so if it's immune mediated haemolytic anaemia. (indirect before blood transfusions)
103
which malaria does sickle cell disease protect from?
malaria falciparum
104
what will you find elevate in a sickle cell patient?
reticulocytes
| bilirubin
105
what is the conclusive test for sickle cell diagnosis
hb electrophoresis
106
what triggers sickle cell crises
```
cold
infection
dehydration
hypoxia
lead to microvascular occlusion
```
107
what is affected in a sickle cell crisis?
marrow>pain
hands and feet>dactylitis
mesenteric ischaemia
spleen>splenomegaly>hyposplenism+immunocompromise (septicaemia)
pulmonary>acute chest syndrome
CNS (children only)>stroke/seizures/cog defects
108
treatment for sickle cell crises?
```
IV opiates immediately
crossmatch blood
FBC+reticulocytes, cultures
hydrate
keep warm
give o2 if low sats
```
109
where is the spleen?
between 9-11th ribs on left, posterior to stomach
110
function of spleen
red pulp-filtration of RBCs, stores platelets
white pulp-active immune response (like a large lymph node) synethesises antibodies and complement, recycles iron and metabolises Hb
111
what is the reticuloendothelial system?
macrophages and monocytes throughout the body, remove dead cells and act as phagocytes, produce bile pigment, produce plasma protein, stores iron, clears heparin
112
another name for reticuloendothelial system
mononuclear phagocytic system
113
where are the fixed parts of the reticuloendothelial system?
spleen, joints, alveoli, sinusoidal liver cells, skin
