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haematology Flashcards

1
Q

what is the most common WBC?

A

neutrophil

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2
Q

what is the precursor to lymphocytes?

A

lymphoblasts

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3
Q

what produces platelets

A

megakaryotes which are formed from megakaryoblasts

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4
Q

what are RBCs formed from?

A

reticulocytes

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5
Q

when is the neutrophil count raised?

A

inflammation
myeloid leukaemia
steroid therapy
bacterial infection

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6
Q

when are neutrophils low?

A

viral infection
bone marrow failure
sepsis
B12 deficiency

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7
Q

what causes eosinophils to be high?

A

parasitic infection
allergy
lymphoma

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8
Q

what causes basophils to be high?

A

hypersensitivity reactions

chronic inflammation

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9
Q

what would cause lymphocytes to be high but neutrophils to be low?

A

viral infection

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10
Q

what cells do CD4 cells activate (T helper)

A

cytotoxic CD8

B cells

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11
Q

which clotting factor is not synthesised in the liver?

A

5

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12
Q

which leukaemia mainly affects children?

A

ALL acute lymphoblastic (remember AML M for mature)

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13
Q

which leukaemia is the most common?

A

chronic lymphocytic leukaemia

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14
Q

what are the 3 stages of therapy for leukaemia?

A

induction
consolidation
maintenance
CNS prophylaxis

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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

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16
Q

what is the staging system in Hodgkin’s lymphoma

A

Ann Arbour

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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)

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18
Q

what might lead to febrile neutropenia?

A

leukaemia or chemotherapy, it is very dangerous

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19
Q

give the most common causes of normocytic anaemia

A

haemorrhage
combined haematinic deficiency
chronic disease

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20
Q

give some causes of macrocytic anaemia

A

hypothyroidism
pregnancy
alcohol
B12/folate deficiency

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21
Q

what drugs might cause macrocytic anaemia?

A

rituximab
trimethoprim
anti epileptic drugs lead to folate deficiency and decreased RBC production

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22
Q

where is folate absorbed?

A

the duodenum

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23
Q

what is a complication of transfusion?

A

haematochromatosis

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24
Q

what infection leads to bone marrow aplasia (failure of erythropoiesis) in sickle cell disease?

A

Parovirus B19

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25
Q

where is B12 absorbed?

A

terminal ileum with intrinsic factor from parietal cells

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26
Q

what does prothrombin time measure

A

the extrinsic pathway 10, 9, 7, 2

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27
Q

what does activated partial thromboplastin time measure?

A

the intrinsic pathway

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28
Q

how do you reverse the action of heparin on Xa?

A

protamine sulfate

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29
Q

what is haemophilia A

A

deficiency of VIII

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30
Q

what is haemophilia B

A

deficiency of IX

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31
Q

what will be elevated in haemophilia?

A

activated partial thromboplastin time (intrinsic), the prothrombin time will be normal

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32
Q

what is the most common cause of congenital thrombophilia?

A

factor V leiden

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33
Q

give symptoms of haemophilia

A

haemoarthosis (arthritis)
spontaneous soft tissue bleeds
GI bleeds
haematuria

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34
Q

what should be avoided in a patient with haemophilia?

A

NSAIDs and IM injections

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35
Q

what will give elevated activated thromboplastin time but low INR?

A

vWF deficiency, it is affecting V-the intrinsic pathway

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36
Q

what kind of bleeding will haemophilia lead to?

A

haemophilia>mucosal bleeding (epistaxis, gingival) and subcutaneous bleeds (haemartoma)

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37
Q

give signs of DVT

A 
redness
swelling
Homan's sign (pain on dorsiflexion of foot)
erythema
pitting oedema
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38
Q

what is the Wells criteria

A

measures the probablility of someone having a DVT, includes: active cancer, paralysis, bedridden, loackised tenderness, whole leg swollen, previous DVT

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39
Q

what is the treatment for DVT?

A

dalteparin and then warfarin or a NOAC

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40
Q

what is sickling precipitated by?

A

cold
hypoxia
dehydration
infection

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41
Q

what kind of anaemia does sickle cell disease cause?

A

normocytic

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42
Q

give some long term complications of sickle cell disease

A 
pulmonary hypertension
cardiomegaly
MI
priapism
chronic bone infarcts>avascular necrosis
infections
leg ulcers
stunted growth
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43
Q

what disease may lead macrocytic anaemia?

A

coeliac or tropical sprue>folate cannot be absorbed in the duodenum.

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44
Q

what may malignancy of differentiated B lymphocytes lead to?

A

monoclonal gammopathy of unknown significance
asymptomatic myeloma
symptomatic myeloma

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45
Q

which blood malignancy is AIDS defining

A

lymphoma

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46
Q

which virus has a role in the pathogenesis of both types of lymphoma?

A

EBV

47
Q

which leukaemias affect adults

A

AML Mature
CML
(CLL ellllllderly)

48
Q

how do you treat someone who has heparin induced thrombocytopenia?

A

stop heparin never give heparin again, another anticoagulant (immunity)

49
Q

what does vWF do?

A

prevents inactivation of VII

50
Q

how is von Willebrand disease inherited?

A

autosomal dominant

51
Q

possible complication of chemotherapy

A

AML

52
Q

in which leukaemia is CNS involvement most common?

A

ALL

53
Q

how do you differentiate between ALL and AML

A

microscopy and immunophenotyping on bone marrow aspirate

54
Q

what is the most common leukaemia

A

chronic lymphocytic

55
Q

what characterises chronic lymphocytic leukaemia?

A

smear cells

56
Q

what leukaemia has blast crises?

A

chronic myeloid leukaemia

57
Q

in which anaemia is there abdominal discomfort?

A

chronic myeloid because there is massive splenomegaly

58
Q

what is combined haematinic deficiency?

A

low iron, low folate, low B12 leads to normochromic normocytic

59
Q

what is pernicious anaemia?

A

folate deficiency

60
Q

treatment for iron deficiency anaemia

A

ferrous sulfate

61
Q

symptoms specific to iron deficiency anaemia?

A

atrophic glossitis
angular stomitis
brittle hair and nails

62
Q

what kind of anaemia does multiple myeloma cause?

A

normocytic

63
Q

where in the diet does B12 come from?

A

meat
fish
dairy

64
Q

causes of bleeding

A

XS destruction GP-tirofiban, heparin, DOAC-apixiban
BM suppression from radiotherapy, leukaemia
DIC
ITP
haemophilia

65
Q

how is haemophilia inherited

A

the factor VIII or IX deficiency is X linked

66
Q

ITP symptoms

A

purpura
easy bruising
menorrhagia
epistaxis

67
Q

where is there usually bleeding into with haemophilia

A

joints>arthropathy

68
Q

how is ITP treated

A

splenomegaly
steroids
IV Ig

69
Q

when is bleeding treated with heparin?

A

in DIC

70
Q

what are the free light chains in multiple myeloma restricted to?

A

kappa or lambda

71
Q

who gets multiple myeloma?

A

70yo+ and Afro-Carribean men

72
Q

what is MGUS?

A

monoclonal gammopathy of unknown significance

73
Q

why are there bone lesions in multiple myeloma?

A

tumour produces growth factors which lead to osteoclast action

74
Q

urine in patient with multiple myeloma

A

bence jones protein

75
Q

lots of RBCs?

A

polycythaemia rubra vera

76
Q

treatment for polycythaemia

A

venesection and aspirin

77
Q

causes of polycythaemia

A

XS EPO, renal carcinoma
decreased plasma volume
hypoxia

78
Q

what might chemotherapy or bone marrow transplant complicate into?

A

febrile neutropenia

79
Q

what haematological conditions cause spinal cord compression

A

malignancy-esp myeloma and lymphoma

80
Q

what will tumour lysis syndrome eventually lead to?

A

acute renal failure

81
Q

causes of iron deficiency anaemia?

A

hookworms, blood loss (PUD, menorrhagia), clopidogrel, warfarin, diet, malabsorption (coeliac, surgery, long term PPI), pregnancy, haemolysis

82
Q

causes of normocytic anaemia?

A

blood loss, anaemia of chronic disease, bone marrow failure, renal failure, hypothyroidism, haemolysis, pregnancy

83
Q

macrocytic anaemia causes?

A

b12/folate deficiency, liver disease, alcohol XS, reticulocytosis, myeleoplastic syndromes, marrow infiltration

84
Q

what kind of anaemia does alcohol XS cause?

A

non-megaloblastic macrocytic anaemia

85
Q

when does a patient need transfusion?

A

Hb<70g/L

86
Q

how does anaemia of chronic disease happen?

A

poor use of iron in erythropoiesis and cytokine induced shortening of RBC life, reduced EPO, reduced EPO response. Hepcidin plays regulatory role

87
Q

what are causes of megaloblastic anaemias?

A

B12, folate, cytotoxic drugs

88
Q

where is folate found?

A

green veg
nuts
yeast
liver

89
Q

where is folate absorbed

A

duodenum and proximal jejunum

90
Q

causes of folate deficiency

A 
poor diet
high demand (pregnancy, haemolysis, malignancy, inflammatory disease, dialysis)
malabsorption (coeliac, tropical sprue)
alcohol
anti epileptics
MTX
trimethoprim
91
Q

what is vit B12 in a drug called?

A

hydroxycolbamin

92
Q

what does b12 help synthesis

A

thymidine, if low>low RBCs

93
Q

what lasts longer, b12 or folate stores?

A

b12-4 years

folate-4 months

94
Q

where is b12 found?

A

meat
dairy
fish

95
Q

how is b12 absorbed?

A

intrinsic factor from parietal cells so can be absorbed in terminal ileum

96
Q

what is pernicious anemia

A

autoimmune destruction of parietal cells

97
Q

what are non pernicious b12 deficiency anaemias?

A

Crohn’s, tropical sprue
bacterial overgrowth
tapeworms

98
Q

how does b12 deficiency affect the nervous system?

A

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
Q

what blood results suggest haemolysis?

A

anaemia with a normal or increased mean corpuscular volume, high bilirubin (esp unconjugated), high urinary urobilinogen and high serum LDH

100
Q

what suggests high RBC production

A

increased reticulocytes so high MCV

101
Q

what complications can result from hamolysis

A

gallstones

leg ulcers

102
Q

why would you used the coombs test?

A

direct-sees if there’s antigens on RBC surface so if it’s immune mediated haemolytic anaemia. (indirect before blood transfusions)

103
Q

which malaria does sickle cell disease protect from?

A

malaria falciparum

104
Q

what will you find elevate in a sickle cell patient?

A

reticulocytes

bilirubin

105
Q

what is the conclusive test for sickle cell diagnosis

A

hb electrophoresis

106
Q

what triggers sickle cell crises

A 
cold
infection
dehydration
hypoxia
lead to microvascular occlusion
107
Q

what is affected in a sickle cell crisis?

A

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
Q

treatment for sickle cell crises?

A 
IV opiates immediately
crossmatch blood
FBC+reticulocytes, cultures
hydrate
keep warm
give o2 if low sats
109
Q

where is the spleen?

A

between 9-11th ribs on left, posterior to stomach

110
Q

function of spleen

A

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
Q

what is the reticuloendothelial system?

A

macrophages and monocytes throughout the body, remove dead cells and act as phagocytes, produce bile pigment, produce plasma protein, stores iron, clears heparin

112
Q

another name for reticuloendothelial system

A

mononuclear phagocytic system

113
Q

where are the fixed parts of the reticuloendothelial system?

A

spleen, joints, alveoli, sinusoidal liver cells, skin

Pathology (21 decks)

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