Haematology Flashcards
What are the 3 primary elements of blood?
- Erythrocytes/RBC’s
- Leukocytes/WBC’s
- Granulocytes [neutrophils, eosinophils, basophils]
- Agranulocytes [lymphocytes, monocytes and macrophages] - Platelets
What are the 3 primary proteins in plasma?
- Albumin [main contributor to blood and colloid osmotic pressure].
- Globulins [transport other proteins, provide immunity to disease]
- Fibrinogen [blood clotting]
What are the other functions of plasma?
Maintain blood pH. Transportation of fat-soluble vitamins, hormones and carbohydrates - a source of energy for the body.
Approximately 90-92% water. Also contain’s salts, metals and inorganic compounds.
What is the function of erythrocytes?
Primarily responsible for tissue oxygenation.
Blood cell formation is referred to as: haematopoiesis. Compromised mainly of water and the red protein haemoglobin. It’s production takes place in bone marrow. Destroyed haemoglobin molecules are used again, although some are broken down to the waste product: bilirubin.
What is the function of leukocytes?
Destroy foreign substances: bacteria, viruses, parasites, toxins and tumour cells. Clear bloodstream of debris, numbers increase in response to infection.
Produced and stored in thymus, spleen and bone marrow.
What is the function of platelets?
Small sticky cells that play a role in blood clotting. Travel to site and swell into odd, irregular shapes.
Repair millions of capillaries each day. Platelets chemically signal the complex clotting process - the clotting cascade.
What is the Rh factor?
Rhesus (Rh) factor is an inherited protein found on the surface of red blood cells. If your blood has the protein, you’re Rh positive.
What are potential indications for RBC transfusion?
- Dilutional anaemia following severe burns.
- Iron-deficiency anaemia
- Megaloblastic anaemia
- Anaemia of chronic disorders
- Chronic renal failure
- Failure of erythropoiesis
- Sickle cell disease
- Septic shock
- Disseminated intravascular coagulopathy.
What is the blood loss [mL & %] for class I haemorrhage [70kg man]?
<750mL 15%, signs generally normal.
What is the blood loss [mL & %] for class II haemorrhage [70kg man]?
750-1000mL, 15-30%, PR starts decreasing.
What is the blood loss [mL & %] for class III haemorrhage [70kg man]?
1500-2000mL, 30-40%, BP & PP decrease, RR & PR increase, urine output decrease
What is the blood loss [mL & %] for class IV haemorrhage [70kg man]?
> 2000mL, >40%, PR & RR increases, BP & PP decrease
What is haematocrit?
Fraction of the total volume of blood that consists of RBCs [normally 45%].
Low haematocrit indicates:
- Anaemia, trauma, surgery, internal bleeding, nutrictional deficiency, bone marrow disease, sickle cells disease.
High haematocrit indicates” Dehydration, lung disease, certain tumours, disorders of the bone marrow.
List a number of 10 haematological disorders.
- Anaemia
- Leukaemia
- Lymphoma’s
- Polycythaemia
- Disseminated intravascular coagulopathy.
- Haemophilia
- Multiple myeloma
- Neutropenia
- Leucopenia [decrease # of WBC’s]
- Thrombocytopenia [reduction in platelets]
What is haemoglobin? What effect is included in this?
Haemoglobin is the iron-containing protein attached to RBC’s. Transports oxygen from the lung’s to the rest of the body.
Bohr effect, carbon monoxide.
What is anaemia and the 3 primary causes of it?
Decreased in blood haemoglobin.
- Not producing enough RBC’s
- Destroying then too quickly
- Bleeding
What are the symptoms of anaemia?
- Tiredness
- Lethargy
- Impaired performance
- SOB
- Exertion
- Giddiness
- Restlessness
- Apprehension
- Confusion
- Collapse
Who is the most risk of anaemia?
- Menstruating women
- Pregnant & breastfeeding women
- Babies [*premature]
- Pubescent
- Vegetarians
- Anorexia
- Bulimia
- People with cancer, stomach ulcers & some chronic diseases
- Dieting
- Athletes
- Elderly
What is iron deficiency anaemia?
Correction of anaemia - ferrous sulphate tablets, blood transfusion, diet, correction of underlying cause.
Overdose of ferrous sulphate tablets in children - can cause seizures
What is haemolytic anaemia?
Disorders that cause RBC’s death in the blood. Can occur in any part of the body and can lead to organ failure. Genetic defect in the haemoglobin [thalassaemia, sickle cell disease]. Management - general and pain.
How would you manage a sickle cell crises?
- General
- Oxygen
- Fluid therapy
- Pain relief
What is Leukaemia? Classification?
- Umbrella term for several types of cancers
- Abnormal proliferation of WBC’s in the bone marrow [weakens normal productions or RBC’s, WBC’s and platelets].
- Classification [lymphoid, myeloid, acute and chronic].
- Large numbers of WBC’s are produced and accumulates which in turn causes organ failure and eventually death
What are the 3 most common reasons why leukaemia patients are seen in ambulances?
- Infection [lymphocytes]
- Anaemia [erythrocytes]
- Bleeding episodes [platelets]
What is your management strategy for leukaemia patients?
- General management
- Pre Alert
What are the 2 types of Lymphoma?
- Hodgkin’s Lymphoma [rare, curable and characterised by swollen nodes]
- Non-Hodgkin’s lymphoma [several types, low/intermediate/high aggressive progress].
What are the three primary types of polycythaemia?
- Primary [idiopathic]
- Secondary [hypoxia - heavy smokers, COPD, high altitude, deep sea divers]
- Apparent [dehydration]
*Increase RBC mass of the blood.
What are the 4 primary pathophysiological exacerbation’s of disseminated intravascular coagulopathy?
- Obstetric
- Infective
- Malignant
- Traumatic
What are the primary causes of disseminated intravascular coagulopathy? (6)
- Loss of platelets and clotting factors
- Fibrinolysis
- Fibrin degradation interference
- Small vessel obstruction
- Tissue ischaemia
- RBC injury
What is haemophilia?
A hereditary bleeding disorder that means that the possessor’s blood insufficiently clots.
What is the treatment plan for haemophilia?
Infusions of factor VIII [antihaemophilic globulin] which is made from large pools of donor blood.
Manage haemorrhaging.
What does R.I.C.E stand for?
Rest - Ice - Compression - Elevation - Splint
What specific bleeds are of greater concern in those with haemophilia? [location/injury type]
- Epistaxis
- Oral, dental bleeds
- Trauma
- Abdominal discomfort/pain
- Haematuria
- Head injury
What is multiple myeloma?
Malignant neoplasm of the bone marrow.
Coagulated protein collect in the tissues and impair function - such as kidney failure - renal tubules become blocked.
General management required to transport patient with plenty of rest & reassurance.
What is neutropenia?
Decrease in the amount of circulating neutrophils.
Risk of infection due to drop in amount of circulating neutrophils.
What are 6 primary causes of neutropenia?
- Anaemia’s
- Leukaemia’s
- Lymphoma’s
- Metastatic cancer
- Hypersplenism
- Viraemia
How would you manage neutropenia?
- General management, particularly BP and O2 levels.
- Consider pre-alerting so that haematology knows of the Pt admission.
What is thrombocytopenia?
A reduction in the number of circulating platelets.
List some causes of thrombocytopenia?
- Platelet clumping/agglutination
- Idiopathic
- Autoimmune associations
- Drug induced/iatrogenic
- Pregnancy
- Pre-eclampsia
- Congenital
- Viral
- Cytotoxins
- Radiotherapy
- Massive blood transfusion
- Hypersplenism
- Splenomegaly
- Hypothermia
How does thrombocytopenia present?
- Bleeding
- Petechiae
- Purpura
- Epistaxis
- Gingival bleeding
- GI bleeding
How would you manage thrombocytopenia?
General management and transport for possible platelet transfusion.
What is the clotting cascade?
Is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in haemostasis, the cessation of blood loss from a damaged vessel, followed by repair.
