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3 - Immunology & Haematology > Haematology > Flashcards

Haematology Flashcards

1
Q

Indications for red cell transfusion

((transfusion of blood products in dangerous and must be justified as essential to prevent major morbidity or mortality))

A
  1. To correct severe acute anaemia which may cause organ damage
  2. To improve QoL in a patient with uncorrectable anaemia
  3. To prepare a pt. for surgery/ speed up recovery
  4. To reverse damage caused by a patients own red cells (e.g. sickle cell disease)
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2
Q

Indications for platelet transfusion

((transfusion of blood products in dangerous and must be justified as essential to prevent major morbidity or mortality))

A

Massive haemorrhage
Dilutional thrombocytopenia after massive transfusion
Bone marrow failure/ abnormalities of platelet function
Prophylaxis for surgery (esp. cardiopulmonary bypass)
DIC if bleeding

((try not to cross blood groups but you can))

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3
Q

Effects of development of maternal anti-D antibodies on an RhD+ baby

A

Anti-D is an IgG so crosses the placenta

Reacts with baby’s RBCs

Baby develops cardiac failure and dies in utero or shortly after

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4
Q

SPIKES model for delivering bad news

A

S-etting and listening skills (e.g. private place)
P-atient’s perspective (what do they already know?)
I-indication (warning shot)
K-nowledge (chunking + checking)
E-xplore emotions and empathise
S-trategy and summary

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5
Q

Thrombus =

A

“clot arising in the wrong place”

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6
Q

Thromboembolism =

A

“movement of clot along a vessel”

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7
Q

Virchow’s Triad

A

Stasis
(bed rest, travel)

Hypercoagulability
(high oestrogen (pregnancy, OCP, HRT), trauma)

Vessel damage
(atherosclerosis)

((imbalance of any one can lead to thrombosis))

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8
Q

Things to ask about when investigating a potential bleeding disorder

A 
POST SURGICAL BLEEDING
Bruising
Epistaxis
Menorrhagia
Post trauma bleeding
(post-partum haemorrhage)

And to establish whether congenital or acquired…

  • previous episodes?
  • age at first event?
  • previous surgical challenges
  • FH
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9
Q

A platelet type pattern of bleeding (i.e. bleeding caused by failure of primary haemostasis)

A 
Mucosal
Epistaxis
Menorrhagia
GI
Post-surgery
Purpura/ petichiae (don't blanche!)

(e.g. von Willebrand Disease, Thrombocytopenia)

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10
Q

A coagulation factor pattern of bleeding

A

Artigular
Muscle haematoma
CNS

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11
Q

Indications for transfusions of different blood products

A

Red cells - anaemia

Platelets - thrombocytopenia

FFP - low coagulation factors

Cryoprecipitate - low fibrinogen

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12
Q

Aim to keep a patient’s haemoglobin level above…

A

70

90 - 100 if cardiac impairment

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13
Q

The process of recovering blood lost during surgery and re-infusing it into the patient is called

A

IOCS (intra-operative cell salvage)

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14
Q

immediate action for a patient with major haemorrhage

A

Call 2222

State: “major haemorrhage protocol activation” + location of patient

((you will then be passed to blood bank))

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15
Q

Indications for FFP use

((transfusion of blood products in dangerous and must be justified as essential to prevent major morbidity or mortality))

A

Replacement of coagulation factors (due to major haemorrhage)
DIC if bleeding
Thrombotic Thrombocytopenic Purpura (TTP)
Replacement of coagulation factor deficiencies where factor concentrate unavailable

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16
Q

cryoprecipitate contains

A

FIBRINOGEN

coagulation factors F8, F13

vWF

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17
Q

Indications for use of cryoprecipitate

((transfusion of blood products in dangerous and must be justified as essential to prevent major morbidity or mortality))

A

Hypofibrinogenaemia secondary to massive transfusion

DIC with bleeding and fibrinogen <1g/L

Bleeding associated with thrombolytic therapy causing hypofibrinogenaemia

Renal or liver failure and abnormal bleeding

Inherited hypofibrinogenaemia

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18
Q

what units are used to prescribe a blood transfusion?

A

“units”

1 unit = from 1 donation (separated)

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19
Q

the set of surveillance procedures covering the entire blood transfusion chain, from the donation and processing of blood and its components, through to their provision and transfusion to patients, and including their follow-up

A

Haemovigilance

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20
Q

pyrexia following a transfusion may be due to a….

+ treatment

A

febrile non-hemolytic transfusion reaction (FNHTR)

management: antipyretic

((usually another underlying cause))

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21
Q

Urticaria following a transfusion may be due to a….

+ treatment

A

Causes:

  • mild allergic reaction
  • anaphylaxis

management: antihistamine, adrenaline

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22
Q

Dyspnoea following a transfusion may be due to a….

+ treatment

A

Transfusion associated circulatory overload (TACO)
Transfusion related acute lung injury (TRALI)
Anaphylaxis

Management: O2, diuretic, ventilation, adrenaline

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23
Q

Shock following a transfusion may be due to a….

+ treatment

A

Incorrect blood component transfused (IBCT)
Transfusion associated sepsis (TAS)
TACO
TRALI

Management:

  • IV adrenaline/ hydrocortisone/ antihistamine
  • IV fluid
  • ventilation
  • antibiotics
  • FFP/platelets if DIC
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24
Q

Supportive measures aimed at reducing risk of sepsis in Haematological malignancy (pharmacological prophylaxis)

A

Antibiotics (ciprofloxacin)
Anti-fungal (fluconazole or itraconazole)
Anti-viral (aciclovir)
PJP (co-trimoxazole)

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25
Q

Supportive measures aimed at reducing risk of sepsis in Haematological malignancy (other than pharmacological prophylaxis)

A

Stem cell transplant
Protective environment (e.g. laminar flow rooms)
IV immunoglobulin replacement
Vaccination

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26
Q

Components of blood

A

Plasma

  • clotting/coagulation factors
  • albumin
  • antibodies

Buffy coat

  • platelets
  • white cells

Red blood cells

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27
Q

Donated plasma is separated into 2 components…

+ associated lab tests

A

Fresh frozen plasma
lab tests = PT and APTT

Cryoprecipitate
lab tests = fibrinogen

28
Q

Too many platelets

+ causes

A

thrombocytosis

  • myeloid maligancies
  • infection/inflammation (IBD, RA)
  • post surgery/ trauma
  • iron deficiency
29
Q

Not enough platelets

+ causes

A

Thrombocytopenia

Decreased Production
 - marrow failure/infiltration
Increased Consumption
 - ITP
 - non-immune DIC
 - hypersplenism

((These things cause ACQUIRED bleeding disorder))

30
Q

too many neutrophils

+ causes

A

Neutrophilia

  • Inflammation (MI, post-operative, rheumatoid arthritis)
  • Infection
31
Q

Not enough neutrophils

+ causes

A

Neutropenia

decreased production:
 - drugs (e.g. methotrexate)
 - marrow failure
increased consumption:
 - sepsis
 - autoimmune
32
Q

too many lymphocytes

+ causes

A

lymphocytosis

  • Viral infection (e.g. EBV)
  • Other infections (TB, brucellosis, syphilis)
  • vasculitis
  • lymphoid malignancies
33
Q

not enough lymphocytes

+ causes

A

lymphopenia

  • usually post-viral
  • lymphoma
34
Q

Normal range of haemoglobin

Male + female

A

Male: 135 - 170 g/L
Female: 120 - 160 g/L

35
Q

Normal range of platelets

A

150 - 400 10^9 / L

has to be under 10 for spontaneous mucosal bleeding

36
Q

Normal range of RBC

A

4-5 10^12 / L

37
Q

Normal range of WBC

A

4-10 10^9/L

38
Q

RED CELL donor/recipient compatibility

A

A can give to A
B can give to B

O can give to everyone

AB can receive from everyone

((antibodies are in plasma, antigens are on cells))

39
Q

FFP donor/recipient compatibility

A

A can give to A
B can give to B

AB can give to everyone

O can receive from everyone

((reverse from red cells))
((antibodies are in plasma, antigens are on cells))

40
Q

RhD negative individuals have a deletion of the RhD gene, they can receive red cells from…

A

ONLY other RhD -ve donors

RhD -ve idividuals can make anti-D if exposed to RhD+ cells
e.g. from transfusion or pregnancy

((anti-D can cause transfusion reactions/ haemolytic disease of the newborn

41
Q

Steps of primary haemostasis after exposure to a breach in the endothelium (abnormal surface)

+ aim

A

Platelets…

  1. Adhere
  2. Activation (+degranulation)
  3. Aggregation
  4. Coagulation

Aim is to form a platelet plug

42
Q

Primary haemostasis

Step 1: platelet adherence

A

Platelets adhere to collagen fibres in the subendothelium* via GP1a
GP1b binds to vWF

((GP = glycoprotein))
((vWF = von Willebrand factor))

*exposed due to breach in endothelial surface

43
Q

Primary haemostasis

Step 2: platelet activation (+degranulation)

A

Platelet changes shape + granules are released into the blood

  • alpha: fibrinogen, vWF
  • dense: serotonin, ADP, Ca2+

Production of thromboxane A2

44
Q

Primary haemostasis

Step 3: platelet aggregation

A

caused by thromboxane A2

45
Q

Primary haemostasis

Step 4: platelet coagulation

A

Scramblase flips the membrane, providing a phospholipid surface for coagulation

46
Q

Secondary haemostasis =

+ formation of a stable clot

A

COAGULATION PATHWAY

a complicated cascade of coagulation factors (proteins)
+
Tissue factor (released when vessel damaged)
–>
conversion of prothrombin to thrombin
–>
conversion of fibrinogen to fibrin*

*Fibrin binds to the newly exposed phospholipid surface of the platelets in the platelet plug
==> a stable clot

47
Q

Function of natural anticoagulants

A

confine a clot to the area of tissue damage

48
Q

what natural anticoagulant inactivates thrombin and coagulation factor X

A

Antithrombin

49
Q

what natural anticoagulant inactivates coagulation factors V and VIII

A

Protein C + Protein S

50
Q

what natural anticoagulant inactivates coagulation factors Xa and VIIa

A

Tissue Factor Pathway Inhibitor (TFPI)

51
Q

The process of getting rid of a clot is called…

A

fibronolysis

52
Q

Fibrinolysis

A

endothelium produces tPA (a protease)
–>
“activates” plasminogen to form plasmin
–>
Plasmin fragments the fibrin clot producing
- fibrinogen
- fibrin degradation products (FDPs) - e.g. d-dimer

53
Q

Drugs that inhibit platelet activation and aggregation

examples and mechanism of action

A

Clopidogrel, prasugrel, tricagrelor

Irreversibly bind to ADP receptors on platelets

54
Q

Drugs that bind to GPIIb/IIIa, preventing binding of:

  • fibrinogen
  • von Willebrand factor
  • other adhesive molecules

examples

A

Abciximab, tirofiban, eptifibatide

55
Q

Mechanism of action of aspirin

A 
inhibits cyclooxygenase (COX) enzyme 
 - therefore inhibits thromboxane A2 formation
56
Q

Mechanism of action of warfarin

A

inhibits several coagulation factors + prothrombin

57
Q

Mechanism of action of heparins

A

inhibit thrombin and coagulation factor Xa

increases ability of antithrombin

58
Q

Inhibitors of coagulation factor Xa

examples

A

Rivaroxaban, edoxaban, apixaban

59
Q

Thrombin inhibitors

examples

A

dabigatran, bivalirudin, argatroban

60
Q

Questions to ask in suspicious iron deficiency anaemia

A

Bleeding (inc. menorrhagia)
Pregnancy
Diet (esp. vegan)
GI symptomatology (may be malabsorption)

61
Q

definitions of different sizes of bruising

A 
Ecchymosis = >10mm
Purpura = 3 - 10mm
Petichiae = <3mm

((DON’T blanche - skin only blanches if blood is INSIDE blood vessels))

*FBC if any of these present

62
Q

3 signs of bone marrow failure

A

↓ Hb (symptoms of anaemia)
↓ platelets (mucosal bleeding)
↓WCC (infections)

63
Q

Be suspicious of haematological malignancy if lymphocyte count + neutrophil count =

A

less than total WCC

64
Q

Lymphocytes found in normal peripheral blood

A

T cells

NOT B cells

65
Q

Structure for breaking bad news

A

S - setting + listening skills (silence + pauses, “is there anybody here with you?”)
P - patient perception (“tell a bit about what’s been happening”)
I - invitation (“i’m afraid it’s bad news”)
K - knowledge (chunking + checking, “would you like me to continue”)
E - empathy (but don’t get upset, “we’ll be here with you through this”, “how are you feeling”)
S - summarise and strategy (give leaflets, explain next steps)

66
Q

Substances related to bleeding and clotting produced by the liver:

A

Most clotting factors (I, II, V, VII, VIII, X, XI)
Fibrin

so liver failure = Increased risk of venous thrombosis AND bleeding

67
Q

Red cell breakdown occurs in the…

A

reticuloendothelial system

consists of macrophages in the SPLEEN, liver, lymph nodes, lungs…

3 - Immunology & Haematology (3 decks)

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