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3 - Immunology & Haematology > Haematology > Flashcards

Haematology Flashcards

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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
Supportive measures aimed at reducing risk of sepsis in Haematological malignancy (other than pharmacological prophylaxis)
Stem cell transplant Protective environment (e.g. laminar flow rooms) IV immunoglobulin replacement Vaccination
26
Components of blood
Plasma - clotting/coagulation factors - albumin - antibodies Buffy coat - platelets - white cells Red blood cells
27
Donated plasma is separated into 2 components... | + associated lab tests
Fresh frozen plasma lab tests = PT and APTT Cryoprecipitate lab tests = fibrinogen
28
Too many platelets + causes
thrombocytosis - myeloid maligancies - infection/inflammation (IBD, RA) - post surgery/ trauma - iron deficiency
29
Not enough platelets + causes
Thrombocytopenia ``` Decreased Production - marrow failure/infiltration Increased Consumption - ITP - non-immune DIC - hypersplenism ``` ((These things cause ACQUIRED bleeding disorder))
30
too many neutrophils + causes
Neutrophilia - Inflammation (MI, post-operative, rheumatoid arthritis) - Infection
31
Not enough neutrophils + causes
Neutropenia ``` decreased production: - drugs (e.g. methotrexate) - marrow failure increased consumption: - sepsis - autoimmune ```
32
too many lymphocytes + causes
lymphocytosis - Viral infection (e.g. EBV) - Other infections (TB, brucellosis, syphilis) - vasculitis - lymphoid malignancies
33
not enough lymphocytes + causes
lymphopenia - usually post-viral - lymphoma
34
Normal range of haemoglobin | Male + female
Male: 135 - 170 g/L Female: 120 - 160 g/L
35
Normal range of platelets
150 - 400 10^9 / L | has to be under 10 for spontaneous mucosal bleeding
36
Normal range of RBC
4-5 10^12 / L
37
Normal range of WBC
4-10 10^9/L
38
RED CELL donor/recipient compatibility
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
FFP donor/recipient compatibility
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
RhD negative individuals have a deletion of the RhD gene, they can receive red cells from...
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
Steps of primary haemostasis after exposure to a breach in the endothelium (abnormal surface) + aim
Platelets... 1. Adhere 2. Activation (+degranulation) 3. Aggregation 4. Coagulation Aim is to form a platelet plug
42
Primary haemostasis | Step 1: platelet adherence
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
Primary haemostasis | Step 2: platelet activation (+degranulation)
Platelet changes shape + granules are released into the blood - alpha: fibrinogen, vWF - dense: serotonin, ADP, Ca2+ Production of thromboxane A2
44
Primary haemostasis | Step 3: platelet aggregation
caused by thromboxane A2
45
Primary haemostasis | Step 4: platelet coagulation
Scramblase flips the membrane, providing a phospholipid surface for coagulation
46
Secondary haemostasis = + formation of a stable clot
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
Function of natural anticoagulants
confine a clot to the area of tissue damage
48
what natural anticoagulant inactivates thrombin and coagulation factor X
Antithrombin
49
what natural anticoagulant inactivates coagulation factors V and VIII
Protein C + Protein S
50
what natural anticoagulant inactivates coagulation factors Xa and VIIa
Tissue Factor Pathway Inhibitor (TFPI)
51
The process of getting rid of a clot is called...
fibronolysis
52
Fibrinolysis
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
Drugs that inhibit platelet activation and aggregation examples and mechanism of action
Clopidogrel, prasugrel, tricagrelor Irreversibly bind to ADP receptors on platelets
54
Drugs that bind to GPIIb/IIIa, preventing binding of: - fibrinogen - von Willebrand factor - other adhesive molecules examples
Abciximab, tirofiban, eptifibatide
55
Mechanism of action of aspirin
``` inhibits cyclooxygenase (COX) enzyme - therefore inhibits thromboxane A2 formation ```
56
Mechanism of action of warfarin
inhibits several coagulation factors + prothrombin
57
Mechanism of action of heparins
inhibit thrombin and coagulation factor Xa | increases ability of antithrombin
58
Inhibitors of coagulation factor Xa examples
Rivaroxaban, edoxaban, apixaban
59
Thrombin inhibitors examples
dabigatran, bivalirudin, argatroban
60
Questions to ask in suspicious iron deficiency anaemia
Bleeding (inc. menorrhagia) Pregnancy Diet (esp. vegan) GI symptomatology (may be malabsorption)
61
definitions of different sizes of bruising
``` 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
3 signs of bone marrow failure
↓ Hb (symptoms of anaemia) ↓ platelets (mucosal bleeding) ↓WCC (infections)
63
Be suspicious of haematological malignancy if lymphocyte count + neutrophil count =
less than total WCC
64
Lymphocytes found in normal peripheral blood
T cells | NOT B cells
65
Structure for breaking bad news
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
Substances related to bleeding and clotting produced by the liver:
Most clotting factors (I, II, V, VII, VIII, X, XI) Fibrin so liver failure = Increased risk of venous thrombosis AND bleeding
67
Red cell breakdown occurs in the...
reticuloendothelial system | consists of macrophages in the SPLEEN, liver, lymph nodes, lungs...

3 - Immunology & Haematology (3 decks)

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