Haematology Flashcards
1
Q
What is different between serum and plasma?
A
Plasma- liquid with clotting factors
Serum- liquid without clotting factors
(both without RBCs)
2
Q
Which part of skeleton produces most blood products in adults?
A
Axial skeleton
3
Q
In what state can iron bind oxygen?
A
Ferrous, Fe2+
4
Q
In what state is iron useless at binding oxygen?
A
Ferric, Fe3+
Ferric, DICK, we don’t like
5
Q
How does Ferrous iron become Ferric iron?
A
Oxidisation, removing of electron
6
Q
Why is the RBC membrane like a tent?
A
Made up of: Lipid bilayer (waterproof canvas tent) & Protein spars (tent poles)
7
Q
Which glycoprotein do the terms ‘haematopoietin’ and ‘haemopoietin’ refer to?
A
Erythropoietin
This is a shit flashcard
8
Q
When is erythropoietin released?
A
When blood oxygen is low
9
Q
Why is Ferric iron dangerous?
A
Doesn’t bind oxygen, allowing oxygen radicals to form & damage RBCS
Ferric, DICK, we don’t like
10
Q
What biochemical step prevents Ferrous iron becoming Ferric iron?
A
Reduction
NADH sacrifices electron to prevent oxidisation
Remember this happens to Ferric, DICK, we don’t like
11
Q
What happens to NADH after it prevents oxidisation of ferrous iron?
A
Becomes NAD-
12
Q
Where does the body get NADH from?
A
Byproduct of ATP synthesis
you’d know if you listened in higher biology lol
13
Q
What do enzymes do to oxygen radicals?
A
React to form hydrogen peroxide then water
14
Q
What reduces hydrogen peroxide to water?
A
Glutathione
15
Q
What does glutathione do?
A
Prevents RBC damage form oxidative stress, eg by forming water with hydrogen peroxide
16
Q
What reduces glutathione to its useful state?
A
NADPH
kevin bridges: glutaPHione reduced by NADPH
17
Q
What does NADPH do to glutathione?
A
Reduces it (to useful state)
18
Q
What is NADPH generated by?
A
G6PD
Like a like a G6 Police Department
19
Q
Relevance of G6PD to keeping blood cells healthy? (3 steps)
A
G6PD generates NADPH
NADPH reduces Glutathione to useful state
Glutathione reduces hydrogen peroxide/ oxygen radicals to water
20
Q
Who gets problems with G6PD?
A
Mainly boys, as its X linked
In F much more unlikely as need 2 faulty copies
Like a G6- song has one female singer, four males
21
Q
What food should G6PD deficiency sufferers avoid?
A
Fava beans lmao
Pythagoras made all his bros swear off beans
22
Q
Red cell appearance seen in G6PD deficiency?
A
Bite cells (degmacytes) Blister cells
Shouldn’t take a BITE of fava beans or you will not be fly like a G6 (you will get blisters..?)
23
Q
Red cell inclusion classically seen in G6PD deficiency?
A
Heinz body
Can you actually believe the disease that stops you eating beans has Heinz bodies as a feature HA HA HA
24
Q
Explain difference between Thrombocytosis and Thrombophilia
A
Thrombocytosis- loadsa platelets
Thrombophilia- tendency to clot, excessive to stimulus
25
What is a reticulocyte?
Baby RBC just released into blood
wook at the wittle weticulocyte (vomit)
26
Differences between reticulocyte and RBC? (2)
Reticulocytes- larger and have some RNA
27
What does erythropoietin do?
Causes erythroid hyperplasia in bone marrow
28
What does low ferritin mean?
Iron deficiency
29
What is best treatment for iron deficiency?
Oral ferrous fumarate
| but treat the underlying cause as GI bleed etc can be masked by symptomatic tx
30
Where is iron absorbed?
Proximal small bowel (Duodenum and Jejunum)
Remember DJ Ileum? Now DJ= Iron
31
Presence of Intrinsic Factor antibodies indicates what?
Pernicious anaemia (very specific)
32
What is Pernicious Anaemia? (3)
Autoimmune destruction of gastric parietal cells ∴
Can't produce Intrinsic Factor ∴
Can't absorb Vitamin B12
33
What makes Intrinsic Factor?
Gastric parietal cells
34
What does Intrinsic Factor do?
Binds to Vitamin B12 allowing it to be absorbed (in the ileum)
35
Where is Folate absorbed?
Jejunum
36
Where is B12 absorbed?
Ileum
| Highest number B vitamin, furthest away in small bowel
37
How long do B12 stores last?
4 years
remember sudden anaemia in vegan after years
38
How long do Folate stores last?
4 months
39
1st line tx in B12 deficiency?
Hydroxocobalamin (B12) IM for life
40
Causes of spurious macrocytosis? (2)
```
Reticulocytosis
Cold agglutins (IgM mediated)
```
41
What is reticulocytosis?
Increased reticulocyte level (ie normal haemostatic response to bleed)
42
What is polychromatic blood film?
Blood film seen in reticulocytosis
RBCs- red
Reticulocytes- purple
43
What causes the anaemia in megaloblastic macrocytic anaemia?
Those big boys get whacked by apoptosis in marrow
| Fewer RBCs released> anaemia
44
How to assess impact of iron treatment etc on child?
Symptomatic improvement
Don't try and stick excess needles in them they'll probably run away
45
What does polychromasia indicate?
New RBC production
46
Define polychromasia
High numbers of immature red blood cells leading to diff colours in blood film
47
Child with:
- jaundice & anaemia,
- family history of splenectomy,
- spherocytes without normal RBCs seen in blood smear.
Diagnosis?
Hereditary spherocytosis
48
Why should the underlying cause of Iron Deficiency Anaemia be investigated before giving Iron?
Can mask worrying pathology
GI bleed etc can be masked by symptomatic tx
49
What type of Immunoglobin is anti-ABO antibody?
IgM
50
When should Fresh Frozen Plasma (FFP) not be given? (2)
Absence of bleeding
Without procedure planned
Even in coagulopathy
51
Patient with coagulopathy, raised Prothrombin time, not bleeding & no planned procedure. Can I give FFP?
NO!
Only give FFP in bleeding or with procedure planned, even in coagulopathy
52
What is raised HbA2 diagnostic of?
Beta Thalassaemia trait
53
What is there none of in Beta Thalassaemia major?
Adult haemoglobin (HbA)
54
How are Alpha Thalassaemia trait & Beta Thalassaemia trait differentiated from Iron Deficiency anaemia?
Ferritin normal in the thalassaemia traits
| Ferritin low in IDA
55
Alpha Thalassaemia disease not compatible with life?
Hb Barts Hydrops Foetalis Syndrome
56
Why is there bony overgrowth in Beta Thalassaemia Major?
Extramedullary haematopoiesis
57
What are the endocrine symptoms of Iron Overload? (3)
Delayed growth/ puberty
DM
Osteoporosis
58
How is iron overload managed in Thalassaemia?
Iron chelating drugs (can't venesect as in haemophilia because you just put more blood in)
eg Desferrioxamine
59
Why does iron overload cause cardiac abnormalities like arrhythmia?
Iron in myocardium
60
What are the Hepatic sequelae of Iron Overload? (2)
Cirrhosis
| Hepatocellular cancer
61
How are haemoglobinopathies diagnosed?
Electrophoresis
Prenatal screening based on parent genotype
(High Performance Liquid Chromatography in the past)
62
Long term management of hyposplenism? (2)
Vaccinate
| Prophylactic penicillin
63
Name a drug that increases the production of foetal haemoglobin (HbF)
Hydroxycarbamide
Also known as Hydroxyurea, it's same thing
64
What does Hydroxycarbamide do?
Increases the production of foetal haemoglobin (HbF)
Useful in sickle cell disease
65
What does Hepcidin do? (2)
Decreases iron absorption
| Inhibits iron release from macrophages and enterocytes
66
When is Hepcidin decreased?
If body iron is low
67
What channel does Hepcidin bind to, to inhibit iron transport?
Ferroportin
68
When is Ferritin raised? (3)
Too much iron
Malignancy
Tissue damage/inflammation
It's an acute phase protein too!
69
Why is Ferritin level increased in inflammation, malignancy and tissue damage?
It is an acute phase protein
70
In what type of anaemia does iron build up in the mitochondria due to failure to incorporate it into haeme?
Sideroblastic anaemia
71
Why is Anaemia of Chronic Disease hypothesised to occur?
To starve pathogens of iron- they need it too!
72
What gene is mutated in haemochromatosis?
HFE
Haeme For Ever!!
73
Treat haemochromatosis?
Weekly venesection to deliberately exhaust iron stores
74
What is the main thing that happens in primary homeostasis?
Formation of platelet plug
75
What is the main thing that happens in secondary homeostasis?
Formation of Fibrin clot
76
What factors are Vitamin K dependant?
2, 7, 9, 10
| BLOODy sunday happened in 1972
count 1 as 10
77
What does Vitamin K do?
Makes Koagulation factors
Originally named in Danish!
78
What factor is deficient in Haemophilia A?
Factor VIII
A- Eight- 8
79
What factor is deficient in Haemophilia B?
Factor IX
We know factor Eight is deficient in type A
B comes after A, Nine comes after Eight
80
Boy with repeated bleeding into load bearing muscles and joints. Diagnosis?
Haemophilia
81
What is a 'target joint' in haemophilia?
Joint with recurrent bleeds
Leads to fused joint with loss of joint space
82
Sequelae of untreated 'target joint' in haemophilia? (2)
Fused joint
| Loss of joint space
83
Prevalence of Haemophilia A vs B?
A 5:1 B
ABrAcAdABrA (not QUITE magic cos there's an extra B)
84
How is Haemophilia treated?
Intravenous clotting factor (whichever is missing)
85
Give some indications for longterm anticoagulation in Venous Thrombosis (4)
Previous thrombosis
Spontaneous (eg can't identify trigger, no surgery etc)
Foetal loss
Arrhythmia
86
What mode of inheritance is seen in Haemophilia?
X linked recessive
87
Mechanism of Warfarin?
Vitamin K inhibitor
88
What is Vitamin K soluble in- fat or water?
Fat
89
The production of what is inhibited by Warfarin? (6)
Clotting factors 2, 7, 9, 10
| Protein C and S
90
Why must LMWH be given with Warfarin? (3)
Warfarin inhibits protein C and S production (not just clotting factors)
C and S have shorter half life than clotting factors, so are cleared faster
There is a period of time where anticoagulating effects of C and S are removed, allowing unopposed coagulation by factors 2, 7, 9, 10
LMWH makes up the difference in this gap!
91
How is response to heparin monitored?
Activated Partial Thromboplastin Time (APTT)
92
What type of heparin needs monitored?
Unfractionated Heparin
93
What are the two types of heparin?
Unfractionated
| Low Molecular Weight (LMWH)
94
What anticoagulant has the shortest half life?
Unfractionated Heparin
therefore can be titrated right up to last minute before surgery
95
What is the antidote to unfractionated heparin?
Protamine Sulphate
96
What is the mechanism of heparin?
Potentiates anti-thrombin
97
Rivaroxaban, apixaban, edoxaban inhibit which clotting factor?
Factor Xa
rivaroXaban, apiXaban, edoXaban all have Xa in name
98
Which blood test is most raised with Warfarin treatment?
PT or INR (both measure same thing, whichever is available)
99
How do we reverse warfarin treatment? (2)
Oral Vitamin K (6hr response)
| IV Clotting factors (immediate response)
100
What is the blood finding seen in multiple myeloma?
Rouleaux formation
RBCs make a wee stack
101
What is suggested by RBCs all in a little stack?
This is the Rouleaux formation
Seen in Myeloma
102
What type of poisoning is a cause of Sideroblastic Anaemia?
Lead poisoning
103
Causes of vitamin K deficiency? (3)
```
Dietary insufficiency (commonest)
Malabsorption
Storage problems (liver disease)
```
104
Best test to confirm haemolysis?
Reticulocyte count
105
Why is there macrocytic anaemia in Pernicious Anaemia?
No B12> cells don't mature properly, retain nucleus > macrocytic
They undergo apoptosis due to being abnormal/nucleated > anaemia
106
Why is there hyperbilirubinaemia in Pernicious Anaemia?
Breakdown products of increased apoptosis of RBC precursors in marrow
107
What does 'blast' refer to in haematology?
A nucleated precursor cell
108
What is a Megakaryocyte?
Platelet precursor cell
| platelets break off from cytoplasm
109
How are platelets produced by a Megakaryocyte?
Platelets break off from Megakaryocyte cytoplasm
110
When embryologically does bone marrow become the main site of haemopoiesis?
Week 16
111
Where is the main site of embryological haemopoiesis at roughly week 1-3 of development?
Yolk sac
112
Where is the main site of embryological haemopoiesis at roughly week 3-16 of development?
Liver & Spleen
113
Where is bone marrow biopsy taken in normal healthy adult?
Posterior Iliac Crest
114
Where is bone marrow biopsy taken in a small child?
Tibial Marrow Cavity
115
Why is bone marrow biopsy not taken from the tibia in normal healthy adult?
No red marrow to sample
In adults haemopoiesis occurs in the axial skeleton, ie no haemopoiesis in the tibia
116
What does red bone marrow change to with increasing age?
Yellow marrow, ie fat
117
What is Neutrophil maturation stimulated by?
Granulocyte-Colony Stimulating Factor (G-CSF)
118
What is stimulated by G-CSF?
Neutrophil maturation
G-CSF stands for Granulocyte- Colony Stimulating Factor
119
Define immunophenotyping
Study of antigen presentation using specific antibodies
(Antigen expression is unique to each cell lineage, immunophenotyping allows for histologically identical cells to be differentiated from one another)
120
What does immunophenotyping allow us to do?
Differentiate histologically identical cells
| tests antigen expression using antibodies, this is unique to each cell
121
Generalised lymphadenopathy raises suspicion of which malignancies? (2)
Leukaemia
| Lymphoma
122
Excess blasts (>20%) suggests what?
Acute Leukaemia
123
Two types of Acute Leukaemia?
Myeloblastic
| Lymphoblastic
124
Commonest childhood cancer?
Acute Lymphoblastic Leukaemia (ALL)
125
Which organs does Acute Lymphoblastic Leukaemia affect much more than Acute Myeloblastic Leukaemia? (2)
CNS
| Testes
126
Surface protein on Hemopoietic Stem cells and Progenitor Cells?
CD34
+34 is Spain's dialling code, where the BLOOD runs HOT and RED because they have lots of CD34 (idk)
127
Auer rod cell inclusion suggests what?
Acute Myeloblastic Leukaemia
AML>Anti Money Laundering 👮♂️
Au> gold 🥇
128
Test to differentiate AML and ALL?
Immunophenotyping
129
Life threatening feverish infection with marrow suppression. Causative organism?
Gram Negative bacteria
130
Neutropenic patient is feverish. Treatment?
Broad-spectrum antibiotics STAT
(covering gram negative bacteria)
Do not wait for culture/microbiology (emergency)
131
Neutropenic patient is feverish, and hasn't responded to broad-spectrum antibiotics. Causative organism?
Fungus
132
Low levels of what type of blood cell makes a patient more susceptible to Pneumocystis Jirovecii pneumonia?
Neutrophils
133
Mega side effects of anthracycline chemotherapy?
Cardiomyopathy
134
Painful lymph nodes after drinking alcohol. Classic symptom of what?
Hodgkin's Lymphoma
135
Best node biopsy for lymphoma?
Excisional biopsy
Core biopsy is a bit shit as can't see cellular architecture
136
Which is better for ?lymphoma- excisional or core biopsy?
Excisional biopsy
Core biopsy is a bit shit as can't see cellular architecture
137
Reed Sternberg cells suggest what?
Hodgkin's Lymphoma
138
Tests to identify spread of Lymphoma? (2)
CT
| PET
139
Main drug in Hodgkin's Lymphoma?
Bleomycin
140
Bleomycin used to treat what?
Hodgkin's Lymphoma
141
Characteristic cell seen in Hodgkin's Lymphoma?
Reed Sternberg cells
142
Cellular inclusions classically seen in Acute Myeloid Leukaemia?
Auer bodies
AML>Anti Money Laundering 👮♂️
Au> gold 🥇
143
What virus is Hodgkin's Lymphoma strongly associated with?
Epstein Barr Virus
144
At what age is Hodgkin's Lymphoma most commonly seen?
20s
145
Name a common high grade Non-Hodgkin's Lymphoma
Diffuse Large B-Cell (Lymphoma)
146
Non-Hodgkin's Lymphoma with a propensity for extra-nodal disease? (2)
T Cell Non-Hodgkin's Lymphoma
| Burkitt Lymphoma
147
Rituxumab targets what surface protein?
CD20 on B cells
Useful in B Cell Non-Hodgkin's Lymphomas
148
Brentuximab targets what surface protein?
CD30 on T cells
Useful in T Cell Non-Hodgkin's Lymphomas
149
CD20 seen on the surface of which cells?
B Cells
150
CD34 seen on the surface of which cells? (2)
Hemopoietic Stem cells
Progenitor Cells
+34 is Spain's dialling code, where the BLOOD runs HOT and RED because they have lots of CD34
151
Fastest growing human tumour?
Burkitt lymphoma
152
Endemic Burkitt lymphoma is associated with which infections? (2)
EBV (most)
| Malaria
153
Chromosomal translocation seen in Burkitt Lymphoma?
c-myc
154
c-myc chromosomal translocation is seen in what haematological malignancy?
Burkitt Lymphoma
Burkitt was an Irish surgeon
myc sounds like start of an Irish name
155
boobs
dleet this card
156
Why should biopsy be performed before giving steroids in ?Burkitt Lymphoma ?
Avoids tumour lysis
157
Electrolyte abnormalities seen in Tumour Lysis syndrome
Hyperphosphataemia (Ph)
Hyperuricaemia (U)
Hyperkalaemia (K)
Hypocalcaemia (Ca)
PhUK Ca-ncer
158
Causative haematological abnormality in Fanconi Anaemia?
Unable to correct inter-strand DNA crosslinks
Macarena, Fanconi, CRISS CROSS
159
Myelodysplastic syndromes tend to evolve into what?
Acute Myeloblastic Leukaemia
160
Hyper or Hypocellular marrow seen in aplastic anaemia?
Hypocellular
161
Hyper or hypocellular marrow seen in B12 deficiency anaemia?
Hypercellular
162
Hyper or hypocellular marrow seen in hypersplenism?
Hypercellular
163
Hyper or hypocellular marrow seen in myelodysplastic syndromes?
Hypercellular
164
Commonest cause of hypocellular bone marrow?
Aplastic Anaemia (idiopathic)
165
Feverish neutropenic patient has had tests sent off to microbiology. What should be done now?
Treat with broad spectrum antibiotics
Don't wait for culture
Gram Negative bacteria can cause fulminant sepsis
166
What happens in Tumour Lysis Syndrome
Large number of cancer cells die within a short period, releasing their contents into the blood
167
Type of Acute Leukaemia affecting testes and CNS?
Acute Lymphoblastic Leukaemia
168
Which immunoglobin is dimeric?
IgA
169
Which immunoglobin is pentameric?
IgM
170
Clock face nucleus seen in what cell?
Plasma cells
171
What is a paraprotein?
Protein produced by underlying B-Cell or Plasma Cell disorder
172
At what age is Myeloma typically diagnosed?
65
173
What is MGUS?
Monoclonal Gammopathy of Unknown Significance
Paraprotein without myeloma organ damage
174
Vincristine side effect?
Neuropathy
175
Philadelphia Chromosome suggests what malignanacy?
Chronic Myeloid Leukaemia
176
Emergency Lymphoma treatment?
Steroids
Preferably do a biopsy first
177
Suggest haematological malignancies that don't require treatment (2)
Early Chronic Lymphocytic Leukaemia
Low grade Lymphoma
(if no symptoms or cytopenia due to marrow infiltration)
178
How to treat CLL without symptoms or cytopenia due to marrow infiltration?
Watchful waiting (ie no treatment)
179
How to treat Low Grade Lymphoma without symptoms or cytopenia due to marrow infiltration?
Watchful waiting (ie no treatment)
180
Commonest symptoms of Myeloma?
Calcium high
Renal failure
Anaemia
Bone lesions/ pain
a C.R.A.B. called Mylo 🦀
181
CRAB symptoms of Myeloma?
Calcium high
Renal failure
Anaemia
Bone lesions/ pain
a C.R.A.B. called Mylo 🦀
182
What is seen on a Leukoerythroblastic Blood Film? (2)
Immature granulocytes
| Nucleated RBCs
183
Causes of Leukoerythroblastic Blood Film? (3)
Haemorrhage
Bone marrow malignancy
G-CSF Administration
184
Smudge Cells indicate?
Chronic Lymphocytic Leukaemia
185
Smear Cells indicate?
Chronic Lymphocytic Leukaemia
