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CMS: Musculoskeletal Disease, Elderly, Bleeding, Oral Medicine > Haematology > Flashcards

Haematology Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What are the functions of blood?

A
  • transport: oxygen, nutrients, hormones, waste
  • immune system support - WBCs
  • coagulation
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2
Q

What is the blood made up from?

List some components of each:

Where are cells mainly produced?

A

Composed of plasma and cells

Plasma: proteins, lipids, nutrients, hormones, electrolytes, water

  • red blood cells: oxygen and CO2 transport via haemoglobin
  • white blood cells - immune system
  • platelets - clotting

Cells are mainly produced in bone marrow

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3
Q

A full blood count (FBC) tests the following aspects of blood. What do they mean?

  • WBC
  • RBC
  • Hb
  • Hct
  • MCV
  • MCH
  • Plts
  • Neut
  • Lymph
A
  • WBC - white blood cell count
  • RBC - red blood cell count
  • Hb - haemoglobin (indicates whether pt is anaemic or not)
  • Hct - haematocrit (ratio of colume of red cells to the volume of whole blood - whether pt is bleeding/overproducing RBCs)
  • MCV - mean corpuscular volume (size of RBC)
  • MCH - mean cellular haemoglobin (density of Hg in given RBC)
  • Plts - platelet count
  • Neut - neutrophils
  • Lymph - lymphocytes
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4
Q

What is contained within RBCs?

What is the function of this molecule?

Lack of this causes?

What does MCV show?

What are they termed if too big?

Too small?

A

Haemoglobin: reflects quantity and quality of RBCs

Lack of haemoglobin = anaemia

MCV - size of red blood cells

Too big = macrocytic

Too small = microcytic

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5
Q

What is WCC?

Too many?

Too little?

What is a differential count?

What is the condition associated with too little platelets?

Too many?

Which is less common?

A

Total quantity of WBCs - WCC

Too many = leukocytosis

Too little = leukopaenia

Differential count - number of particular types of white cells e.g. neutrophils, lymphocytes, basophils, eosinophils, monocytes

Too little platelets = thrombocytopaenia

Too many = thrombocythaemia (less common)

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6
Q

What is a blood film?

An acute infection will look like what on a blood smear?

A

Blood film: a smear of blood cells examined under a microscope

An acute infection results in higher numbers of neutrophils e.g. Neutrophilia

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7
Q

What does this blood film show?

A

Malaria: infectious disease caused by Plasmodium parasites, abnormality of RBC form - lost central pale area and more rounded, edges becoming more rough and rugged

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8
Q

When would you sample bone marrow and where from?

List some coagulation tests and what they are used for:

A

Bone marrow sample - if platelet levels, WBC or RBCs are too high or too low, a sample of bone marrow is taken from sternum or iliac crest

Coagulation Tests:

  • activated partial thromboplastin time (APTT): intrinsic pathway of coagulation
  • prothrombin time(PT)/international normalised ratio (INR): functioning of extrinsic pathway to see how certain factors in our blood are working to clot properly

INR - ratio rather than time incase pt takes meds such as warfarin, hence not actual time

Normal time for PT = 12-13 seconds

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9
Q

What is anaemia?

Causes?

What is the normal RBC life in circulation?

A

Haemoglobon deficiency due to lack of cells or lack of haemoglobin itself

Causes:

  • lack of raw materials - iron deficency anaemia, hookwork (ongoing blood loss)
  • production problem
  • longevity problem e.g. overactive spleen, turnover time will drop hence you lose more of this

Normal RBC life in circulation = 120 days

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10
Q

When anaemia is due to lack of raw materials, give examples of these materials and how they are lacking:

What does a blood film of anaemia look like?

A

Iron and folic acid - usually dietary, rarely malabsorption

  • more likely when increased demand i.e. pregnancy

Vitamin B12 - pernicious anaemia

  • autoimmune disease affects absorption of B12

Iron deficiency anaemia blood film will be paler than normal (hypochromic) and smaller than normal (microcytic)

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11
Q

A production problem causes anaemia, which chemical causes this?

A

Lack of erythropoietin due to renal failure

  • can be abused in sport as can increase oxygen carrying capacity

Bone marrow failure

  • aplastic anaemia - complete failure of bone marrow to produce RBCs
  • chemotherapy/immunosuppressants
  • haematological malignancy
  • anaemia of chronic disease: any chronic inflammatory process e.g. rheumatoid arthritis
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12
Q

How can anaemia be caused by losses from circulation?

What disease does this blood film show?

A

Blood loss - most common cause of anaemia

  • bowel (majority)
  • menstruation
  • trauma/post operative
  • bleeding from other organs (unusual)

Haemolysis - destruction of cells in circulation

  • autoimmunity (antibodies against red blood cells and destroy them)
  • sickle cell anaemia
  • thalassaemia

Blood film = sickle cell anaemia

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13
Q

How does anaemia influence cell size (MCV)?

A
  • microcytic (small cells): iron deficiency
  • macrocytic (large cells): B12/folate deficiency, autoimmune
  • normocytic: marrow, renal failure
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14
Q

List some signs and symptoms of anaemia:

A

Symptoms:

  • tired and weak
  • breathless
  • dizzy
  • palpitations
  • specific to cause i.e. blood loss

Signs:

  • pale
  • rapid pulse
  • may be oral features, dependant on type e.g. gingiva more pale
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15
Q

How is anaemia managed?

How is it treated?

A
  • history and examination
  • establish type of anaemia: FBC, blood film, haematinics (iron, B12, folate levels)
  • establish cause - identify source of bleeding, cause of haemolysis

Treatment:

  • replace whats missing (iron sulphate, folic acid, vit B12, erythropoietin, blood transfusion)
  • address underlying cause
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16
Q

List some dental aspects of anaemia:

A
  • characteristic oral abnormalities
  • general anaesthesia: O2 capacity affected in anaemia, need to verify sickle cell status in all patients of black african or caribbean descent before GA
17
Q

What is neutropenia and its causes?

Clinical features?

A

Neutropenia - most important white cell deficiency

  • bone marrow failure
  • autoimmune i.e. viral infection

Clinical features:

Infection in mouth or throat:

  • candida, viral i.e. herpes simplex, commensal bacteria

Risk of life threatening disseminated infection

  • from oral infection or other source
18
Q

List some dental aspects of neutropenia:

A
  • high risk of serious disseminated infection
  • be aware of who is at risk
  • urgent referral required
  • avoid invasive treatment when suspected i.e. pts on chemotherapy, clinical suspicion
19
Q

What are haematological malignancies mainly due to?

What are the two main types?

A

Majority due to uncontrolled proliferation of white cells

  1. Leukaemia: proliferation of immature cells in blood and bone marrow
  2. Lymphoma: proliferation of cells within lymphoreticular system - nodes, liver, spleen, bone marrow
20
Q

What is leukaemia and their two forms of manifestation?

A

Leukaemia: proliferation of primitive blood cells

  • acute - presents within weeks/days (most common malignancy in children)
  • chronic - months to present
21
Q

How does acute leukaemia present?

Survival rate?

What does the blood film of acute leukaemia look like?

A

Presentation:

  • marrow failure: anaemia, infection, bleeding
  • lymphadenopathy
  • soft tissue infiltration
  • chance finding

5 year survival for 50% overall, best in children

Blood film: immature white blood cells and low RBCs

22
Q

How does chronic leukaemia present?

What does the blood film look like?

A
  • anaemia
  • lymphadenopathy

Presents in adults, may transform to acute

Blood film: shows lymphocytes in blood which should not be present

23
Q

What are the two main types of lymphoma?

What is the presentation of each and survival rate?

A

Hodgkin’s Lymphoma

  • mainly young adults esp. males
  • lymphadenopathy (cervical)
  • fever, weight loss, night sweats, itch, anaemia

Prognosis - 5 year survival 80%

Non-Hodgkin’s Lymphoma

  • older adults
  • lymphadenopathy
  • fever, weight loss

Prognosis: variable, 50% 5 year survival

24
Q

How are haematological malignancies treated?

A
  • supportive: transfusions, infection management
  • chemotherapy - kill off abnormal cell line developing
  • radiotherapy - kill off all bone marrow and need a transplant
  • bone marrow transplant (autologous - own stem cell, allogeneic - donor stem cell)
  • novel therapies
25
Q

What are some dental aspects of haematological malignancies:

A

Primary presentation to dentist:

  • atypical infections
  • bleeding
  • lymphadenopathy
  • gum infiltration
26
Q

Coagulation depends upon what?

What happens at site of bleeding?

What aims to achieve a clot formation?

A

Platelets:

  • number and function

Vessel injury:

  • vasoconstriction
  • platelet aggregation
  • coagulation cascade

Clot formation from coagulation cascade and platelet aggregation

27
Q

List some platelet problems:

What is a common platelet aggregation problem and management?

Coagulation cascade problems:

A
  • deficiency: B12, folate
  • production problem: bone marrow failure
  • destruction: immune mediated or portal hypertension

Platelet aggregation problems:

  • function impaired due to medical therapy: aspirin/clopidogrel

Management:

  • treat underlying cause
  • platelet transfusions may be necessary

Coagulation cascade problems:

generalised deficiency

  • protein deficiency (most clotting factors)

Due to liver disease or severe malnutrition

28
Q

Coagulation cascade problems:

A

Coagulation cascade problems:

Generalised deficiency

  • protein deficiency (most clotting factors)

Due to liver disease or severe malnutrition

Specific deficiency

  • congenital: haemophilia, von willebrands disease
  • drugs: warfarin and heparin, NOACs
29
Q

What is haemophilia A and B?

Which factors are affected?

What is von willebrands disease?

A

Haemophilia A and B: X-linked genetic disorder (males only)

  • absent/low clotting factors

A - factor VIII

B - factor IX

Von Willebrands Disease: autosomal sominant (males and females affected)

  • platelet/factor VIII function problem
30
Q

How is haemophilia/von willebrands disease treated?

A

Factor replacement:

  • early or prophylactic

DDAVP (desmopressin) for haemophilia A and von willebrands: increases factor VIII levels

Tranexamic acid - inhibits clot breakdown

31
Q

Dental considerations for Haemophilia/Von Willebrand’s Disease?

A

Risk management:

  • trauma avoidance
  • preparation for expected bleeding i.e. operations

Associated conditions secondary to treatment with unscreened blood products

  • HIV
  • Hepatitis
32
Q

How can bleeding problems manifest?

A
  • cutaneous bleeding
  • mucosal surface bleeding: intraoral, GI, ecess menstrual bleeding (menorrhagia), urinary tract bleeding (haematuria)
  • traumatic bleeding: post-operative, after minor trauma, joints (haemarthroses)
33
Q

What are the dental aspects of coagulation:

A

Identify in history - specific diseases, drugs, symptoms (post-op bleeding, mucosal bleeds)

  • suspected undiagnosed bleeding disorder: do not proceed, refer to GP
  • known bleeding disorder: may need to liase woth GP/haematologist, specific guidelines for anticoagulants

CMS: Musculoskeletal Disease, Elderly, Bleeding, Oral Medicine (9 decks)

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