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Haematology Flashcards

1
Q

What are some causes for microcytic anaemia?

A

TAILS

  • Thalassaemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic
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2
Q

What are some causes of normocytic anaemia?

A 
Acute blood loss
Chronic disease
Aplastic
Kidney disease
Hypothyroid
Pregnancy
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3
Q

What are some causes of macrocytic megaloblastic anaemia?

A

Deficiency of B12 or Folate

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4
Q

What are some causes of macrocytic normochromic anaemia?

A 
Alcohol
Liver disease
Reticulocytosis
Hypothyroid
Azathioprine
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5
Q

What other blood tests would you order if you find an anaemia?

A

B12/folate
Reticulocytes - in FBC
Iron studies - iron, TIBC, transferrin, ferritin
TFT’s

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6
Q

What are some signs and symptoms of anaemia?

A 
Tired
SOB
Dizzy
Palpitations
Worsening HF/angina/PVD

Pale conjunctiva
Bounding pulse
Postural hypo
Hair loss

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7
Q

What are the signs of iron deficiency anaemia?

A

Koilonychia
Angular stomatitis
Atrophic glossitis
Brittle hair and nails

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8
Q

What can cause iron deficiency?

A

Reduced intake
Increased excretion - menstruation, GI cancer
Reduced absorption - coeliacs, crowns, PPI
Increased need - pregnancy

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9
Q

What would iron studies show in anaemia?

A

Low iron, ferritin, transferrin saturation

Raised TIBC

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10
Q

Why is total iron binding capacity high in iron deficiency anaemia?

A

Transferrin may be normal or raised

TIBC is the space of transferrin for iron to be bound. Less iron = more spaces

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11
Q

What can give false results for iron deficiency anaemia?

A

Iron tablets
Acute liver damage
Iron containing food

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12
Q

How can iron be replaced?

A

Oral - not in malnourished
IV - not if septic
Blood transfusion

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13
Q

What iron studies are seen in anaemia of chronic disease?

A

Low iron, transferrin and TIBC

Raised ferritin

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14
Q

Why do you get anaemia of chronic disease?

A

Hepcidin stops iron being available for micro-organisms
Reduced EPO
Impaired erythropoiesis
Reduced red cell survival

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15
Q

What are the types of thalassaemia?

A

Alpha - may be incompatible with extra-uterine life
Beta major - both beta genes abnormal
Beta minor - one abnormal beta gene

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16
Q

What are some features of thalassaemia and why do you get them?

A

Splenomegaly and Jaundice:

  • Ineffective erythropoiesis with haemolysis
  • Excess alpha chains

Prominent forehead and cheek bones:
- Extramedullary haematopoesis

Thrombosis - hypercoaguable

Iron overload

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17
Q

Why does iron overload occur in thalassaemia?

A

Increased absorption due to chronic anaemia
Repeated transfusions
Creation of faulty RBC’s

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18
Q

How is thalassaemia managed?

A

Transfusion
Iron chelation - deferoxamine
Bone marrow transplant

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19
Q

What are some common features of haemolytic anaemia?

A

Jaundice
Splenomegaly
Gallstones
Dark urine

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20
Q

What blood results are seen in a haemolytic anaemia?

A

Normocytic anaemia
High reticulocyte count
High LDL
Unconjugated hyperbilirubinaemia

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21
Q

What can precipitate an aplastic crisis?

A

Parvovirus

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22
Q

How does G6PD deficiency appear on blood film?

A

Heinz bodies

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23
Q

What can trigger a G6PD crisis?

A

Broad beans
Anti-malarials
Ciprofloxacin
Infection

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24
Q

Whats the difference between warm and cold haemolytic anaemias?

A

Warm is idiopathic and due to autoantibodies at room temperature

Cold is often due to leukaemia, SLE, EBV or CMV where autoantibodies lead to clumping at low temperatures

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25
What is microangiopathic haemolytic anaemia?
Small blood vessels have structural abnormalities that cause haemolysis Caused by HUS, TTP, DIC
26
What are some complications of sickle cell anaemia?
``` Increased risk of infection Vaso-occlusive events - stroke, priapism CKD AVN of hip Splenic sequestration Aplastic crisis Acute chest syndrome ```
27
What are the key risk factors for b12 anaemia?
Crohns Vegan diet Reduced intrinsic factor - pernicious or post-gastrectomy Inadequate release of b12 from food - alcohol, gastritis
28
What can cause reduced folate?
``` Poor intake Poor absorption - coeliac, diseases affecting duodenum/jejunum Increased req. - pregnancy Increased loss - liver disease Anti-convulsants ```
29
What does subacute degeneration of the cord present like?
Dorsal columns - proprioception, vibration, ataxia Lateral columns - pyramidal weakness, hyper-reflexia, upgoing plantars Mix of UMN and LMN This is why B12 deficiency must be managed before folate
30
What antibodies are associated with pernicious anaemia?
Anti-intrinsic factor - MAIN Anti-parietal cell
31
What are some causes of neutrophilia?
``` Reaction to infection Inflammation - RA, IBD Hyposplenism Hypoxia Lithium and steroids CML ```
32
What are some causes of neutropenia?
``` Chemotherapy agents Carbamazepine, clozapine, carbimazole Bone marrow failure Hypersplenism - felty SLE Low B12/folate ```
33
What are some causes of lymphocytosis?
CLL and lymphoma Viral infections Chronic infection
34
What are some causes of eosinophilia?
Allergy Parasite infections Drug reactions Hodgkins
35
What are some causes of thrombocytosis?
Reaction to Infection Essential thrombocytosis Reaction to iron deficiency anaemia Post splenectomy
36
What are some causes of thrombocytopenia?
``` DIC, ITP, TTP, HELLP Haemorrhage BM failure Post transfusion - dilution Splenomegaly ```
37
What are some risk factors for VTE?
``` Pregnancy Long haul flight Recent illness Recent immobility Antiphospholipid/SLE Factor V Leiden, antithrombin, protein C&S deficiency Cancer COCP/HRT CML/polycythaemia ```
38
What are some risk factors for arterial thrombosis?
``` Smoking Diabetes HTN Hypercholesterolaemia Obesity ```
39
What are some risk factors for bleeding and bruising?
``` DIC Haemophilia A/B Thalassaemia ITP/TTP HELLP On anticoagulation Leukaemia HUS Clotting factor deficiency Liver disorders ```
40
Summarise the response to injury leading to platelet aggregation
1 Von willebrand factor bind to area of vascular injury 2 VwF bind to Glycoprotein 1b receptors and activate ADP to increase expression of Gp11b/IIIa 3 These receptors bind to fibrinogen which leads to further platelet aggregation
41
How are platelets broken down?
Plasminogen activated to form plasmin by tPA --> breaks down fibrin mesh
42
What clotting factors are in the intrinsic and extrinsic pathway?
Intrinsic: VIII, IX, XI, XII Extrinsic: VII Common - X, V, thrombin, fibrin
43
What does the PT test tell you?
Extrinsic and common pathway Most accurate determinant of impact on liver function Increased by: - warfarin, dabigatran, direct Xa inhibitors - Vit K deficiency - Liver disease - DIC - Isolated factor 7 deficiency
44
What does APTT tell you?
Intrinsic and common pathway - Haemophilias and von willebrand - Liver disease - DIC - warfarin, dabigatran, direct Xa inhibitors, unfractionated heparin - Vit K
45
What does bleeding time tell you?
Platelets - Von willebrand - TTP, ITP, HUS - DIC - Thrombocytopenia - Aspirin
46
What does TT tell you?
Fibrinogen Increased by dabigatran and unfractionated heparin
47
How does warfarin work and how is it monitored/reversed?
Inhibit vit K which is key to platelet aggregation Monitor PT and INR Vit K/prothrombin complex
48
How do heparins work and how are they monitored/reversed?
Activate antithrombin - LMWH is only factor Xa LMWH (Dalteparin/enoxaparin) - only affect factor Xa unfractionated - APTT Protamine sulphate for unfractionated
49
How does fondaparinux work?
Indirect factor Xa inhibitor
50
How do rivaroxaban and apixaban work?
Direct factor X/Xa inhibitor
51
How does dabigatran work and how is it monitored/reversed?
Antithrombin III inhibitor Idarucizumab
52
How does aspirin work?
COX-1 inhibitor which inhibits thromboxane A2 so reduced platelet aggregation
53
How does clopidogrel work?
Inhibit P2Y12 stopping glycoprotein aggregation
54
How are major bleeds on warfarin managed?
Stop warfarin IV Vit K 5mg IV prothrombin complex
55
How are minor bleeds on warfarin managed?
INR >5 - stop warfarin and IV Vit K 5mg Restart warfarin when INR <5
56
How is a raised INR on warfarin managed with no bleeding?
>8 - Stop warfarin and oral vit K. Restart when <5 5-8 - Stop 2 doses of warfarin and reduce subsequent dose
57
What is heparin induced thrombocytopenia?
Reaction to heparin leading to a hypercoaguable state with reduced platelets (consumption thrombocytopenia) IgG antibodies 5-14 days post heparin treatment
58
How does heparin induced thrombocytopenia present?
Stroke, DVT, PE, MI, Ischaemic limb
59
How is heparin induced thrombocytopaenia managed?
Stop heparin | Give fondaparinux
60
Why can't you give warfarin in heparin induced thrombocytopenia?
Risk of warfarin necrosis - skin gangrene
61
What are the types of haemophilia, what do they affect and how are they inherited?
A - factor VIII - x linked recessive B - factor IX - x linked recessive C - factor XI - autosomal recessive
62
How does haemophilia present?
Easy bleeding and bruising Haemarthosis Muscle haematomas Prolonged bleeding time post op
63
What blood results are seen in haemophilia?
Prolonged APTT
64
How is haemophilia managed?
FFP and cryoprecipitate
65
What is von willebrand disease?
Autosomal dominant condition where there is a deficiency of von willebrand factor - key in platelet aggregation
66
What blood results does von willebrands disease present with?
Prolonged bleeding time | Prolonged APTT - VW factor bind to factor 8 - stop destruction
67
How is von willebrand disease managed?
Tranexamic acid | Desmopressin
68
How does von willebrand present?
Petechiae Menorrhagia Bleeding gums
69
Which clotting factors are affected by vitamin k deficiency and as such what blood result is seen?
2, 7, 9 and 10 prolonged APTT and PT - PT affected by 7
70
What can cause a vitamin k deficiency?
Dietary insufficiency | Fat malabsorption - cholestasis
71
How would liver disease cause coagulopathy?
Global decline in clotting factors affecting both extrinsic and intrinsic pathway PT is most accurate for liver disease
72
How can hypersplenism affect clotting?
Reduced platelets
73
What coagulopathies are seen in renal disease?
Haemorrhage | Thrombosis
74
Why is thrombosis seen in renal disease?
Uraemia alter platelet function Increased normal risk factors - dehydrated, immobilised Loss of proteins in nephrotic syndrome - protein C&S, antithrombin
75
Why is haemorrhage seen in renal disease?
Loss of clotting factors in nephrotic syndrome Anaemia Uraemia alter platelet function Deranged VWf
76
Why does coagulopathy occur post massive bleeding?
Following acute trauma, increased activated protein C -> fibrinolysis Fluids result in acidosis, dilution and hypothermia which worsen coagulopathy
77
What happens in DIC?
Dying cells release pro-coagulant agents --> small vessel occlusion Platelets and clotting factors used up --> bleeding elsewhere
78
What is seen on investigation of DIC?
Prolonged APTT, PT, bleeding time and reduced platelets, raised D dimer May see schistocytes on blood film - microangiopathic haemolytic anaemia
79
What are the signs and symptoms of TTP?
- Renal failure - Low platelets - Anaemia - Fever - Fluctuating neurology
80
What can cause TTP?
Post infection - GI Pregnancy Drugs - COCP, cyclosporin, penicillin, aciclovir
81
What is ITP?
Antibodies against glycoprotein 2b/3a leads to thrombocytopaenia - Petechia/purpure - Epistaxis - Rare - intracranial bleeds
82
How is ITP managed?
Oral pred | IVIG
83
What typically causes ITP in children?
Post infection or vaccination
84
What blood results are seen in antiphospholipid syndrome?
Prolonged APTT | Thrombocytopaenia
85
What happens in factor V Leiden?
Resistance to activated protein C Clotting factor V is inactivated slowly High risk of VTE
86
When is packed red cells indicated?
Hb <70 Hb <80 in ACS
87
When are platelets indicated?
Haemorrhagic shock Count <20 Bleeding with thrombocytopaenia Pre-op <50
88
When is FFP indicated? What does it contain?
Prolonged PT DIC Haemorrhage in liver disease Factor 5, 8, 9, 10 and fibrinogen
89
When is cryoprecipitate indicated? What does it contain?
DIC VW disease Haemophilia A Factor 8, 13, VW and fibrinogen
90
When is prothrombin complex indicated?
Major bleed on warfarin
91
How quickly should red blood cells be given?
If no emergency - over 90-120 mins
92
Which antibodies do you look for when doing a G&S?
ABO | Rhesus
93
What can cause target cells on blood film?
Hyposplenism Iron deficiency anaemia Sickle cell/thalassaemia Liver disease
94
What causes Howell jolly bodies on blood film?
Hyposplenism | Pencil poikilocytes
95
What causes a tear drop poikilocyte?
Myelofibrosis
96
What causes schistocytes?
Intravascular haemolysis Mechanical heart valves DIC
97
What causes heinz bodies on blood film?
G6PD
98
What causes pencil poikilocytes on blood film?
Iron deficiency anaemia
99
What causes burr cells on blood film?
Uraemia

Finals (16 decks)

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