Haematology/Lymphatic Lecture

Question 1

What is anaemia is characterised by?

Answer 1

Insufficient red blood cells or haemoglobin

Question 2

Anaemia occurs due to one (or more) of the following three factors:

Answer 2

Blood loss
Deficient erythropoiesis
Excessive haemolysis

Question 3

Blood loss can be characterised as:

Answer 3

Acute or Chronic

Question 4

Compare and Contrast between Acute and chronic blood loss in anemia

Answer 4

Acute:
Blood loss does not immediately result in anaemia
Chronic:
blood loss can result in anaemia either:
1. When the rate of RBC loss is greater than the ability of the body to replace them
2. When increased erythropoiesis results in depletion of iron stores

Question 5

What are causes of Deficient erythropoiesis?

Answer 5

Iron deficiency anaemia
Anaemia of chronic disease
Megaloblastic Macrocytic Anaemia

Question 6

Why can chronic diseases (infection, inflammation or cancers) cause anaemia?

Answer 6

Because of:
Slightly shortened RBC survival
Impaired erythropoiesis
Impaired intracellular iron metabolism

Question 7

What is Megaloblastic Macrocytic Anaemia?

Answer 7

Results from Vitamin B12 and folate deficiency

Onset is insidious and may not cause symptoms until severe

Question 8

Give examples of conditions arising from B12 deficiency

Answer 8

Peripheral neuropathy

Dementia

Question 9

Give examples of conditions arising from Folate deficiency

Answer 9

Diarrhoea 
Tongue inflammation (glossitis)

Question 10

What is Haemolysis?

Answer 10

Premature destruction of RBCs

before the usual 120 days

Question 11

Excessive Haemolysis is caused by which two factors?

Answer 11

1. Intrinsic RBC disorders
   e. g. sickle-cell disease, thalassemia

2.Extrinsic RBD disorders
immunological, infection, toxins, mechanical trauma

Question 12

Describe the Signs and Symptoms of Anaemia.

Answer 12

Vague - Symptoms are anything to do with not getting enough Oxygen.
e.g. weakness fatigue drowsiness, angina, syncope, dyspnoea on exertion, vertigo, HA, tinnitus

Question 13

What symptoms suggest blood loss anaemia?

Answer 13

Hematemesis
Melena
Menorrhagia

Question 14

What symptoms suggest haemolysis?

Answer 14

Jaundice
Dark urine (if no liver disease)
Splenomegaly

Question 15

Diffuse, severe bone and chest pain may suggest

Answer 15

sickle-cell disease

Question 16

What causes Stocking-glove paraesthesias?

Answer 16

Vitamin B12 or Folate deficiency

Question 17

What are some Risk factors of Anaemia?

Answer 17

Vegan diet = B12 deficiency
Alcoholism = folate deficiency
Haemoglobinopathies = familial
Medication = haemolysis
Chronic conditions (cancer, rheumatic disorders, chronic inflammation) can suppress bone marrow activity and cause splenomegaly

Question 18

What condition results from increased production of RBCs, WBCs and platelets and what are the consequences?

Answer 18

• Polycythemia Vera

Question 19

Why are sufferers of Polycythemia Vera prone to thrombosis and what could this lead to?

Answer 19

Because of excessive production of blood components results in increased blood volume and viscosity.

This could lead to strokes, TIAs, DVTs, MI, retinal artery/vein occlusion and/or splenic infarction

Question 20

What is Haemophilia?

Answer 20

An X-linked inherited disorder, almost exclusively affects males

Question 21

What are the consequences of Haemophillia?

Answer 21

Minimal trauma can lead to bleeding:
Haemarthroses,
Muscle haematomas
Retroperitoneal haemorrhage

Question 22

Chronic/recurrant haemarthroses can lead to

Answer 22

Synovitis and arthropathy

Question 23

What is Haemochromatosis?

Answer 23

Excessive accumulation of iron, resulting in tissue damage

Question 24

Why is it unusual to see symptoms of Haemochromatosis in pre-menopausal women?

Answer 24

Because menstruation offsets it

Question 25

Are most common complications of Haemochromatosis

Answer 25

liver disease and cardiomyopathy

Question 26

What is Lymphadenopathy

Answer 26

A palpable enlargement of one or more lymph nodes

Question 27

What are the most common causes of lymphadenopathy?

Answer 27

Idiopathic, self-limited
Upper respiratory infections
Local soft-tissue infections

It may also arise due to cancer, HIV infection and TB; however most clinical cases are likely benign

Question 28

What are some Red Flags for Lymphadenopathy

Answer 28

Node > 2 cm
Node that is hard or fixed to underlying tissue
Supraclavicular node
Risk factors for HIV or TB 
Fever and/or weight loss
Splenomegaly

Question 29

What is Lymphoedema?

Answer 29

Obstruction or destruction of lymph vessels, This often results from surgery, radiation therapy, trauma or obstruction by a tumour

Question 30

What are the three stages of oedema in Lymphoedema

Answer 30

1. Oedema is pitting, and the affected area often returns to normal by morning.
2. Oedema is non-pitting, and chronic soft-tissue inflammation causes early fibrosis.
3. Oedema is brawny and irreversible, largely because of soft-tissue fibrosis.