Haematology practical 1 Flashcards
Basic tests investigations
- Full blood Count and a peripheral smear
- PTT
- PT
Full Blood Count (FBC): This test measures the levels of different cells in your blood, including red blood cells, white blood cells, and platelets. It helps diagnose conditions like anemia, infections, and many other disorders.
Partial Thromboplastin Time (PTT): This test measures how long it takes for your blood to clot. It helps evaluate the function of certain clotting factors and can be used to diagnose bleeding disorders or monitor patients on heparin therapy.
Prothrombin Time (PT): Similar to the PTT, this test measures the time it takes for blood to clot, but it focuses on different clotting factors. It is often used to monitor patients on warfarin therapy and to check for bleeding disorders.
Coagulation cascade
Other names for factor 1 and 2
Factor I is also known as fibrinogen. When activated, it is converted into fibrin, which forms the mesh that stabilizes the blood clot.
Factor II is also known as prothrombin. When activated, it becomes thrombin, an enzyme that plays a crucial role in converting fibrinogen into fibrin.
Vitamin K dependent factors
Factor:2,7,9 and 10
Factor II (Prothrombin): Converts to thrombin, which then converts fibrinogen to fibrin.
Factor VII: Initiates the coagulation process by activating Factor X.
Factor IX: Works with Factor VIII to activate Factor X.
Factor X: Converts prothrombin to thrombin in the presence of Factor V.
Additionally, Vitamin K is necessary for the production of anticoagulant proteins such as Protein C and Protein S, which help regulate the coagulation process
Case 1:
A well looking 5 year old girl,presents with 2 days only petechiae on her arm and in her mouth
Viral infection 3 weeks prior
No family history ,fever,lymphadenophathy,
Qs:
1,
2.
3.
Case 1: Differential diagnosis for petechiae in children
- Petechiae(<2mm,pinpoint)
Purpura(>2mm,pinhead)
Ecchimoses (Bruising)
- Immu e mediated thrombocytopenia purpura
- Meningococcus
- Aplastic anemia
pancytopenia - Leukemia
bone marrow infiltration - HIV
6.HSP
inflammaition of the vessel wall thus palpable purpura
Case 1: Screening blood tests
PT and PTT normal
FBC:
low platelets
peripheral smaer: no latelet smear
0Diagnosis : Immune Mediated thrombocytopenia purpura
-Most common thrombocytopenia in children
- Age: 2-5 yrs
Boys and girls
-well child
- post viral infection
severe bleeding e.g intracranial bleeding is uncommon
ash guidelines:
Immune thrombocytopenia ranges
actute: 0-3 months
persistent ITP 3 month
chronic:> 12 months
Case 2
2 years old boy
fell while playing
limping 2 days
right knee: swollen
maternal ulcer bleeder
bleeding after circumsion
mother: menorrhagia
uncle:bleeds
no fever
Vitamin K deficiency of newborn
- pathophysiology
Natural Vit K is synthesized by the intestinal flora
Fat soluble
Requires bile for absorption
Not stored in body
Liver ….
Most common inherited bleeding disoder
Liver Disease: The liver produces most of the clotting factors, so liver dysfunction can lead to prolonged PT and aPTT12.
Vitamin K Deficiency: Vitamin K is essential for the synthesis of certain clotting factors. Deficiency can result from poor diet, malabsorption, or certain medications13.
Disseminated Intravascular Coagulation (DIC): This is a serious condition where widespread clotting in small blood vessels leads to a depletion of clotting factors, causing prolonged PT and aPTT12.
Anticoagulant Therapy: Medications like warfarin and heparin can prolong PT and aPTT12.
Factor Deficiencies: Deficiencies in clotting factors such as II, V, X, or combined deficiencies can lead to prolonged clotting times1
Most common acquired bleeding disorder
Disseminated Intravascular Coagulation (DIC): This serious condition involves widespread clotting in small blood vessels, leading to a depletion of clotting factors and platelets, which can cause severe bleeding
Liver Disease-Associated Bleeding: Since the liver produces most of the body’s clotting factors, liver disease can significantly impair blood clotting1.
Vitamin K Deficiency: Vitamin K is essential for the synthesis of certain clotting factors. Deficiency can result from poor diet, malabsorption, or certain medications1.
Acquired Hemophilia: This rare condition occurs when the body produces antibodies that attack clotting factors, most commonly factor VIII1.
Platelet Disorders: These are often acquired and can result from conditions like immune thrombocytopenia (ITP) or medications that affect platelet function2.
Vitamin K dependent Factors
2,7,9 and 10
When a child is sick which other 2 screening tests do you include
Fibrinogen
D-dimers
Normal haemostatsis
process whereby bleeding is stopped in a closed circulatory system
Primary vs secondary and tertiary haemostasis
FBC plus smear
diffrential
intrinsic pathway
Initiation: Triggered by damage to the blood vessel and exposure of collagen.
Key Factors: XII, XI, IX, and VIII.
Process: Factor XII activates Factor XI, which then activates Factor IX. Factor IX, with the help of Factor VIII, activates Factor X in the common pathway.
extrinsic pathway
Initiation: Triggered by external trauma that causes blood to escape from the vessel.
Key Factors: VII and Tissue Factor (TF).
Process: Tissue Factor (TF) released from damaged tissue binds to Factor VII, forming a complex that activates Factor X in the common pathway.
Common pathway
Initiation: Convergence of the intrinsic and extrinsic pathways.
Key Factors: X, V, II (Prothrombin), and I (Fibrinogen).
Process: Activated Factor X (Xa) combines with Factor V to convert Prothrombin (Factor II) into Thrombin. Thrombin then converts Fibrinogen (Factor I) into Fibrin, forming a stable clot.
Coagulation disorders
inherited vs acquired
Factor 8 more common than 9
haemophilia A and (B) grading
x-linked recessive (DEFECTIVE GENE
severe <1%
moderate 1-5%
Severe 5-50%
prolongued aPTT
