Haemotology Flashcards
1
Q
what is anaemia
A
it is a lower than normal concentration of haemoglobin or red blood cells
2
Q
what levels of haemoglobin suggests anaemia in
1. men
2. women
A
- less than 130
- less than 120
3
Q
what is haemolytic anaemia
A
increased breakdown of red blood cells
4
Q
what is anaplastic anaemia
A
decreased red blood cells, white cells and platelets
5
Q
what is microcytic anaemia
A
a reduced mean corpuscular volume
6
Q
what is a MVC blood test
A
An MCV blood test measures the average size of your red blood cells
7
Q
what is macrocytic anaemia
A
a raised MCV
8
Q
what are the general symptom of anaemia
A
fatigue, headache, dizziness, dyspnoea (especially on exertion)
9
Q
what are signs of anaemia
A
tachycardia, skin pallor, conjunctiva pallor, intermittent claudication
10
Q
What is koilonychia and what does it indicate
A
spoon shaped nails - iron deficiency
11
Q
what is angular stomatitis a sign of
A
iron deficiency and B12 deficiency
12
Q
what does lemon yellow skin indicate
A
B12 deficiency
13
Q
what does jaundice or dark urine indicate
A
haemolytic anaemia
14
Q
what is microcytic anaemia
A
it is iron deficiency with low Hb, and a low MCV (less than 80 fl)
15
Q
what is seen in iron studies of someone with microcytic anaemia
A
there is low ferratin (unless active inflammation)
low serum iron
low transferrin saturation
raised transferrin
16
Q
what is seen on a blood film with microcytic anaemia
A
small hypochromic cells
17
Q
what are causes of microcytic anaemia
A
reduced absorption - low intake, malabsorption or drugs like PPIs
increased utilization - pregnancy
blood loss - stool, trauma, surgery, menorrhagia
Thalassemia
scleroblastic anaemia
18
Q
in chronic microcytic anaemia what is seen on a full blood count
A
low Hb, normal or low MVC but high ESR
19
Q
what do iron studies of someone with chronic microcytic anaemia look like
A
normal or raised ferratin
low serum iron
low transferrin saturation and transferrin
20
Q
what might be causes of chronic microcytic anaemia
A
chronic infection
chronic inflammation (connective tissue disease)
neoplasia
21
Q
what could be other causes of microcytic anaemia
A
- sickle cell
- Thalassemia
- Sideroblastic anaemia
22
Q
what is sideroblastic anaemia
A
it is when the bodies iron levels are normal but the body cant insert the iron into Hb
23
Q
what can cause normocytic anaemia
A
acute blood loss
bone marrow failure
pregnancy
Haemolytic anaemia
aplastic anaemia
chronic disease
24
Q
what is the presentation of haemolytic anaemia
A
jaundice and dark urine
25
what investigations are done to test for haemolytic anaemia
raised reticulocytes (chronic), raised bilirubin, raised urobilinogen, schistocytes on blood film (fragmented RBCs)
26
what are causes of haemolytic anaemia
1. autoimmunity
2. sepsis or disseminated intravascular coagulopathy
3. Sickle cell
4. thalassemia
27
what is a type of macrocytic anaemia
B12 deficiency
28
what are causes of B12 deficiency
perncious anaemia - lack of intrinsic factor (cant absorb B12)
malabsorption - (coeliac, IBD, bowel resection, ileostomy)
decreased dietary intake
chronic nitrous oxide use
29
how does B12 deficiency present
Bloods: raised MCV, low Hb, low B12
Megaloblastic anaemia: defined by cell changes on blood smear
S&S: general anaemia presentation and a range of neurological symptoms as well
30
what is megablastic anaemia characterised by
oval shaped RBC's, hyper segmented neutrophils
31
what could be other causes of macrocytic anaemia
diseases of the liver and spleen
haematological malignancy
alcohol
32
what can cause neutrophilia
infection
inflammation
CML
33
what can cause neutropenia
antibiotics
chemotherapy
marrow failure
liver disease
34
what can cause thrombocytosis
infection
inflammation
tissue injury
splenectomy
essential thrombocytopenia
35
what can cause thrombocytopenia
production failure - marrow failure (congenital/leptospirosis)
increased removal - ITP, TTP, DIC
36
what can cause lymphocytosis
EBV
CMV
hepatitis
malignancy - CLL, ALL, lymphoma
stress
37
what can cause lymphocytopenia
steroids
HIV
post - viral
marrow failure
chemotherapy
38
what is primary haemostasis
initiation and formation of a platelet plug
- platelet activation
39
what is secondary haemostasis
the formation of the fibrin clot
- intrinsic and extrinsic coagulation pathway
40
what causes initial platelet activation
collagen binding to GPVI/GPIIbIIIa via vWF
41
what causes amplification of platelet activation and clotting
thromboxane - binds TPa receptors
ADP binds P2Y12/P2Y1 receptors
other platelets form GPIIbIIIa cross bridges
thrombin - binds to PAR1/PAR4 receptors
42
what are the effects of platelet activation
platelets change shape
dense granules are released - contains ADP
alpha granules are released - inflammatory mediators and clotting factors
43
what drugs inhibits thromboxane formation
NSAIDS
44
what drugs inhibit P2Y12 binding
clopidogrel or ticagrelor
45
what drugs inhibits thrombin
dabigatran
46
what is the intrinsic clotting cascade
12 - 11 - 9 - 8 - 10 - 10a
47
what is the intrinsic clotting cascade initiated by
endothelial collagen exposure
48
what is the extrinsic clotting pathway
7 - 10 - 10a
49
what is the extrinsic clotting cascade initiated by
tissue factor - expressed on immune cells and endothelium
50
what is the common clotting cascade
10a - prothrombin (II) - thrombin (IIa) - fibrinogen - fibrin
51
what factor reinforces fibrin
factor 13
52
what does warfarin do
it blocks vitamin K - therefore vitamin K derived clotting factors - 2, 7, 9, 10 `
53
what is the action of heparin
acts via antithrombin III to prevent prothrombin activation
54
what is sickle cell
it is a genetic condition affecting the B globin chain (glutamic acid is substituted with valine)
55
what is the acute presentation of sickle cell
1. MSK: bone and joint pain
2. Infection
3. Resp: dysponea, cough, hypoxia
4. CNS: stroke
5. GI: sequestration crisis
56
what is sequestration crisis
it is when the blood outflow of the spleen is blocked and blood accumulates leading to splenomegaly
57
what are risk factors for sickle cell crisis
low oxygen
cold weather
parvovirus B19
exertion
58
what are chronic complications of sickle cell
avascular necrosis of joints
silent CNS infarct
retinopathy
nephropathy
ED
59
what investigations are done for sickle cell anaemia
FBC - low MCV and low Hb
Blood smear - sickles erythrocytes
sickle solubility test
Hb electrophoresis
60
what is the management for Sickle cell crisis
1. Acute: Morphine, O2, IV fluids, transfusion exchange
2. Chronic: hydroxycarbamide
61
What is thrombotic thrombocytopenic purpura
ADAM TS13 protein deficiency - vWF cleaving protease
- you cant break clumps of vWF into monomers and it can cause microvascular clots to form
62
what are the risks for developing thrombotic thrombocytopenic purpura
being adult
being female
63
how does thrombotic thrombocytopenic purpura present
fatigue
fever
jaundice
petechiae
purpura
neurological defects
64
how do you diagnose thrombotic thrombocytopenic purpura
FBC: raise white cell count, low Hb and low platelets
Other: raised bilirubin and raised creatinine
blood smear: schistocytes
Clotting: PT and APTT is normal
65
what is the treatment for thrombotic thrombocytopenic purpura
plasma exchange, IV methylprednisolone, monoclonal Abs
66
what is immune thrombocytopenic purpura
it is autoimmune IgG destruction of GPIIbIIIa meaning platelets cant activate and therefore causes problems with primary haemostasis
67
what are the risk factors for developing immune thrombocytopenic purpura
paediatric
post viral
68
what is the presentation of ITP
very similar to TTP - fatigue
fever
jaundice
petechiae
purpura
neurological defects
it is a diagnosis of exclusion really
69
what is seen when investigating ITP
FBC: raised white cell count, low Hb, low platelets
clotting: PT and APTT are normal
Blood smear is normal
70
What is the treatment for ITP
steroids or IV IgG
71
what is leukaemia
is the the cancer of bone marrow
72
what causes leukaemia
it is where immature blast cells proliferate uncontrollably, it takes up space within the bone marrow and then infiltrates into other tissues.
the lack of space within the bone marrow means fewer healthy cells can mature and be released into the blood.
73
what are the 4 types of leukaemia
acute myeloid leukaemia
acute lymphoblastic leukaemia
chronic lymphoblastic leukaemia
chronic myeloid leukaemia
74
what are features of acute lymphoblastic leukaemia
it is most common in children (0-4)
proliferation of immature lymphoblasts
75
how does acute lymphoblastic leukaemia present
general anaemia symptoms
bleeding/bruising
infections
hepatosplenomegaly
lymphadenopathy
CNS infiltration - headaches and palsies
76
How do you diagnose acute lymphoblastic leukaemia
FBC - anaemia, thrombocytopenia, neutropenia
blood film
bone marrow biopsy
imaging (CXR/CT) - lymphadenopathy
77
how do you manage acute lymphoblastic leukaemia
blood and platelet transfusions
chemotherapy (methotrexate)
steroids
stem cell or bone marrow transplant
antibiotics
78
how does anaemia present
fatigue
dizziness
palpitations
pallor
shortness of breath
79
what is acute myeloid leukaemia
it is the proliferation of immature myelobasts
80
what are features of acute myeloid leukaemia
it is present mostly in the elderly
it only has a 15-5% survival
81
how does acute myeloid leukaemia present
general anaemia symptoms
bleeding or bruising
infections
hepatosplenomegaly
gum hypertrophy
82
how do you diagnose acute myeloid leukaemia
FBC - anaemia and thrombocytopenia
blood film
bone marrow biopsy - auer rods
83
how do you manage acute myeloid leukaemia
blood and platelet transfusions
chemotherapy
stem cell or bone marrow transport
antibiotics
84
what is chronic lymphoblastic leukaemia
proliferation of B lymphocytes
85
what are the features of chronic lymphoblastic leukaemia
mostly affects those 60 plus
most common type of leukaemia in adults
86
how does chronic lymphoblastic leukaemia present
it is often asymptomatic
lymphadenopathy
may have night sweats and weight loss
87
how do you diagnose chronic lymphoblastic leukaemia
FBC - anaemia, thrombocytopenia, leukocytosis
blood film - smudge cells
bone marrow biopsy
88
how do you manage chronic lymphoblastic leukaemia
watch and wait in early stages
chemotherapy (rituximab)
stem cell or bone marrow transplant
89
what is chronic myeloid leukaemia
it is proliferation of myeloid blood cells
90
what are features of chronic myeloid leukaemia
most common in adults over 40
the vast majority of cases are associated with the Philadelphia chromosome
91
how does chronic myeloid leukaemia present
general anaemia symptoms
blooding or bruising
infections
hepatosplenomegaly
weight loss and night sweats
gout
92
how do you diagnose chronic myeloid leukaemia
FBC: anaemia, thrombocytopenia and leukocytosis
bone marrow biopsy
blood film
genetic testing
93
how do you manage chronic myeloid leukaemia
chemotherapy
stem cell or bone marrow transplant
tyrosine kinase inhibitors (Imatinib)
94
what is Hodgkin lymphoma
proliferation of lymphocytes in the lymph nodes
95
what is Hodgkin lymphoma associated with
EBV and immunosupression
96
what sort does incidence does Hodgkin lymphoma have
Bimodal distribution - peaks in early 20s and then in the 70s
97
what is the presentation of Hodgkin lymphoma
lymphadenopathy - painful upon drinking alcohol !!!
B-symptoms - fever, night sweats and weight loss
98
How do you diagnose Hodgkin lymphoma
ESR is raised
imaging is done (CXR/CT) - staging
lymph node biopsy - reed sternberg cells !!!
99
how do you manage Hodgkin lymphoma
ABVD chemotherapy - Doxorubicin, bleomycin, vinblastine, dacarbazine
radiotherapy
steroids
stem cell or bone marrow transplant
100
What is associated with Non- Hodgkin lymphoma
associated with EBV and immunosuppression
101
when does Non-Hodgkin lymphoma typically present
predominantly affects adults - over the age of 40
102
How does Non-Hodgkin lymphoma present
painless lymphadenopathy
B symptoms are weight loss, night sweats, fever
can get hepatosplenomegaly
103
How do you diagnose Non-Hodgkin lymphoma
imaging (CXR/CT) for staging
Lymph node biopsy - no Reed Sternberg cells
104
how do you manage Non-Hodgkin lymphoma
RCHOP chemotherapy
- rituximab
- cyclophosphamide
- hydroxy-daunorubicin
- vincristine
- prednisolone
radiotherapy
105
how do you stage lymphoma
the ann arbor staging is used for lymphoma staging
106
what is stage 1 on the Ann arbor scale
the disease is only in one area only
107
what is stage 2 on the Ann arbor scale
the disease is in 2 or more areas on the same side of the diaphragm
108
what is stage three on the Ann Arbor scale
the disease is in 2 or more areas on both sides of the diaphragm
109
what is stage four on the Ann Arbor scale
the disease has spread beyond the lymph nodes
110
what age group does multiple myeloma occur in (normally)
predominantly occurs in those over the age of 40
111
what condition does multiple myeloma have a close link to
monoclonal gammopathy of undetermined significance
112
what is monoclonal gammopathy of undetermined significance
there is too much of an immunoglobulin released by abnormal plasma cells
113
how does multiple myeloma present
hypercalcaemia - polydipsia, polyuria, constipation, abdominal pain
renal impairement
anaemia - fatigue, dizziness
bone lesions - bone pain
114
how do you diagnose multiple myeloma
FBC - anaemia, rouleaux formation (aggregation of RBC)
ESR is raised
Blood film - rouleaux formation
Serum and urine electrophoresis - bence jones protein in urine !!!!
bone marrow biopsy
imaging (X-ray/CT) - bone lesions
115
how do you manage multiple myeloma
chemotherapy
stem cell transplant
analgesia
bisphosphonates
blood transfusions
116
what are common chemotherapy combinations
VCD - bortezomib, cyclophosphamide, dexamethasone
VTD - bortezomib, thalidomide, dexamethasone
MTP - melphalan, thalidomide, prednisolone
117
what is polycythaemia
a high concentration of erythrocytes in the blood
118
what are types of polycythaemia
absolute - split into primary and secondary
relative
119
what is relative polycythaemia
there are a normal number of erythrocytes but there is a reduction in plasma
120
what are causes of relative polycythaemia
causes include obesity, dehydration and excessive alcohol consumption
121
what is absolute polycythaemia
there is an increased number of erythrocytes
122
what is primary absolute polycythaemia
abnormality in the bone marrow
- caused polycythaemia vera
123
what is secondary absolute polycythemia
a disease outside the bone marrow causing overstimulation of the bone marrow
124
what causes secondary absolute polycythaemia
COPD, sleep apnoea, PKD, renal artery stenosis, kidney cancer
125
what is a myeloma
a malignant tumour of the bone marrow
126
what are the features of monoclonal gammopathy of undetermined significance
it is a myeloma made up of either solitary, multiple solitary or extramedullary plasmacytomas
127
what is multiple myeloma
neoplastic proliferation of bone marrow plasma cells
128
what is multiple myeloma characterised by
Monoclonal protein in serum or urine
lytic bone lesions/ CRAB end organ damage
excess plasma cells in bone marrow
129
what is the criteria for multiple myeloma diagnosis
protein in the blood
bone marrow plasma cells in excess of 10%
CRAB - cancer renal anaemia bone
130
what are common chromosomal abnormalities that can cause multiple myeloma
T(11:14) - most common
13q - associated with treatment resistance and poorer prognosis
131
What are common presenting features of multiple myeloma
tiredness and malaise
bone/back pain and more common fractures
infections
non specific symptoms
132
what lab results would you expect for someone with multiple myeloma
anaemia
abnormal FBC
renal failure
hypercalcaemia
raised globulins
raised ESR
serum or urine paraprotein
133
what is the main cause of death in myeloma
infection
134
what is amyloidosis
it is a group of rare serious conditions caused by a build up of an abnormal protein called amyloid in the organs and other tissues in the body
135
how can clonal expansion in MGUS lead to plasma cell leukemia
MGUS - early myeloma - late myeloma - plasma cell leukemia
136
what can plasmacytoma at a critical site lead to
cord compression
risk of fracture
137
what are the response rates in malignant myeloma treatment
many will respond to the treatment but will eventually relapse
can prolong survival by keeping people in plateau rather than try to cure it
both the disease and the treatment have a morbidity
138
what is leukaemia
malignant proliferation of haematopoietic cells
139
what might the history of a patient with leukaemia be
1. anaemia - fatigue or shortness of breath
2. infection - tonsillitis or fever
3. thrombocytopenia - bruising, bleeding, rash
140
what does the blood of someone with leukaemia look like
low haemoglobin, low platelets, very low neutrophils, blast cells present with auer rods
141
what does blast cells present with auer rods suggest ?
someone has acute myeloid leukaemia
142
what is the differential diagnosis for leukaemia be
- Acute leukaemia: AML, ALL, CML in blast crisis, myelofibrosis
- severe sepsis
- post operative
143
what blood cells type does acute myeloid leukaemia come from
myeloblasts (progenitor of basophil/eosinophil/neutrophil/monocytes)
144
what blood cell type does chronic myeloid leukaemia come from
basophil, neutrophil, eosinophil
145
what cell type does acute lymphoblastic leukaemia come from
lymphoblasts
146
what cell type does chronic lymphoblastic leukaemia come from
B lymphocytes
147
what is chronic myelomonocytic leukaemia
it is when there are too many monocytes in the blood
148
how do you diagnose chronic myelomonocytic leukaemia
blood tests - morphology, cytogenetics, flow cytometry, sequencing
Bone marrow aspirate and trephine biopsy
cytogenetics for prognosis
molecular genetics for prognosis
immunophenotyping
149
is chronic myeloid leukaemia slow or fast onset
slow onset
150
what is seen in the blood of someone with chronic myeloid leukaemia
a high white cell count
basophilia
151
what is a key diagnostic feature of chronic myeloid leukaemia
Philadelphia chromosome
152
what is the treatment for chronic myeloid leukaemia
you have targeted molecular therapy - tyrosine kinase inhibitors
- Imatinib
153
what is the treatment for acute myeloid leukaemia
chemotherapy and supportive measures
- need to take into account patient age, fitness, comorbidities, AML features, and clinical trials that may be happening
154
what is the most common paediatric malignancy
acute lymphoblastic leukaemia
155
what is the acute presentation of acute lymphoblastic leukaemia
bone marrow failure
organ infiltration
156
how do you treat ALL
CNS directed therapy
stem cell transplant
treatment phases - induction, consolidation, delayed intensification and maintenance
157
what is the most common type of leukaemia
chronic lymphocytic leukaemia
158
what is chronic lymphocytic leukaemia
there is gradual accumulation of B lymphocytes
- this accumulates in blood or bone marrow
- lymph glands including the spleen can accumulate
159
what age group does CLL normally affect
generally in the elderly
- 20% occurs in under 55s
160
what is the clinical course of CLL
it is variable - can get progressive lymphadenopathy or hepatosplenomegaly. You can get autoimmune issues with haemolysis and ITP, and you can get bone marrow failure due to the marrow replacement
161
how do you treat CLL
you can do nothing
chemotherapy
monoclonal antibodies
targeted therapy
bone marrow transplant
162
what is the action of chemotherapy
it damages highly proliferative cells (preferentially)
163
why is dosing important with chemotherapy
as it needs to be a balance between
1. Destroying leukemic cells
2. not causing irreversible toxicity to other normal cells
164
what are other things you can consider pre-chemotherapy
supportive measures - fertility cryopreservation
clinical trial availability
165
what are side effects of chemotherapy
nausea
cytopenias = anaemia, neutropenia, low platelets and risk of bleeding
bystander organ damage - kidney, liver
temporary hair loss
166
what is a lymphoma
it is a malignant growth of white blood cells - predominantly in the lymph nodes
- can also be in the blood, spleen, bone marrow, liver
167
what is the aetiology (causes) of lymphoma
1. primary immunodeficiency - ataxia telangiectasia
2. secondary immunodeficiency - HIV, transplant recipients
3. Infection - EBV, helicobacter pylori
4. Autoimmune disorders
168
what are signs and symptoms of lymphoma
common nodal disease symptoms
compression syndromes
systemic symptoms - B symptoms
169
how do you diagnose lymphoma
blood film
bone marrow biopsy
immunophenotyping
cytogenetics (FISH)
molecular techniques - PCR
170
how would you assess a new cause of lymphoma
staging - how bad is it
assessment of patient - how good is it
MDT
171
how do you stage a lymphoma
blood tests - FBC, U/E, viral serology
CT scan or the chest, abdomen and pelvis
Echo
Bone marrow biopsy
172
what are the performance status stages in a patient with lymphoma
0 = Asymptomatic
1 = symptomatic but completely ambulatory (able to carry out light work)
2 = Symptomatic <50% of the day in bed
3 = symptomatic >50% in bed but not bedbound
4 = bedbound
5 = death
173
what are the subtypes of lymphoma
Hodgkins lymphoma
Non - hodgkins lymphoma
174
what are the different types of Non-Hodgkin lymphoma
Low grade - follicular lymphoma
High grade - diffuse large B cell lymphoma
very high grade - burkitts lymphoma
175
how does Hodgkin lymphoma present
painless lymphadenopathy
B symptoms - sweat, weight loss
176
How do you diagnose Hodgkin lymphoma
Reed Sternberg cell - abnormal, large lymphocytes that may contain more than one nucleus
- 4 histological subtypes
177
what is the treatment for stage 1-2A Hodgkins lymphoma
short course of combination chemotherapy followed by radiotherapy
178
what is the treatment for stage 2B-4 Hodgkin lymphoma
combination chemotherapy
179
what are the long term effects of chemotherapy
infertility
Anthracyclines - cardiomyopathy
Bleomycin - lung damage
Vinca alkaloids - peripheral neuropathy
second cancers
psychological issues
180
what are the features of a low grade (indolent) non-hodgkin lymphoma
it is slow growing and is usually advanced at presentation
181
what are the different types of low grade non-hodgkin lymphoma
Follicular lymphoma - MOST COMMON
mantle cell lymphoma
marginal zone lymphoma
small lymphocytic lymphoma
lymphoplasmacytic lymphoma
skin lymphoma
182
what is the treatment for low grade non hodgkin lymphoma
alkylating agents
combination chemotherapy
purine analogues
monoclonal antibodies
radiotherapy
oral targeted agents
bone marrow transplant
183
what are features of high grade (aggressive) non hodgkin lymphoma
they usualy have nodal presentation and 1/3 cases are extranodal as well
184
what are the most common types of high grade non hodgkin lymphoma
diffuse large B cell lymphoma
Burkitt lymphoma
peripheral T cell lymphoma
185
how do you treat aggressive non hodgkin lymphoma
early - use a short course of chemotherapy with radiotherapy
late - combination chemotherapy with monoclonal antibodies
186
what is anaemia
it is reduced red cell mass - can also have a reduced haemoglobin concentration as well
187
what are the consequences of anaemia
reduced oxygen transport
tissue hypoxia
compensatory changes - increased tissue perfusion, oxygen transfer to tissues and red cell production
188
what are the pathological changes of anaemia
there can be myocardial fatty change
fatty change within the liver
it can aggravate angina or claudication
can cause atrophy of the skin and nails
can cause CNS cell death in the cortex and the basal ganglia
189
what is the lifespan of red blood cells
120 days
190
what is anaplastic anaemia
a condition that occurs when your bone marrow fails and stops making haematopoetic stem cells meaning your body stops producing enough new blood cells
191
what can reduce circulating red blood cell levels
hypoplastic anaemias
post haemorrage anaemia
haemolytic anaemia
dyshaemopoietic anaemias
192
what are examples of microcytic anaemia
iron deficiency
chronic disease
thalassaemia
rare diseases: congenital sideroblastic anaemia, lead poisoning
193
how do you investigate iron deficiency
tests of deficiency - ferritin and iron studies
test of causes
treatment
194
what are examples of normocytic anaemia
acute blood loss
anaemia of chronic disease
combined haematinic deficiency
195
what is combined haemanitic deficiency
combined iron/vitamin B12 or folate deficiency
196
what are examples of macrocytic anaemia
B12 or folate deficiency
alcohol excess or liver disease
hypothyroidism
antimetabolite therapy
haemolysis
bone marrow failure
bone marrow infiltration
197
how do you investigate B12 deficiency
look for Intrinsic factor antibodies
the Schilling test
look for Coeliac antibodies
B12 replacement
198
what is the schilling test
it is the Vitamin B12 absorption test
199
what should you think when someone has combines haemanitic deficiency
they have malabsorption problems
200
what investigations should be done when someone presents with anaemia
- thorough history and examination
- full blood count and blood film
- reticulocyte count
- U+Es, LFT and TSH
- B12, folate and transferrin levels
201
what can a small decrease in red cell survival be compensated by
increased EPO and a reduced apoptosis
202
what is foetal haemoglobin
it is 2 alpha and two gamma chains
203
what chromosome codes for beta globin chains
chromosome 11 - 2 genes
204
what chromosome codes for A globin chain
chromosome 16 - 4 genes
205
what is haemoglobin S
it is a variant of haemoglobin arising because of a point mutation on the beta globin gene
206
what does the carrier status of haemoblobin S offer protection against
offers protection against falciparum malaria
207
what are common complications of sickle cell disease
chronic haemolytic anaemia
infections
acute chest syndrome
stroke
avascular necrosis
pulmonary arterial hypertension
ocular disease
208
what are acute complications of sickle cel disease
painful crisis
sickle chest syndrome
stroke
209
what are chronic complications of sickle cell disease
renal impairment
pulmonary hypertension
joint damage
210
what is disease modifying treatment for sickle cell disease
transfusion
hydroxycarbamide
stem cell transplant
211
what is thalassaemia
it is a globin chain disorder which results in the diminished synthesis of one or more of the globin chains which then causes consequent reduction in the haemoglobin
212
what is anaemia of chronic disease
it is a multifactorial anaeima. Diagnosis generally requires the presence of a chronic inflammatory condition, such as infection, autoimmune disease, kidney disease, or cancer. It is characterized by a microcytic or normocytic anemia and low reticulocyte count.
213
what is the pathology of thalassaemia
Insufficient global chains cause precipitation of dominant chain
Causes abnormalities in the red cells
These red cells are then destroyed
Additional ineffective erythropoiesis
214
what are the clinical classifications of beta thalassaemia
thalassaemia major - transfusion dependent
thalassaemia intermedia - less severe and can survive without regular blood transfusions
thalassaemia carrier - asymptomatic
215
what is beta thalassaemia major
A rare, genetic disease that causes severe anaemia due to the inadequate production of haemoglobin. Children who are afflicted with thalassaemia major require lifelong blood transfusions if they develop to adulthood.
216
at what age do people start to present with beta thalassaemia major
6-12 months of age
217
what are the clinical presentations of beta thalassaemia
failure to feed
listless
crying
pale
218
what would blood results show in someone with beta thalassaemia
Hb 40-70g/L, with low MCV and MCH
the blood film will show large and small very pale red cells and nucleated red blood cells
219
how do you treat beta thalassaemia
regular transfusion
iron chelation
endocrine supplementation
support bone health
220
what monitoring needs to occur in beta thalassaemia
ferritin
cardiac and liver MRIs
endocrine testing - gonadal function, diabetes screening, growth and puberty, thyroid function, Vitamin D, Calcium and PTH
DEXA scanning for fertility
221
what is a major consequence of transfusions in thalassaemia major
someone can get morbidity and mortality iron overload from transfusions
222
how might someone get iron overload with thalassaemia major
due to lifelong blood transfusions there will be a progressive increase in the body iron load. There is no means for the body to eliminate the excess iron and these patients develop clinically worsening hemosiderosis
223
what happens as a consequence of iron overload in thalassaemia major
excess iron is mainly deposited in the liver and spleen leading to liver fibrosis and cirrhosis. deposits in the endocrine glands and heart leads to diabetes, heart failure and eventually premature death
224
what are the four types of alpha thalassaemia
alpha thalassemia silent carrier - one gene missing
alpha thalassaemia carrier - two genes missing, mild anaemia
hemoglobin H disease - three genes are missing
alpha thalassemia major - all 4 genes missing, severe anaemia
225
what is hereditary RBC membranopathies
mutations in genes encoding skeletal proteins that alter the membrane complex structure
226
what types of inheritance pattern are membranopathies
autosomal dominant conditions
227
what are the most common types of membranopathies
spherocytosis and elliptocytosis
228
what is the pathology of membranopathies
- neonatal jaundice
- mold to moderate haemolytic anaemia (exacerbation during infection)
- gallstones
- folic acid and splenectomy
229
what is a common and serious complication of parvovirus B19
haemolytic anaemia
230
what age demographic is parvovirus + haemolytic anaemia common in
children
231
what is Glucose - 6- phosphate dehydrogenase deficiency
a genetic disorder that affects red blood cells, which carry oxygen from the lungs to tissues throughout the body. In affected individuals, a defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely.
- haemolytic anemia
232
what ethnic groups is glucose-6-phosphate dehydrogenase deficiency more common in
african, middle eastern, mediterranean, s. asian
233
what is the genetic inheritance of glucose 6 phosphate dehydrogenase deficiency
it is X linked but mostly women are affected
234
what is glucose 6 phosphate dehydrogenase deficiency precipitated by
broad beans
infections
drugs
235
what drugs shouldnt be given to those with glucose 6 phosphate dehydrogenase deficiency
primaquine
sulphonamides
nitrofurantoin
quinolones
dapsone
236
what is pyruvate kinase deficiency
a condition in which red blood cells break down faster than they should
237
what is the inheritance pattern of pyruvate kinase deficiency
autosomal recessive
238
what are the clinical features of pyruvate kinase deficiency
variable chronic haemolysis
can be apparent in neonates, or in later life
they are prone to aplastic crisis if they get parvovirus B19
239
what is the treatment for pyruvate kinase deficiency
folic acid
transfusion during severe crisis
consider splenectomy if there are high transfusion requirements
240
what are secondary causes of anaemia
smoking
lung disease
cyanotic heart disease
altitude
EPO or androgen excess
241
what is polycythaemia Rubra vera
it is a myeloproliferative disorder which causes 'overreactive bone marrow', making too many red blood cells
242
what mutation makes up 95% of polycythaemia rubra vera
JAK2 mutations
243
what is the clinical presentation of polycythaemia rubra vera
plethoric appearance
thrombosis
itching (especially after a bath)
Burning in the fingers and toes
headache
splenomegaly
abnormal full blood count
244
how do you treat polycythaemia rubra vera
aspirin
venesection
bone marrow suppressive drugs
245
what are causes of neutrophilia
reactive - infection, inflammation, malignancy
primary - CMV
246
what is neutrophilia
it is when you have too many white blood cells
247
what is lymphocytosis
too many white blood cells - normal neutrophil count
248
what are causes of lymphocytosis
reactive - infection, inflammation, malignancy
primary - CLL
249
what is thrombocytopaenia
it is when there is not enough platelets
250
what is thrombocytosis
it is when you have too many platelets
251
what are causes of thrombocytosis
reactive - infection, inflammation, malignancy
primary - essential thrombocythemia (make too many platelets)
252
what is neutropenia
when there is not enough neutrophils
253
what are causes of neutropenia
underproduction - marrow failure, infiltration or toxicity (drugs)
increased removal - autoimmune, felty's syndrome, cyclical
254
what is the physiology of platelets
they are fragments of megakaryocytes (produced in the bone marrow), and they are regulated by thrombopoietin (produced in the liver)
255
in normal physiology what happens when you have low platelets
there is reduced bound TP, meaning there is increased free TPO. This causes an increased megakaryocyte stimulation and therefore increases platelet production
256
what are features of platelets
- they are anucleated cells
- they have a lifespan of 7-10 days
- normal count is 150-400x10^9/L
257
what are the surface proteins found on platelets
ABO
HPA
HLA class 1
glycoproteins - GP1a
258
what are platelets activated by
- Adhesion to collagen via GP1a
- Adhesion to vWF via GP1b and IIa/IIIb
259
what does platelet activation lead to
- release of alpha granules containing PDGF, fibrinogen, vWF, PF4
- Dense granules - nucleotides (ADP), Ca2+, serotonin
- membrane phospholipids activate clotting factors
260
what is the steps taken by platelets following damage to he endothelium
1. Platelets adhere to vascular endothelium via collagen & vWF (von Willebrand factor)
2. Binding of platelets to collagen stimulates cytoskeleton shape change within the platelets, and they spread out
3. This increases their surface area and results in their activation, leading to the release of platelet granule contents including ADP, fibrinogen, thrombin and calcium. These components facilitate the clotting cascade ending with the production of fibrin
4. Aggregation of platelets then occurs, which involves the cross-linking of activated platelets by fibrin
5. Activated platelets also provide a negatively charged phospholipid surface, which allows coagulation factors to bind and enhance the clotting cascade
261
what are the different ways you can test platelet function
1. number - full blood count
2. appearance - blood film
3. function - PFA - response to aggregating agents
4. surface proteins - flow cytometry
262
what problems can cause bleeding
injury
vascular disorders
low platelets
abnormal platelet function
defecting coagulation
clinical patterns - platelet type v haemophiliac
263
what are the clinical features of platelet dysfunction
mucosal bleeding
easy bruising
petechiae - pinpoint spots that appear on the skin due to bleeding
purpura - small blood vessels leaking under skin
traumatic haemotomas
264
what are aquired reasons why platlet production might fail
drugs
marrow suppression
marrow failure
marrow replacement
265
what can cause increased removal of platelets
immune dysfunction
consumption
splenomegaly
266
what is an artefactual reason for low platelets
EDTA induced clumping
267
what are platelet disorders which cause impaired function
1. storage pool disorders
2. Glanzmann - reduction/deficiency of GPIIb/IIIa
3. Bernard soulier - reduction/deficiency of GP1b
4. Von Willebrand disease
268
what are some acquired causes of impaired platelet function
uraemia
drugs
269
what is congenital thrombocytopenia
it is absent/reduced/malfunctioning megakaryocytes in the bone marrow, meaning there is affected platelet production
270
what infiltrations of the bone marrow could cause a reduced platelet production
leukaemia
metastatic malignancy
lymphoma
myeloma
myelofibrosis
271
what can cause a reduced platelet production from the bone marrow
- low B12 or folate
- reduced TPO
- medication: methotrexate or chemotherapy
- toxins: alcohol
- infections: viral
- aplastic anaemia
272
what is myelodysplasia
a group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells. The different types of myelodysplastic syndromes are diagnosed based on certain changes in the blood cells and bone marrow
273
what can cause dysfunctional production of platelets in the bone marrow
myelodysplasia
274
what are diagnostic features of dysfunctional platelets
do a blood smear - will see abnormal sizes of platelets (small, large, giant) and an absence of platelet alpha granules
275
what autoimmune conditions can cause thrombocytopenia
immune thrombocytopenia - primary or secondary
276
what can cause thrombocytopenia
autoimmune
hypersplenism - portal hypertension and splenomegaly
drugs related - heparin induced
277
what can cause increased consumption of platelets
disseminated intravascular coagulopathy
thrombotic thrombocytopenic purpura
haemolytic uraemic syndrome
haemolysis, elevated liver enzymes and low platelets
major haemorrhage
278
what medications affect platelets
1. clopidogrel - inhibits P2Y12
2. Tirofiban - inhibits GpIIb/IIIa
3. Aspirin - inhibits COX1
279
what causes immune thrombocytopenia
IgG antibodies form to platelet and megakaryocyte surface glycoproteins
Opsonized platelets are removed by reticuloendothelial system
280
what are reasons for primary immune thrombocytopenia
may follow viral infection/immunisation especially in children
281
what are reasons for secondary immune thrombocytopenia
occurs in association with malignancies such as CLL, and infections such as HCV/HIV
occurs in adults, often adult women
282
what is the treatment for immune thrombocytopenia
immunosuppression (steroids)
treat the underlying cause
if bleeding then give platelets
tranexamic acid - inhibits fibrin breakdown (good for mucosal bleeding)
283
what is disseminated intravascular coagulopathy
a rare but serious condition that causes abnormal blood clotting throughout the body's blood vessels. You may develop DIC if you have an infection or injury that affects the body's normal blood clotting process
284
what is the pathophysiology of disseminated intravascular coagulopathy
it is provoked due to systemic inflammatory response syndrome (i.e sepsis, severe shock, septic shock, multiple organ dysfunction syndrome). Cytokines are released causing systemic activation of the clotting cascade leasing to microvascular thrombosis and organ failure. Because of this you have have an increased consumption of platelets and clotting factors leading to bleeding
285
what investigations are done for disseminated intravascular coagulopathy
find the underlying cause - sepsis or malignancy and treat
provide platelets, FFP (contains clotting factors) and cryoprecipitate (contains fibrinogen and clotting factors)
286
what investigations are done for DIC
what is the underlying cause
look at if there is evidence of organ failure
test for thrombocytopenia
prolonged PT and APTT
look at fibrinogen levels
look at d-dimer levels
287
what is thrombotic thrombocytopenic purpura
Spontaneous platelet aggregation in microvasculature
Brain, kidney, heart
288
what are signs and symptoms of TTP
Bleeding into the skin or mucus membranes.
Confusion.
Fatigue, weakness.
Fever.
Headache.
Pale skin color or yellowish skin color.
Shortness of breath.
Fast heart rate (over 100 beats per minute)
289
what genetic abnormality can lead to TTP
Reduction in a protease enzyme - ADAMTS13
Acquired TTP - due to antibodies against ADAMTS13
ADAMTS13 breaks down vWF into smaller pieces
Failure to break down high molecular weight vWF multimers
290
what is the treatment for TTP
Urgent plasma exchange (replaces ADAMTS 13 and removes antibody)
Immunosuppression (reduce antibody level)
Do not give platelets - increases thrombosis
291
what are the risk factors for developing disseminated intravascular coagulation
sepsis
crush trauma
maliganacy
292
how does DIC present
bleeding
epistaxis
bruising
rash
GI bleed
ARDS
293
what is the pathology of DIC
there is widespread activation of the coagulation cascade ad platelet activation, caused by inflammation or injury. This causes mircovascuar thrombosis all over the body, initially causing clotting. Then as all clotting factors are consumed, the body can no longer clot and lead to bleeding
294
what is seen on blood test of a patient with DIC
there are low platelets
low fibrinogen
high D dimer
long PT
long APTT
295
what is seen on the blood smear of a patient with DIC
schistocytes - fragmented parts of red blood cells
296
what does APTT measure
measures the intrinsic and common clotting pathway
297
what does the prothrombin time measure
the extrinsic pathway
298
how do you treat DIC
treat the underlying cause
treat low fibrinogen with cryoprecipitate
treat low platelets with a platelet transfusion
299
What are the two types of haemophilia
type A and type B
300
what is type A haemophilia
X linked recessive disorder which causes factor VIII deficiency (affects the intrinsic clotting pathway), causing secondary haemostasis
301
what is type B haemophilia
it is a rare genetic condition which causes factor IX deficiency (affecting the intrinsic clotting pathway)
302
how does haemophilia present
present with a soft tissue bleeding - bleed into muscles and joints leading to haematoma formation
303
what is seen in bloods for haemophilia
APTT is long
PT may be normal
304
what is required for haemophilia testing
genetic testing - look at factor IX or VII
305
how do you treat haemophilia
recombinant factor VIII or IX treatment
306
what is von willebrands disease
disease which causes a defect in the quantity or quality of vWF
- many different subtypes
307
What is the most common type of von Willebrand's disease
Type 1
308
How is Type 1 vW disease inherited
autosomal dominant
309
what is the pathogenesis of Von Willebrands disease
Due to a deficiency in either the quality or quantity of vWF there is an inability for blood to clot. Furthermore vWF protect factor VII from liver protein C destruction. Without vWF factor 8 deficiency can occur as well
310
what id the definition of neutrophilia
neutrophil levels over 7.5 x10^9/L
311
what is the definition of neutropenia
neutrophil levels under 2 x 10^9/L
312
what is the definition of lymphocytosis
lymphocyte levels over > 3.5 x 10 ^9/L
313
what is the definition of lymphocytopenia
lymphocyte levels under <1.3 X 10 9/L
314
what is the definition of thrombocytosis
when platelet levels are over 400 x10^9/L
315
what is the definition of thrombocytopenia
when platelet levels are under <150 x10^9/ L
316
what is the normal range for neutrophils in the blood
2-7.5 x109/L
317
what is the normal range of lymphocytes in the body
1.3-3.5X109/L
318
what is the normal range for platelets in the body
150-400 x109/L
319
what is the normal INR range
between 0.8 and 1.2
320
what is the normal INR range if someone is on warfarin
2-3
321
why might someones INR increase
if they are on anticoagulants
if they have liver disease
if they have vitamin K deficiency
if they have disseminated intravascular coagulation
322
what is the normal APTT
between 35-45 seconds
323
what is the APTT of someone on heparin
60 - 80
324
What is APTT affected by
haemophilia A
haemophilia B
Von Willebrand's disease
325
what is the mean corpuscular volume
it measures the average size and volume of you red blood cells
326
What MCV level is microcytic anaemia
anything less than 80
327
what MCV level is nromocytic anaemia
80-95
328
what MCV level is macrocytic anaemia
anything higher than 95
329
what can cause non haemalytic normacytic anaemia
anplastic anaemia
chronic disease - CKD
pregnancy
myelophthisic anaemia
330
what is often seen in bloods for haemolytic normocytic anaemia
an increase in reticulocytes and schistocytes
331
what are causes of haemolytic normocytic anaemia
sickle cell disease
GPDH deficiency
AHA
hereditary spherocytosis
332
when would you consider someone with anaemia for a transfusion
when haemoglobin is under 70g/L or under 80g/L with cardiac myopathy
333
what are causes of iron deficiency anaemia
infants = malnutrition, prolonged breastfeeding
children = malnutrition and malabsorption
adults = malnutrition, malabsorption and menorrhagia
elderly = this is rare and a red flag for colon cancer bleeding
334
what is the pathophysiology of iron deficient anaemia
iron normally circulated bound to transferrin and is stored as ferritin. however in iron deficiency anaemia there is low haemoglobin synthesis and leads to microcytic anaemia
335
what are Howell jolly bodies
nucleated red blood cells
336
what does iron studies look like in an iron deficient patient
low serum iron
low ferritin
low transferrin saturation
high TIBC
337
what is thalassemia
it is an autonomic recessive haemoglobinopathy
338
what is the pathology of alpha thalassemia
this is associated with a decrease in the amount of alpha chains resulting in less haemoglobin. It also leads to the production of unstable beta globin molecules which increases red blood cell destruction
339
what is alpha thalassemia associated with
HbH - when there is an abnormal Hb isoform where beta chain tetramers form
340
how many genes encode for alpha haemoglobin
4 genes found on chromosome 16
341
how many genes encode for beta globin
two genes on chromosome 11
342
what is beta thalassemia
where there is a mutation in beta thalassemia gene resulting in normal haemoglobin isoforms but a depletion of the beta chains
343
what are symptoms of beta thalassemia
it can cause major issues in the first year of life with general anaemia symptoms
- can cause chipmunk facies where there is a large forehead and cheekbones
- hepatosplenomegaly
- failure to thrive
- gallstones
344
how do you diagnose thalassemia
Full blood count - hypochromic RBCs, target cells, microcytic anaemia, increased reticulocytes
Blood film
Haemoglobin electrophoresis (Gold standard)
345
how do you treat thalassemia
regular transfusions
iron chelation (desferrioxamine) to prevent iron overload
splenectomy
folate supplements
346
how do you diagnose sideroblastic anaemia
FBC and blood film = microcytic cells with ringed sideroblasts
iron studies show increased serum iron, ferritin, transferrin saturation and decreased TIBC
347
what is acute chest crisis
when there is pulmonary vessel occlusion in sickle cell disease which causes respiratory distress
- a medical emergency
348
What is a common side effect of sickle cell disease
Osteomyelitis - caused by salmonella
349
What is G6PDG deficiency
X linked recessive enzymopathy which causes 1/2 lifespan as well as red blood cell degeneration
350
what is G6PDHs normal function
It is involved in glutathione synthesis, and is protective against oxidative damage
351
what are the symptoms of G6PDH deficiency
it is mostly asymptomatic unless its precipitated
can be caused by
Nephthelene
antimalarials
aspirin
fava beans
352
what are the symptoms of a G6PDH deficiency attack
you get a rapid anaemia and jaundice - intravascular haemolysis
353
how do you diagnose G6PDH deficiency
FBC and a blood film
- normal between attacks
- Attach causes increased normocytic blood with increased reticulocytes, Heinz bodies and bite cells
- will see low G6PDH levels in the blood
354
how do you treat G6PDH deficiency
you avoid the precipitants
blood transfusions when attacks occur
355
what is hereditary spherocytosis
it is an autonomic dominant membranopathy which causes deficiency in the structural membrane protein spectrin, causing red blood cells to be more spherical and rigid
356
What is the pathogenesis of hereditary spherocytosis
there is an increase in splenic recycling (extravascular haemolysis) which causes splenomegaly as rigid cells get stuck
- risk of autosplenectomy
357
what are the symptoms of hereditary spherocytosis
general anaemia
neonatal jaundice
splenomegaly
gall stones (50%)
358
how do you diagnose hereditary spherocytosis
FBC and blood = Normocytic normochromic and increased reticulocytes. Spherocytes also seen
359
what is the treatment for hereditary spherocytosis
splenectomy (decreased extravascular haemolysis)
- need to wait until they are 6 to reduce sepsis risk
- folate supplements
- transfusions
360
how do you treat neonatal jaundice
phototherapy
361
what is there a risk of if neonatal jaundice is untreated
risk of kernicterus if untreated - when bilirubin accumulates in the basal ganglia leading to CNS dysfunction and death
362
what is autoimmune hemolytic anaemia
it is when autoantibodies bind red blood cells and lead to intra or extra haemolysis
363
what are the two subtypes of autoimmune hemolytic anaemia
warm and cold subtypes
364
what specialist test can you do for autoimmune hemolytic anemia
the coombs tests - you are direct coombs positive
365
what is the coombs test
causes agglutination of the red blood cells with coombs reagent
366
what is myelophthisic process
it is when the bone marrow is replaced with something else such as a malignancy
367
why can chronic kidney disease cause anaemia
because you can get haemolytic anaemia due to low EPO
368
what are the causes of aplastic anaemia
idiopathic acquired mostly, perhaps with infection or congenital
369
what is the FBC of someone with aplastic anaemia
normocytic anemia with low reticulocytes
370
what are the symptoms of pernicious anaemia
general anemia +
- lemon yellow skin
- angular stomatitis and glossitis
- neurological symptoms
- muscle weakness
- symmetrical paraesthesia
371
what are causes of folate deficient anemia
malnutrition
malabsorption
pregnancy
trimethoprim
methotrexate
372
what are the symptoms of folate deficient anemia
general anemia + angular stomatitis and glossitis
373
what is leukemia
neoplastic proliferation of a white blood cell line resulting in a decreased production of other haematopoetic cells
374
what are the general symptoms of leukemia
BM failure
- bone pain
- bleeding
- infections
- anaemia symptoms
- TATT
375
what is the common chromosomal mutation in acute myeloid leukaemia
translocation (15:17)
376
what is the common chromosomal mutation in chronic myeloid leukaemia
translocation (9:22)
- BCR-ABL
377
what does the 9:22 translocation in CML cause
tyrosine kinase to be irreversibly switched on
- increases cell proliferation
378
what is the most common genetic abnormality in ALL
translocation (12:21)
379
what cells most commonly cause ALL
B cell
380
what is a complication of CLL
Richter transformation: B cells massively accumulate in the lymph nodes causing lymphadenopathy (aggressive lymphoma)
381
How do you diagnose polycythemia vera
Full blood count = increased which blood cells, platelets and red blood cells. Increased haemoglobin
Genetic tests: JAK 2 mutation positive
382
what can cause arterial thrombosis
atherosclerosis
383
what are the symptoms of an arterial blockage
the organs or tissues become cyanotic and cold
384
what can an arterial thrombosis lead to
coronary vascular disease
cerebrovascular disease
peripheral vascular disease
385
what is the symptoms of a venous thrombosis
the affected area is red and warm
386
what causes venous thrombosis
remember virchaus triad
- change in coagulation
- change in vessel wall
- change in flow
387
what can a venous thrombosis lead to
DVT
pulmonary embolism
388
how do you diagnose Von Willebrands disease
normal prothrombin time and an increased APTT. there will be a reduction in vWF
389
How do you treat vWF disease
use desmopressin to increase the release of vWF from endothelial weibelpalade bodies
390
what are symptoms of immune thrombotic purpura
purpuric rash
391
what is seen in bloods when diagnosing immune thrombotic purpura
thrombocytopenia and increased BM megakaryoblasts
392
what is the 1st line treatment of immune thrombocytic purpura
prednisolone
393
what are the 4 types of malaria to be aware of
plasmodium faliparum
plasmodium ovale
plasmodium vivax
plasmodium malariae
394
what is the pathophysiology of malaria
sporozoites in mosquito saliva go into human host
multiply inside hepatocytes as merozoites
then go into RBC and become trophozoites, then schizont and then merozoites
RBC rupture and cause infection
395
what are symptoms of malaria
FEVER AND EXOTIC TRAVEL
anemia
blackwater fever
hepatosplenomegaly
396
how do you treat malaria
quinine and doxycycline
397
what cancers is EBV closely related to
Hodgkins
Burketts
Nasopharyngeal carcinoma
398
what is the pathophysiology of HIV
HIV gp120 binds to CD4 on Th cells
endocytosis and release contents
RNA to DNA via reverse transcriptase
integrase allows viral DNA to integrate with host DNA
protein synthesis
virus forms and exocytosis
399
what are symptoms of HIV
fever
diarrhoea
night sweats
minor opportunistic infections
400
what are the defining conditions of AIDS
CMV - colitis
Pneumocystis jirovecci pneumonia
cryptosporidium (fungal) infection
TB
Karposi sarcoma
toxiplasmosis
lymphomas
401
what does it mean if lactate dehydrogenase is high on a blood test
that there is an increased cell turnover
402
what is the coombs test used for
to differentiate between autoimmune and non autoimmune causes of haemolytic anaemia
403
what is seen in bloods which is specific for AML
AUER RODS
404
what is a diagnostic feature of CML
it has the Philadelphia chromosome
405
what is seen on a blood smear in CLL
SMUDGE CELLS
406
what is a complication of CLL
it can transform into lymphoma - the Richter reaction
407
what is ferritin on an iron study
iron storage
408
what is transferrin
the protein which facilitates iron absorption
409
what is total iron binding capacity
the affinity for iron to bind to protein
