Haemotology Flashcards
Name the different types of blood types and what they are ? how common are they? (%s)
0= A+B antibodies 43% A= A antigens B antibodies 45% B= B antigens A antibodies 9% AB= A + B antigens 3%
Which blood type is the universal donor and which is the universal recipient
o = donor ab = recipient
Describe rhesus D pregnancy problem
Mum Rh -ve baby rh+-e. When born babies rbcs get into maternal blood and mum makes Anti D IgG against the Rh +ve. If the mum then has another baby that is Rh +ve. IgG crosses placenta and attacks babies RBCs
How do we prevent rh D pregnancy problem
give mum Anti D Anti bodies against the RBCs after pregnancy so she doesnt make them herself (antinatal prophylaxis)
What do you do when testing between patient serum and donor cells prior to blood issue
select blood type to match on basis of ABO/ Rh group
mix serum and cells first to test if reaction
Name some risks of a blood transfusion
reactions - febrile and allergic infection -bac virus protazon prion iron overload -cant excrete anaphylaxis viral transmission- HIV, HEP B RBC antibodies - alloimmunisation fluid overload TRALI
hypocalaemia + dilution of clotting factors on a massive transfusion
How much blood in the body?
Composition of blood?
5L.
45% RBC, 55% PLASMA, 1% WBC+ PLATELET
Name the stuff in the blood that helps with immunity
WBC, antibodies, acute phase proteins
difference between serum and plasma and blood
plasma is centrifuged blood
serum is without clotting factors
functions of a RBC
acts as a buffer, gas exchange
normal Hb levels
male 13.5-18
female 11.5-13.5 - less because of menstruation and decreased circulating vol
what is the haematocrit
% of blood that is red cells (often proportional to haemoglobin)
How many platelets in the blood and how long do they last
7-14 days .
150
Descrive the 3 granulocytes
eosinophils
neutrophils
basophils
eosinophils
vital or antiparasite immunity and important in allergic responce
linked to 1gE
biloben nucleus
basophils
function not clear, may be important against parasites and anaphalaxis dark blue granules
neutrophils
phagocytose bacteria and kill (H2o2 and free radicals)
multi lobed nucleus
lifespan 8 hours
2-7%
what are monocytes
macrophages
phagocytose dead or dying cells or foreign material
may contain phagocytic vacuoles
whats the difference between MCV and MCH
and name some disease in each
MCV = mean corpuscular volume - cell size
small in microcytic anaemia
large in macrocytic anaemia
MCH is how red they are
pale in hypochromic anaemia
what is polycythaemia
RBC overproduction in the marrow
or decrease plasma (pseudopolycythameia) - caused by alcohol
name 3 general causes of anaemia
decreased RBC production
increased RBC destruction
increased RBC loss
Name 4 causes of microcytic anaemia
Thalassaemia (a+b globin chains )
Iron deficience
Chronic disease - body tries to decrease amount in inflammation
Sideroblastic anaemia (congenital)
what is a reticulocyte
an immature RBC
around for one day before becomes a RBC
whats the most common cause of microcytic anaemia
blood loss via parasites
descrive 3 causes of macrocytic anaemia
- bone marrow trying to compensate for blood loss (haemorrhage and haemolysis)
- marrow dysfunction 2y to renal liver and thyroid dysfunction or chemo or leukaemia
- megaloblastic anaemia
what is megaloblastic anaemia
caused by b12 or folate deficiency , abnormal maturation of RBC
what is a marker for macrocytic anaemia
reticulocyte counts
what is thrombocytosis
platelet overproduction - normally a reaction ro inflammatory/infection
what is thrombocytopenia
decreased platelets. consumption by clots, infection, liver disease
philia penia cytosis
mean what?
philia - increased
penia - decreased
cytosis - increased
common causes of ?
1) neutrophilia
2) neutropenia
3) monocytosis
4) eosinophilia
1) reaction to infection
2) under production and over consumption
3) chronic inflammation
4) parasites, fungi, allergies
What is virchows triad
clots occur due to :
- stasis of blood
- changes in blood composition
- disturbed vessel - vascular wall injury
type of bloot clot in aa and vv and what you give to treat them
aa - platelet ASPRIN
vv - fibrin WARFRIN
1 What does prothrombin time measure
2 how long is normal
3 what do we use it for
1 activity of extrinsic pathway
2 usually 9-12 s
3 use this to monitor the effect of warfarin
name 2 diseases the prothrombin time will be longer
liver disease and DIC
1 what does the APPT measure
2 how long is normal
3 what do we use it for
1 activity of intrinsic pathway
2 22-32s
3 unfractioned heparin ad hirudin
name some diseases the APPT is prolonged in
haemophilia A&B, liver disease, lupus anticoagulant, von willebrands disease, DIC
1 what does the thromin time measure
2 how long is normal
1 final common pathway
2 13-20
name 1 treatment and 3 pathological diseases that can increased thrombin time
heparin
liver disease
DIC
dysfibrinogenaemia
1 what is the template bleeding time
2 how long is normal
1 measures in vivo. razor cute 5mm cuts in skin
excess blood removed gently
time from cut to bleeding stopped is measured
2 normally 2-8 minute
Name a limitations of the clotting cascade model
1 explains how it clots in a test tube not in mammal
which model is more accurate representation of blood clotting
cell based model
describe the final common clotting pathway
prothrombin(2) to thrombin triggers fibrinogen(1) to fibrin . FXIII cross links fibrin to form strong clot
1 What are D dimers
2 what are they used for
3 Normal amounts
1) fragment of fibrinogen created when its chopped into pieces.
2) thery’re increased if a clot is present so can be used to rule out clots in the worried well
3) normally 250 if
What causes haemophilia A and haemophilia B
A- reduced CF 8
B - reduced CF 9
who gets haemophilia and why
both genes on the X chromosome so sex linked so only present in males
how does haemophilia present
arthritis - bleeding into joins as baby boy starts to walk
causes prolonges APTT (180 seconds)
how do you treat haemophilia
factor replacement intravenously either to treat current bleeding or prophylactically to prevent bleeding
What is Disseminated Intravascular Coagulation
microscopic clots form in the circulation, when platelets and clotting factors run out bleed horrendously
what can trigger DIC
infection, malignancy, pregnancy complications, massive bleeding
how do you treat DIC
identify the cause and remove it, can use plasma and platelet transfusions to buy time whilst treating the cause
what is transfusion coagulopathy
occurs when a massive transfusion
platelets and clotting factors depleted.
circulation becomes acidotic and hypothermic
the temp and ph changes further from norm therefor CFs and platelets dont work
2 things that can case dysfunctional platelets
drugs . asprin clopidogrel abcizimab
2y to liver disease
1 what can dysfunctional platelets lead to?
2 how do you treat it
1 bleeding from mucosal surfaces e.g nosebleeds gum bleeds GI bleeds
2 remove cause
causes of low platelets
liver disease or marrow failure or ITP
1 what can low platelets lead to?
2 how do you treat it
1 mucosal bleeding problems
2 platelet transfusion + procoagulant drugs to prevent bleed
name 2 causes of aa clot and 3 of vv clot
stroke and MI
DVT PE and AF/cardio-embolism
thrombolysis of aa clots?
tPA - activated plasmin
heparin
prevention of aa clots?
platelet inhibition - eg asprin, clopidogrel, abciximab
reduce atheroma - statins to lower cholesterol, treat diabetes, bp, smoking
thrombolysis of vv clots?
immediately using HEPARIN high dose
medium term use warfarin
prevention of vv clots?
keep patients mobile - elastic stockings to maintain venous return. prophylactic heparin
what is warfarin
vit K antag for vit k dependent clotting factors, 2, 7,9,10
how long does warfarin take to work
49-72 hours
how does heparin work
inactivates factor 10 and 2(prothrombin)
difference between LMWH and UFH and one positive of both
LMWH fomed by cleavage of unfractioned heparines
LMWH - consistent
UFH - easily reversible
how do you administer heparin and warfarin
heparin iv
wafarin oral
what is INR used for
warfarin use and acute liver damage
