Haemotology

Question 1

Where are RBCs produced and where are they disposed?

Answer 1

Bone marrow

Spleen and liver

Question 2

Name 3 functions of RBCs

Answer 2

Carry Hb
Generate ATP
Maintain osmotic pressure

Question 3

What is a normal Hb level for a male and female?

Answer 3

M - 130-180 g/L

F - 115-165 g/L

Question 4

Name 3 factors in which ‘normal’ Hb levels can vary?

Answer 4

Age
Sex
Ethnicity

Question 5

What is the definition for anaemia?

Answer 5

Where Hb conc is less than normal range

Question 6

Name some general underlying mechanism for anaemia

Answer 6

Abnormal RBC production
Abnormal Hb synthesis 
Abnormal mature RBC structure, function, metabolism 
Excessive blood loss
Abnormal reticuloendothelial system

Question 7

Explain how the reticuloendothelial system works

Answer 7

O2 levels reduce, kidneys release erythropoietin, stimulates RBC production and reduces apoptosis in bone marrow, RBC levels rises (and 02)

Negative feedback

Question 8

Explain the significant of reticulocyte count

Answer 8

Reticulocyte = immature RBC

Gives to clue to anaemia cause
If low - problem with bone marrow?
If normal - RBCs being destroyed later on?

Question 9

What is the definition of microcytic, normocytic and macrocytic anaemias?

Answer 9

Mic - small RBCs
Nor - nor sized RBCs
Mac - large RBCs

Question 10

Name two conditions in which you would find macrocytic RBCs.

Answer 10

Myelodysplastic syndromes

Vit B12 / folate deficiency

Question 11

In what condition would you find microcytic RBCs?

Answer 11

Thalassaemia

Question 12

What condition would you find teardrop shaped RBCs?

Answer 12

Myelofibrosis

Question 13

Where would you find Howell - Jolly RBCs?

Answer 13

In patients with a splenectomy

Question 14

Microscopically, what would you observe of the RBCs of Vit B12 or folate deficient patients?

Answer 14

Megablastic RBCs
Large nuclei and open chromatin (cannot synthesis DNA), cytoplasm small
Macrocytic RBCS

Question 15

What would you observe of the RBCs of a patient with Thalassaemia?

Answer 15

Target cells
Hypochromic RBCs
Microcytic RBCS
Large nucleated RBCs

Question 16

What is haemolytic anaemia?

Answer 16

Anaemia of high RBC destruction

Question 17

Name 3 causes of haemolytic anaemia.

Answer 17

Autoimmune HA
Myelofibrosis
Anaemia of chronic disease

Question 18

What investigations would you ask for in haemolytic anaemia?

Answer 18

Bilirubin
Reticulocyte count
Macrophage count

Question 19

What are some signs and symptoms of Vit B12 / Folate deficiency?

Answer 19

Low mood
Fatigue
Pallor
Neurological signs - depression, dementia 
Jaundice

Question 20

What investigations would you ask for in a suspected Vit B12 / Folate deficiency?

Answer 20

Vit B12 and folate count 
Hb level 
Mean cell volume
WBC count 
Platelets

Question 21

How does anaemia of chronic disease differ from iron deficiency?

Answer 21

AOCD - Associated with inflammatory conditions and chronic disease.
Increase macrophage production - increased RBC destruction.
Increased cytokines - increased Hepcidin - reduces iron absorption.

Iron deficiency - due to insufficient intake, poor absorption, increase use - not increased destruction

Question 22

What are some microscopic markers of iron deficiency?

Answer 22

Hypochromic RBCS
Microcytic (low MCV)
Pencils cells, target cells
Change in size and shape (anisopoikilocytosis)

Question 23

What is the gold standard test for diagnosing iron deficiency?

Answer 23

Reticulocyte haemoglobin content (CHR)

Question 24

How would you treat an iron deficiency?

Answer 24

Dietary advice
Oral supplements
Intramuscular injections
Transfusions

Question 25

Some signs and symptoms of iron deficiency?

Answer 25

``` Tiredness Pallor Exercise intolerance Tachycardia Angina Respiratory changes - smooth nails Increased resps ```

Question 26

What is Polycythaemia?

Answer 26

High conc RBCs | High haemocrit

Question 27

What is Polycythaemia Vera?

Answer 27

``` Cancer Bone marrow produces too much RBCs and haemocrit Leads to blood thickening Can lead to hypoxia, gout. Treatment - venesection, aspirin ```

Question 28

What are some functions of the spleen?

Answer 28

RBC recycling Phagocytosis Immune functions Stem cell proliferation

Question 29

Name some causes for splenomegly.

Answer 29

Myelofibrosis Leukaemia Endocarditis, Hepititis (infection) Viruses e.g. Glandular fever

Question 30

What can splenomegly lead t?

Answer 30

Portal hypertension Increased RBC production Cancer

Question 31

What is leucopenia?

Answer 31

Low WBC count

Question 32

What is leucocytosis?

Answer 32

Increased WBC count

Question 33

What are some common causes for neutrophilia?

Answer 33

``` Smoking Cancer Inflammation Tissue damage Myeloproliferative disease ```

Question 34

What are some reason for neutropenia?

Answer 34

Reduced production - B12/folate deficiency, aplastic anaemia, viruses, chemo Increased removal - sepsis, splenic pooling

Question 35

What are some reasons for eosinophilia?

Answer 35

Parasitic infection Allergic disease - Asthma, hay fever Hodgkin Lymphoma Myeloproliferative conditions

Question 36

What is pancytopenia? What are some signs and symptoms?

Answer 36

Reduction in WBCs, RBCs, platelets Fatigue, shortness of breath, thrombocytopenia (bleeding, bruising) , neutropenia (infection)

Question 37

How would pancytopenia look microscopically?

Answer 37

High number of fat cells to other cells ratio