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Phase 2a - Haemotology > Haemotology Lectures > Flashcards

Haemotology Lectures Flashcards

1
Q

Where are DVTs generally found?

A

Between hip and knee

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2
Q

What type of DVTs cause significant PEs?

A

DVTs above the knee.

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3
Q

What are pulmonary embolisms

A

Embolus blocks a pulmonary artery, preventing blood oxygenation.

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4
Q

What are DOACs?

A

Direct oral anti-coagulants.

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5
Q

List 2 reasons why are DOACs better than warfarin.

A

1) shorter half life

2) no monitoring required

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6
Q

List 2 types of thrombus.

A

1) white thrombus

2) red thrombus

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7
Q

List 3 features of white thrombi.

A

1) platelet rich
2) occur in arterial circulation (high pressure)
3) cause MIs, strokes and PVDs

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8
Q

List 3 features of red thrombi.

A

1) fibrin rich
2) occur in venous circulation (low pressure)
3) cause DVTs and PEs

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9
Q

How does heparin work?

A

1) binds to antithrombin
2) increases antithrombin activity
3) deceases coagulation

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10
Q

List 3 advantages of low molecular weight heparin over unfractionated heparin.

A

1) smaller molecule
2) less dose variation
3) renally excreted

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11
Q

What is the normal haemoglobin range? (2)

A

1) male Hb 131 - 166 g/L

2) female Hb 110 - 147 g/L

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12
Q

What is the life span of an erythrocyte?

A

120 days.

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13
Q

List 4 ways erythrocytes can be removed.

A

1) spleen*
2) liver
3) bone marrow
4) blood loss

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14
Q

List the 3 types of anaemia.

A

1) microcytic
2) normocytic
3) macrocytic

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15
Q

Define mean corpuscular volume.

A

Average volume of red blood cells.

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16
Q

What is the normal MCV range? (2)

A

1) male MCV 81.8 - 96.3 fl
2) female MCV 80.0 - 98.1 fl
therefore roughly 80 - 100 fl

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17
Q

Define reticulocyte count.

A

Count of immature erythrocytes in the bone marrow.

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18
Q

Describe changes to the RCC. (2)

A

1) low RCC - RBC production issue

2) high RCC - RBC removal issue

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19
Q

List 4 side effects of ferrous sulphate.

A

1) nausea
2) abdominal discomfort
3) diarrhoea/constipation
4) black stools

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20
Q

List 5 conditions that cause secondary anaemia (anaemia of chronic disease).

A

1) tuberculosis
2) Crohn’s disease
3) rheumatoid arthritis
4) systemic lupus erythematosus
5) malignancy

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21
Q

List 3 sources of vitamin B12.

A

1) meat
2) fish
3) dairy

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22
Q

What dietary choice can lead to vitamin B12 deficiency?

A

Veganism.

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23
Q

Describe pernicious anaemia’s pathophysiology. (4)

A

1) autoimmune disorder
2) stomach parietal cells attacked
3) no intrinsic factor production
4) vitamin B12 malabsorption

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24
Q

List 4 sources of vitamin B9 (folate).

A

1) green vegetables
2) nuts
3) yeast
4) liver

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25
Q

What is folate essential for?

A

DNA synthesis.

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26
Q

List 5 things that can precipitate sickling of erythrocytes in sickle cell disease.

A

1) infection
2) dehydration
3) cold
4) acidosis
5) hypoxia

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27
Q

Describe the heterozygous sickle cell trait.

A

1) symptom free

2) protection against falciparum malaria

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28
Q

List the 4 main types of leukaemia.

A

1) acute lymphoblastic leukaemia (ALL)
2) chronic lymphocytic leukaemia (CLL)
3) acute myeloid leukaemia (AML)
4) chronic myeloid leukaemia (CML)

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29
Q

Describe leukaemia.

A

Presence of rapidly proliferating defective immature blast blood cells in the bone marrow.

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30
Q

What population is sickle cell disease generally seen in?

A

African (1/700).

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31
Q

What is the prognosis of sickle cell disease? (2)

A

1) males 42 years

2) females 48 years

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32
Q

What leukaemia is mainly present in childhood?

A

Acute lymphoblastic leukaemia (especially 2-4 years).

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33
Q

What leukaemia is mainly present in the elderly?

A

Chronic lymphocytic leukaemia.

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34
Q

Proliferation of what cells causes acute lymphoblastic leukaemia? (1)

A

1) lymphoblasts

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35
Q

Proliferation of what cells causes chronic lymphocytic leukaemia? (1)

A

1) B lymphocytes

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36
Q

Proliferation of what cells causes acute myeloid leukaemia? (2)

A

1) common myeloid progenitor

2) myeloblast

37
Q

Proliferation of what cells causes chronic myeloid leukaemia? (3)

A

1) basophils
2) eosinophils
3) neutrophils

38
Q

What is the most common leukaemia?

A

Chronic lymphocytic leukaemia.

39
Q

List 2 differences between lymphocytic leukaemias and lymphomas.

A

1) lymphocytic leukaemias begin in bone marrow; lymphomas begin in lymphocytes
2) lymphocytic leukaemia cells are found in bone marrow/blood; lymphoma cells are found in lymph nodes/other tissue

40
Q

What is the characteristic cell of classical Hodgkin’s lymphoma?

A

Reed-Sternberg cells, mirror image nuclei.

41
Q

What is the characteristic cell of modular lymphocyte predominant Hodgkin’s lymphoma?

A

Popcorn cells, popcorn-like nuclei.

42
Q

How many types of non-Hodgkin’s lymphoma are there?

A

> 30.

43
Q

What does Epstein-Barr virus cause?

A

Infectious mononucleosis, glandular fever.

44
Q

Describe the Ann Arbor classification of lymphomas. (6)

A

1) I - one lymph node group
2) II - multiple lymph node groups same side of the diaphragm
3) III - multiple lymph node groups either side of the diaphragm
4) IV - spread beyond lymph nodes (e.g. liver or bone marrow)
5) A - no B symptoms
6) B - B symptoms

45
Q

List the 3 main B symptoms.

A

1) weight loss
2) fever
3) night sweats

46
Q

Describe the cell origin of non-Hodgkin’s lymphoma. (2)

A

1) B lymphocytes - 80%

2) T lymphocytes - 20%

47
Q

What is the most common non-Hodgkin’s lymphoma?

A

Diffuse large B-cell lymphoma.

48
Q

What is a raised lactose dehydrogenase a sign of?

A

Increased cell turner.

49
Q

Describe rituximab. (2)

A

1) monoclonal antibody

2) targets CD20 expressed on B lymphocyte cell surface.

50
Q

What is the highest grade of non-Hodgkin’s lymphoma?

A

Burkitt’s lymphoma.

51
Q

What immunoglobulins are produced in excess in myeloma? (3)

A

1) IgG (55%)
2) IgA (20%)
3) rarely IgM or IgD

52
Q

How many types of immunoglobulin are produced in excess in myeloma?

A

1.

53
Q

List the 3 main complications of myeloma.

A

1) bone disease
2) hypercalcaemia
3) renal failure

54
Q

What is the mnemonic for myeloma presentation?

A

OLD CRAB

1) old
2) calcium (hypercalacaemia)
3) renal failure
4) anaemia
5) bone disease

55
Q

How does myeloma cause bone lytic lesions? (2)

A

1) activate osteoclasts —> increasing bone breakdown

2) inhibit osteoblasts —> decreasing bone synthesis

56
Q

How does myeloma cause renal failure? (4)

A

1) raised immunoglobulins (proteins)
2) proteins precipitate and deposit in kidneys
3) kidney injury
4) renal failure

57
Q

List the 3 types of haemoglobin found in adults.

A

1) HbA (2α + 2β) - 97%
2) HbA2 (2α + 2δ) - 2%
3) HbF (2α + 2γ) - 1%

58
Q

What is a HBB β+ allele?

A

A partially functioning beta globin.

59
Q

What is a HBB β0 allele?

A

A non functioning beta globin.

60
Q

List 5 regions where beta thalassaemia is common.

A

1) Mediterranean
2) North Africa
3) Middle East
4) Indian Subcontinent
5) South East Asia

61
Q

What is beta thalassaemia minor often confused with?

A

Iron-deficient anaemia.

62
Q

When does beta thalassaemia often present?

A

Within 1st year of life.

63
Q

List 2 causes of microcytic anaemia.

A

1) iron deficiency*

2) thalassaemia

64
Q

List 6 causes of normocytic anaemia.

A

1) chronic disease
2) combined haematinic (iron + B9)
3) acute blood loss
4) renal failure
5) pregnancy
6) sickle cell disease

65
Q

List 6 causes of macrocytic anaemia.

A

1) B9 (folate) deficiency
2) B12 deficiency (esp. pernicious anaemia
3) liver disease (alcohol)
4) chemotherapy
5) hypothyroidism
6) bone marrow failure

66
Q

What haemoglobin is found in four gene deletion alpha thalassaemia?

A

HbBarts (4 γ globin)

67
Q

What haemoglobin is found in 3 gene deletion alpha thalassaemia?

A

HbH (4 β globin)

68
Q

Define haemocrit.

A

Percentage volume of blood that is erythrocytes.

69
Q

List 2 alternative names for haemocrit.

A

1) red cell count

2) packed cell volume

70
Q

What is polycythaemia?

A

Increased red blood cell mass.

71
Q

What can cause polycythaemia? (2)

A

1) increased RBC mass
Or
2) decreased plasma volume

72
Q

What is the treatment aim for polycythaemia vera?

A

There’s no cure, so aim to maintain a low blood count with haemocrit > 0.45 to reduce risk of thrombosis.

73
Q

What is the lifespan of a platelet?

A

7-10 days.

74
Q

What hormone regulates platelet production?

A

Thrombopoietin.

75
Q

Where us thrombopoietin predominantly synthesised?

A

Liver.

76
Q

How many platelets are produced per megakarkyocyte?

A

Approximately 4000.

77
Q

Where platelets broken down?

A

Spleen.

78
Q

List 3 general causes of platelet dysfunction.

A

1) decreased platelet production (thrombocytopenia)
2) decreased platelet function
3) increased platelet destruction (thrombocytopenia)

79
Q

List 4 clinical features of platelet dysfunction.

A

1) mucosal bleeding (e.g. epistaxis, gum bleeding, menorrhagia)
2) easy bruising
3) petechia, purpura, ecchymosis
4) haematomas

80
Q

Define thrombocytopenia.

A

Decreased platelets in blood.

81
Q

List 3 general causes of decreased platelet production.

A

1) decreased bone marrow platelet production
2) congenital thrombocytopenia (absent/malfunctioning megakaryocytes)
3) bone marrow infiltration (e.g. leukaemia)

82
Q

List 6 causes of decreased bone marrow platelet production.

A

1) low B9/B12
2) reduced thrombopoietin (e.g. liver disease)
3) chemotherapy (e.g. methotrexate)
4) infections (e.g. HIV or TB)
5) toxins (e.g. alcohol)
6) autoimmune (e.g. aplastic anaemia)

83
Q

List 4 causes of increased platelet destruction.

A

1) autoimmune (e.g. immune thrombocytopenia purpura)
2) hypersplenism (e.g. portal hypertension, splenomegaly)
3) drug related immune destruction (e.g. heparin induced)
4) excessive platelet use (disseminated intravascular coagulopathy, thrombotic, thrombocytopenia purpura)

84
Q

What type of diagnosis is immune thrombocytopenia purpura?

A

Diagnosis of exclusion.

85
Q

List 4 things that should be absent to diagnose immune thrombocytopenic purpura.

A

1) systemic symptoms
2) medications that causes thrombocytopenia
3) hepatomegaly/splenomegaly
4) lymphadenopathy

86
Q

What does a positive direct Coombs test indicate?

A

Haemolytic anaemia.

87
Q

How long does it take for platelets to sharply fall in heparin induced thrombocytopenia?

A

5-10 days.

88
Q

List 2 reasons why ferritin may be low.

A

1) malignancy

2) infection

Phase 2a - Haemotology (3 decks)

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