Heam Flashcards
dabigatron is excreted how
how does it work
renally
direct thrombin inhibitor
extrinsic pathway
intrinsic pathway
PTT
APTT
prolonged PTT
warfarin
liver disease
vit k defic
DIC
which factor is decreased the fastest in liver disease and why
factor 7
has the shortest half life
prolonged APTT
haemophilia heparin DIC WV dx anti phospholipid
ferritin is what
storage iron
acute phase protein
goes up in infections
heriditary spherocytosis is what
what happens
what can be done treatment wise
genetic change in a protein leading to a change in the shape
RBCs cleared faster - hameolysis
splectomy and cholescectomy as gallstones due to increased bilirubin
folic acid 5mg/day due to defic
iron therapy what should be seen
Hb should go up 10g/L per week
pernicious anaemia is a problem with what
treatment
B12 absorption - B12 is needed for division of cells
loading dose of B12 then every 3months
normocytic can be what
aplastic anaemia
anaemia of chronic disease
Gp6D come from where
mediterranean
african origin
lead poisoning
old fashioned house
pain
basophilic stippling
non megaloblastic macrocytic
idiopathic thrombocytopenia purpura
had cold/virus before
INR target for VTE
recurrent VTEs
AFib
- 5
- 5
- 5
tamoxifen increases the risk of what
VTE and endometrial cancer
what do platelet transfusions have more of a risk of than other transfusions and why
bacterial infections
stored at room temp - provide a more favourable enviroment
DVT warfarin target
INR 2-3
burrkits lymphoma gene caused by what in who risk of how can this risk be avoided
C-Myc gene translocation between 8:14 EBV african population chemo can cause tumour lysis syndrome rasburicase is given before chemo to decrease the risk
factor 5 leidan is also known as what
activated protein C resistance
what is the most common inherited bleeding disorder
VW
polycythaemia vera has excessive what
what key symptom/sign
predisposes people to what
20% suffer from what
excessive RBCs
intense itching after shower
blood clots
suffer from gouty arthritis
antiphospholipid syndrome increases what
APTT
neutropenic sepsis treatment
pevacillin and tazobactem
hereditary spherocytosis dx
osmotic fragility test
deficiency in both via B12 and folic acid treatment
IM B12 and start oral folic acid when B12 levels are normal
rheumatoid arthritis and splenomegaly/neutropenia
Feltys
aplastic crisis
signs
cause
decreased Hb
presence of reticulocytes
caused by paravirus infection
chronic lymphocytic leukaemia is the commonest what
where are the lymphocytes seen
signs
leukaemia in adults
lymphocytes in peripheral blood
LNs enlarged, splenomegaly
LMWH ix
unfractionated ix
Xa assay
APTT
how much iron is in the plasma pool
4mg
what is the iron turnover
4mg in the pool and move 20mg in a day
adult male hb and hc
female
130 and 0.38-0.52
120 and 0.37-0.47
what do erythroid precursors cluster around
a central nursing histiocyte
hb concentration
hc
when are both of these not useful
spectrophotometric method
ratio of blood
bleed or plasma expansion
reticulocytes
larger than normal
still have rna
stain purple/deep red
blood film - polychromic
cytoplasmic defects
nuclear defects
bad kidneys
what do all of these lead to
impaired haemaglobinisation
impaired cell division
ero insta being produced
erythropoiesis present but not effective to hyperprloiferation - low reticulocyte count
MCV normal
macrocytic anaemia
80-100
>100
macrocytic causes true
megaloblastic CBF
non megaloblastic - alcol, liver, hypothyroid, marrow failure
megaloblastic macrotyic anaemia causes
can’t be fucked CBF
cytotoxic drugs - methtrexate
b12 and
folate defic
spurious causes of macrocytic anaemia
acute blood loss
cold agglutins
cold agglutins
autoimmune disease against RBC - causes RBC to clump together leading to an increase in MCV
non megaloblastic not assoc with anaemia
non megaloblasts assoc with anaemia
alcohol, liver dx, hypothyroidism
myelodysplasia, myeloma, aplastic anaemia
what do b12 and folate do
enable chemical reactions that provide enough nucleotides for DNA synthesis
causes of b12 defic
coeliac ,crohns, chronic pancreatitis, vegans, bypass
causes of folate defic
dietary, coeliacs, crohns, haemolysis, exfoliating derm, pregnancy, malignancy, anti convulsants
folate
dietary follasse -> mono glutamates
absorbed in jejunum
b12 source
body stores
absorbed
daily requirement
animals
2-4y
ileum
1-3 ug/day
folate source
body stores
absorbed
daily requirement
leafy veg, yeast destroyed when cooking
4month
D+J
100ug/day
what can be caused in b12 deficiency
neuro problems
myelin sheath
what is pernicious anaemia
AI condition with destruction of gastric parietal cells
what is pernicious anaemia associated with
atrophic gastritis
other AI conditions
what does pernicious anaemia lead to
and what are the by products of that
ineffective erythropoiesis - RC die prematurely in bone marrow
dead RC - hb (bilirubin) and lactate dehydrogenase
ix for pernicious
Anti IF - specific but not sensitive
Anti GPC sensative but not specific
treatment for pernicious
vit b12 hydroxycobalamin infections for life
mennorhagia blood loss iron defic
commonest cause of blood loss
av 30-40ml/month which 15/20mg a month
heavy >60ml which is over 30mg/month
relative defic
absolute defic
pregnancy
vegetarian
achlorhydra
absent or low production of HCl
functional iron
hb
transported iron
serum iron
transferrin
transferrin sat
storage iron
serum ferratin
what is tranferrin
protein with 2 binding sites for ion atoms
what is ferratin
large intra cellular protein
spherical protein stores up to 4000 ferric ions
when is transferrin high
genetic haemochromatosis
hb tetramer made up of what
2 alpha globin chains and 2 beta globin chains
one team attached to each globin chain
HbA
HbA2
HbF
alpha2 beta 2
alpha2 8 2
alpha 2 gamma2
alpha like chains on which chromosome how many per cell
beta
choromosome 16 4 per cell
chromsome 11 2 per cell
embryonic Hb
gower 1 and 2 and portland
foetal hb
HbF
adult hb
HbA2 HbA
when are adult levels of hb reached
6-12m of age
