Heamatology Flashcards
To be A positive what could you have inherited
AA or AO alleles
To be O postive what could you inherit
Both OO
How many rhesus antigens are there
4
D
Cc
Ee
What are the consequence of haemolytic disease of he newborn
Anaemia/ jaundice
Intrauterine death
Hydropis fetus
How is haemolytic disease of newborn managed
Pregnant women all offered anti-D if rhesus negative and postnatally if have rhesus d positive child
All women of childbearing age should be given kell negative blood transfusion if required
What alleles do you have to inherit to be rhesus d negative
cde and cde
What alleles can you inherit to be rhesus d positive
CDe and cde
CDe and CDe
How can the patient serum be tested pretransfusion
Antiglobulin test
Direct
Indirect
Red cell comparability testing
What are the risks of blood transfusion
immediate- ABO ag ab interaction
Delay- iron loading
RBC alloimmunisation
transfusion related acute lung injury (6hours, oedema)
Fluid overload
Purples
Dilution of clotting factors and hypoglycaemia ( massive transfusion)
Other none immune - infections and febrile or allergic reactions
What is blood made up of in percentages
45% RBC
55% plasma
1% WBC and platelets
RBC life span
100-120 days (4 months)
What is haematocrit a measure of
% of blood volume that is RBC
Life span of a platelet
7-14 days
What are platelets for and what happens to them when activated
Clotting in high flow areas ( arteries)
Circulate as smooth discs but become sticky and spikey when activated
What are the two divisions of white cells
Phagocytic ( granulocytes and monocytes)
Lymphoid- t and b and NK
Lifespan and functions of a neutrophil
8 hours
Phagocytosed bacteria with free radicals
Many fine red granules
Function of a monocyte
Phagocytosed dead or dying cells and accelerate material
Macrophages in transit
What is the lifespan and role of eosinophils
Circ-8-12 hours Tissues 8-12 days Anti-parasitic Allergic response IgE activity link Characteristic bilobed and red granules
What is the lifespan and function of basophils
2-3 days
Unclear maybe inflammatory
What do lymphocytes look like
Roundish uncles with blue cytoplasmic, mostly agranular
What are the general cause of anaemia
Under production
Increased destruction
Increased loss
What is polycythaemia
Over production in the marrow or reduced plasma = pseudo
How can anaemia be assessed
MCV - how big the red cells are indicate hb or iron content
MHC- mean cell haemoglobin
Reticulocytes- immature red cells
What are the cause of microcytic anaemia
a/b Thalasseamia Iron deficiency Chronic disease ( make the body deficient to limit bacterial growth ) Sideroblastic anaemia Blood loss is most common
What are the causes of macrocyclic anaemia
Reticulocytosis (haemorrhage or haemolytic) Megoblastic anaemia (b12 or folate deficiency) Marrow dysfunction - primary- leukaemia/ myeloma/ myelodysplasia, secondary to renal failure/ thyroid dysfunction/ chemotherapy/
What is thrombocytosis
Too many platelets formed due to marrow over production or reaction to inflammation or infection
What is thrombocytopenia
Reduced platelets Caused by consumption but clotting Infection Liver damage Marrow underproduction
What is neutrophils a reaction to
Infection ( increased)
What is neutropenia a reaction to
Under production or over consumption
What is monocytosis a reaction to
Chronic inflammation or TB
What is eosinophilia a reaction ton
Parasites, fungi, allergies ( asthma)
What is Virchow triad
Explains why blood clots
Reduction in blood flow
Disturbance in blood vessel
Disturbance of blood properties
Why does normal blood not clot
Complex balance between prothrombotic and anticoagulant factors
What are the types of clot, what are they based on and what drug treats them
Arterial- platelets- aspirin
Venous-fibrinogen- warfarin
What can you measure the intrinsic clotting pathway with
ATPP Activated partial thromboplastin time
Usually 22-32 seconds
Assesses effect of u fractionated heparin
What is ATPP elevated in
Haemophilia a+b Von Williebrands disease Lupus Liver disease DIC
How can you asses the extrinsic pathway of clotting
Prothrombin time
Usually 9-12 seconds
Monitors effects of warfarin and liver function ( factor 7)
Pathologically prolonged in liver dysfunction or DIC
What clotting factors are vitamin K dependant
10 9 7 2
What does thrombin time measure
How long is it usually and when is it prolonged
Common pathway function
12-20 seconds
Heparin treatment but esp UFH
Or in liver disease or DIC
Why might you do a mixing study of a patients blood
Prolonged PT/INR or APTT, checks that the patient doesn’t have something other than a clotting factor dysfunction eg an inhibitor
What is the d-dimer test
Normally less than 250, raised means lots of chopped up fibrin by plasmin ( recent clot)
Doesn’t tell you cause of the clot
What is the problem with ATPP PT and TT
Measure isolated cogilation without endothelium and platelets
Better to do basic bleeding time
What is bleeding time usually
2-8 mins
Name 7 cause of abnormal bleeding
Dysfunction of clotting factors Insufficient clotting factors Abnormal biochemical environment (pH) Dysfunctional platelets Insufficient platelets Dysfunctional vascular endothelium Dysfunctional vessel constriction
What is haemophilia
X linked disease
A- reduced factor 8
B- reduced factor 9
Causes prolonged ATPP and joint bleeding and bruises
explain DIC
Disseminated intravascular coagulation .
Causes by infection of gram -ve, malignancy, pregnancy, massive bleeding
Microscopic clots in circ use up all platelets and clotting factors and leading to widespread bleeding
What is transfusion coagulopathy
Occurs when situations of massive transfusion
Platelets and clotting factors depleted and then diluted by the transfusion leading to circ becoming acidotic and hypthermic further inhibiting clotting factors
What are dysfunctional platelets most likely caused by
Drugs- aspirin clopidogrel and abciximab
How does platelet dysfunction manifest
Bleeding from mucosal surface
What are three causes of low platelets
Liver disease
Marrow failure
Immune theomboctypaenic purpura
What are risk factors for arterial clots (8)
Old age Hypertension Diabetes Smoking High cholesterol Past history of stroke or heart attack Family history of stroke or heart attack Infection/inflammation/cancer
Name 8 risk factors for venous clots
Increasing age Immobility Surgery Hospitalisation Long plane journeys Pregnancy Cancer/infection/inflammation Pregnancy COPD
what is the acute treatment for arterial clots
Heparins
What is the immediate treatment for venous clots
High dose heparin
Explain how heparin works
And the difference between LMWH and UFH
Deactivation of factors 10 and 2
LMWH - more consistent anticoagulants on that UFH but UFH more easily reversed
Explain how warfarin works
Antagonises vitamin k needed for factors 10 9 7 and 2
Lots of interactions
What classical blood groups are there and what antigen antibody and prevalence do each have
O = no a or b antigen, anti-a and anti-B 43% A= a antigen, anti-B 43% B= b antigen, anti-A 9% AB= a and b antigens, no antibodies 3%
What are the classifications of haematological malignancy
Myeloid- granulocytes monocytes megakaryocytes and rbcs
Lymphoid- lymphocytes
Name some myeloid disorders
Active myeloid leukaemia
Chronic myeloid leukaemia
Myeloproliferative disorders
Myelodysplasia syndromes
Name some lymphoid disorders
Acute lymphoblastic leukaemia Chronic lymphocytic leukaemia Plasma cell disorders- myeloma T cell lymphomas Non Hodgkin's lymphoma
What are myeloproliferative disorders
Excess mature cells in the blood
Polycythaemia Rubro Vera- RBC
Essential thrombocythaemia- platelets
Have underlying problem with jamuskinase gene.
Myelofibrosis ( abnormal megokaryocytes)
Systemic mastocytosis
Increased clotting
What are acute leukaemia a, what do they present with and how are they treated
Malignancy of bone marrow Very rapid cell growth Abnormal cells fill bone marrow then spill out into circulation Present with Anaemia- fatigue, tiredness, and pallor Thrombocytopenia- bleeding and bruising Neutropenia-infections AML Strong chemotherapy in bursts ALL- strong chemo mixed with persistent milder tablets
What is the commentary leukaemia of children
Acute lymphoblastic leukaemia
What is the prognosis like for acute l l in children
90% revision
85% cured
What characterises chronic myeloid leukaemia
White white cell count with or without leukostasis
Splenomegaly
Priapism
Cause by Philadelphia chromosome - translocation 9 : 22
What is the treatment for chronic M leukaemia
Tumour cell specific enzyme- Imantinib
What characteristics chronic lymphoblastic leukaemia
Relative common high lymphocyte count but normal RBC Smudge cells in blood film Hypoammaglobuliaemia Defective apoptosis May have lymphadenopathy/spenomegaly Immune disturbance Marrow suppression
What is the prognosis like for CLL
Good, ten years
Can be left untreated when without symptoms, bulk disease or bone arrow failure
What is the difference between a non Hodgkin’s lymphoma and leukaemia
Leukaemia effects the blood cells in the bone marrow
Lymphoma effects WBC in tissues (30%) and lymph nodes (70%)
What virus’s may non Hodgkin’s lymphoma be related to
EBV
HTLV
HHV8
HIV
What other than virus’s is NHlymphoma related to
Chemical and sunlight exposure
What are the signs of NH lymphoma
B symptoms- wt loss, drenching night sweats, fevers and lymphadenopathy
What is Hodgkin’s disease
Related to EBV infection
Peaks of prevalence in terms and elderly- when EBV has interstates into lymphocyte DNA closer or further from proto-oncogenes
What does Hodgkin’s disease present with and how is a diagnosis made
B symptoms and contiguous nodal spread
Diagnosis- biopsy lymphadenopathy , CT to stage tumour
What does grade of lymphoma indicate
Low grade- slow grumbling chronic
High grade- fast aggressive and acute
What the different igs for
IgD- newly made lymphocyte IgM- clear pathogens IgE- parasites IgG - pathogens from tissues fluids IgA- mucosal surface
What are paraproteins
Protein caused by abmormal clonal proliferation of plasma cells. Monoclonal antibodies cause a spike in normal globulin pattern in electrophoresis
What are the three steps to diagnosing myeloma
Plasma cells in marrow
Paraproteins detectable in blood or urine
Lytic lesions on skeletal survey (X-ray)
What is igM paraprotein indicative of
Waldenstorms macroglobulinaemia
When would you think of myeloma
Old person with anaemia back pain high ESR unexplained renal failed or unusual fractures
What is hyperviscosity syndrome
Sticky treacle blood
Fibrinogen igM igA or polycythaemia
Symptoms- fatigue headache confusion
