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CLS > Heamatology > Flashcards

Heamatology Flashcards

1
Q

To be A positive what could you have inherited

A

AA or AO alleles

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2
Q

To be O postive what could you inherit

A

Both OO

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3
Q

How many rhesus antigens are there

A

4
D
Cc
Ee

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4
Q

What are the consequence of haemolytic disease of he newborn

A

Anaemia/ jaundice
Intrauterine death
Hydropis fetus

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5
Q

How is haemolytic disease of newborn managed

A

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

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6
Q

What alleles do you have to inherit to be rhesus d negative

A

cde and cde

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7
Q

What alleles can you inherit to be rhesus d positive

A

CDe and cde

CDe and CDe

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8
Q

How can the patient serum be tested pretransfusion

A

Antiglobulin test
Direct
Indirect
Red cell comparability testing

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9
Q

What are the risks of blood transfusion

A

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

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10
Q

What is blood made up of in percentages

A

45% RBC
55% plasma
1% WBC and platelets

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11
Q

RBC life span

A

100-120 days (4 months)

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12
Q

What is haematocrit a measure of

A

% of blood volume that is RBC

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13
Q

Life span of a platelet

A

7-14 days

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14
Q

What are platelets for and what happens to them when activated

A

Clotting in high flow areas ( arteries)

Circulate as smooth discs but become sticky and spikey when activated

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15
Q

What are the two divisions of white cells

A

Phagocytic ( granulocytes and monocytes)

Lymphoid- t and b and NK

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16
Q

Lifespan and functions of a neutrophil

A

8 hours
Phagocytosed bacteria with free radicals
Many fine red granules

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17
Q

Function of a monocyte

A

Phagocytosed dead or dying cells and accelerate material

Macrophages in transit

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18
Q

What is the lifespan and role of eosinophils

A 
Circ-8-12 hours
Tissues 8-12 days
Anti-parasitic 
Allergic response 
IgE activity link 
Characteristic bilobed and red granules
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19
Q

What is the lifespan and function of basophils

A

2-3 days

Unclear maybe inflammatory

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20
Q

What do lymphocytes look like

A

Roundish uncles with blue cytoplasmic, mostly agranular

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21
Q

What are the general cause of anaemia

A

Under production
Increased destruction
Increased loss

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22
Q

What is polycythaemia

A

Over production in the marrow or reduced plasma = pseudo

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23
Q

How can anaemia be assessed

A

MCV - how big the red cells are indicate hb or iron content
MHC- mean cell haemoglobin
Reticulocytes- immature red cells

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24
Q

What are the cause of microcytic anaemia

A 
a/b Thalasseamia 
Iron deficiency 
Chronic disease ( make the body deficient to limit bacterial growth )
Sideroblastic anaemia
Blood loss is most common
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25
Q

What are the causes of macrocyclic anaemia

A 
Reticulocytosis (haemorrhage or haemolytic) 
Megoblastic anaemia (b12 or folate deficiency) 
Marrow dysfunction - primary- leukaemia/ myeloma/ myelodysplasia, secondary to renal failure/ thyroid dysfunction/ chemotherapy/
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26
Q

What is thrombocytosis

A

Too many platelets formed due to marrow over production or reaction to inflammation or infection

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27
Q

What is thrombocytopenia

A 
Reduced platelets 
Caused by consumption but clotting 
Infection
Liver damage 
Marrow underproduction
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28
Q

What is neutrophils a reaction to

A

Infection ( increased)

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29
Q

What is neutropenia a reaction to

A

Under production or over consumption

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30
Q

What is monocytosis a reaction to

A

Chronic inflammation or TB

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31
Q

What is eosinophilia a reaction ton

A

Parasites, fungi, allergies ( asthma)

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32
Q

What is Virchow triad

A

Explains why blood clots
Reduction in blood flow
Disturbance in blood vessel
Disturbance of blood properties

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33
Q

Why does normal blood not clot

A

Complex balance between prothrombotic and anticoagulant factors

34
Q

What are the types of clot, what are they based on and what drug treats them

A

Arterial- platelets- aspirin

Venous-fibrinogen- warfarin

35
Q

What can you measure the intrinsic clotting pathway with

A

ATPP Activated partial thromboplastin time
Usually 22-32 seconds
Assesses effect of u fractionated heparin

36
Q

What is ATPP elevated in

A 
Haemophilia a+b 
Von Williebrands disease
Lupus 
Liver disease 
DIC
37
Q

How can you asses the extrinsic pathway of clotting

A

Prothrombin time
Usually 9-12 seconds
Monitors effects of warfarin and liver function ( factor 7)
Pathologically prolonged in liver dysfunction or DIC

38
Q

What clotting factors are vitamin K dependant

A

10 9 7 2

39
Q

What does thrombin time measure

How long is it usually and when is it prolonged

A

Common pathway function
12-20 seconds
Heparin treatment but esp UFH
Or in liver disease or DIC

40
Q

Why might you do a mixing study of a patients blood

A

Prolonged PT/INR or APTT, checks that the patient doesn’t have something other than a clotting factor dysfunction eg an inhibitor

41
Q

What is the d-dimer test

A

Normally less than 250, raised means lots of chopped up fibrin by plasmin ( recent clot)
Doesn’t tell you cause of the clot

42
Q

What is the problem with ATPP PT and TT

A

Measure isolated cogilation without endothelium and platelets
Better to do basic bleeding time

43
Q

What is bleeding time usually

A

2-8 mins

44
Q

Name 7 cause of abnormal bleeding

A 
Dysfunction of clotting factors
Insufficient clotting factors 
Abnormal biochemical environment (pH)
Dysfunctional platelets
Insufficient platelets
Dysfunctional vascular endothelium 
Dysfunctional vessel constriction
45
Q

What is haemophilia

A

X linked disease
A- reduced factor 8
B- reduced factor 9
Causes prolonged ATPP and joint bleeding and bruises

46
Q

explain DIC

A

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

47
Q

What is transfusion coagulopathy

A

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

48
Q

What are dysfunctional platelets most likely caused by

A

Drugs- aspirin clopidogrel and abciximab

49
Q

How does platelet dysfunction manifest

A

Bleeding from mucosal surface

50
Q

What are three causes of low platelets

A

Liver disease
Marrow failure
Immune theomboctypaenic purpura

51
Q

What are risk factors for arterial clots (8)

A 
Old age
Hypertension
Diabetes
Smoking
High cholesterol
Past history of stroke or heart attack
Family history of stroke or heart attack
Infection/inflammation/cancer
52
Q

Name 8 risk factors for venous clots

A 
Increasing age
Immobility
Surgery
Hospitalisation
Long plane journeys
Pregnancy
Cancer/infection/inflammation 
Pregnancy 
COPD
53
Q

what is the acute treatment for arterial clots

A

Heparins

54
Q

What is the immediate treatment for venous clots

A

High dose heparin

55
Q

Explain how heparin works

And the difference between LMWH and UFH

A

Deactivation of factors 10 and 2

LMWH - more consistent anticoagulants on that UFH but UFH more easily reversed

56
Q

Explain how warfarin works

A

Antagonises vitamin k needed for factors 10 9 7 and 2

Lots of interactions

57
Q

What classical blood groups are there and what antigen antibody and prevalence do each have

A 
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%
58
Q

What are the classifications of haematological malignancy

A

Myeloid- granulocytes monocytes megakaryocytes and rbcs

Lymphoid- lymphocytes

59
Q

Name some myeloid disorders

A

Active myeloid leukaemia
Chronic myeloid leukaemia
Myeloproliferative disorders
Myelodysplasia syndromes

60
Q

Name some lymphoid disorders

A 
Acute lymphoblastic leukaemia 
Chronic lymphocytic leukaemia 
Plasma cell disorders- myeloma 
T cell lymphomas 
Non Hodgkin's lymphoma
61
Q

What are myeloproliferative disorders

A

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

62
Q

What are acute leukaemia a, what do they present with and how are they treated

A 
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
63
Q

What is the commentary leukaemia of children

A

Acute lymphoblastic leukaemia

64
Q

What is the prognosis like for acute l l in children

A

90% revision

85% cured

65
Q

What characterises chronic myeloid leukaemia

A

White white cell count with or without leukostasis
Splenomegaly
Priapism
Cause by Philadelphia chromosome - translocation 9 : 22

66
Q

What is the treatment for chronic M leukaemia

A

Tumour cell specific enzyme- Imantinib

67
Q

What characteristics chronic lymphoblastic leukaemia

A 
Relative common high lymphocyte count but normal RBC 
Smudge cells in blood film
Hypoammaglobuliaemia 
Defective apoptosis 
May have lymphadenopathy/spenomegaly
Immune disturbance
Marrow suppression
68
Q

What is the prognosis like for CLL

A

Good, ten years

Can be left untreated when without symptoms, bulk disease or bone arrow failure

69
Q

What is the difference between a non Hodgkin’s lymphoma and leukaemia

A

Leukaemia effects the blood cells in the bone marrow

Lymphoma effects WBC in tissues (30%) and lymph nodes (70%)

70
Q

What virus’s may non Hodgkin’s lymphoma be related to

A

EBV
HTLV
HHV8
HIV

71
Q

What other than virus’s is NHlymphoma related to

A

Chemical and sunlight exposure

72
Q

What are the signs of NH lymphoma

A

B symptoms- wt loss, drenching night sweats, fevers and lymphadenopathy

73
Q

What is Hodgkin’s disease

A

Related to EBV infection
Peaks of prevalence in terms and elderly- when EBV has interstates into lymphocyte DNA closer or further from proto-oncogenes

74
Q

What does Hodgkin’s disease present with and how is a diagnosis made

A

B symptoms and contiguous nodal spread

Diagnosis- biopsy lymphadenopathy , CT to stage tumour

75
Q

What does grade of lymphoma indicate

A

Low grade- slow grumbling chronic

High grade- fast aggressive and acute

76
Q

What the different igs for

A 
IgD- newly made lymphocyte 
IgM- clear pathogens
IgE- parasites
IgG - pathogens from tissues fluids 
IgA- mucosal surface
77
Q

What are paraproteins

A

Protein caused by abmormal clonal proliferation of plasma cells. Monoclonal antibodies cause a spike in normal globulin pattern in electrophoresis

78
Q

What are the three steps to diagnosing myeloma

A

Plasma cells in marrow
Paraproteins detectable in blood or urine
Lytic lesions on skeletal survey (X-ray)

79
Q

What is igM paraprotein indicative of

A

Waldenstorms macroglobulinaemia

80
Q

When would you think of myeloma

A

Old person with anaemia back pain high ESR unexplained renal failed or unusual fractures

81
Q

What is hyperviscosity syndrome

A

Sticky treacle blood
Fibrinogen igM igA or polycythaemia
Symptoms- fatigue headache confusion

CLS (12 decks)

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