Intro to Haem -1 Flashcards

1
Q

What is the name of the disorder where there is a factor 9 deficiency?

A

Haemophilia B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the name of the condition where there is excess factor 9 and what is this due to?

A

Factor 9 Padua (gene mutation resulting in increased likelihood of thrombosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the mutation in polycythemia?

A

JAK2 somatic mutation (acquired)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the mutation which causes paroxysmal nocturnal haemoglobinuria?

A

PIG-A mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do you not get acquired DNA mutations in the production of soluble factors?

A

Because hepatocytes do not have rapidly dividing cells like the bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you differentiate between a primary and secondary haematological disorder?

A

Primary - due to a disease of the blood or bone marrow

Secondary - the abnormality is elsewhere, but this shows up in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give an example of a secondary blood disease

A

Acquired haemophilia A due to autoantibodies against factor 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When can factor 8 be in excess as a secondary cause? Name two scenarios

A

Can be increased in pregnancy, hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give examples of systemic conditions which cause secondary haematological changes

A

Chronic inflammation - raised factor 8 levels can lead to increased level of thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is factor 8 needed for?

A

Factor 8 is a cofactor of factor 9a, so together they convert more factor 10 to factor 10a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why might rbc levels be raised?

A

Due to high altitude or hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why might rbc levels be reduced?

A

Shortened survival due to haemolytic anaemia
BM infiltration
Iron or B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why might platelet levels be raised?

A

Due to bleeding
Splenectomy
Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why might platelet levels be reduced?

A

ITP
TTP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does TTP stand for

A

Thrombotic thrombocytopenic purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Young male child, haemarthrosis and low factor 8 - condition

A

Haemophilia A

17
Q

Older woman with low factor 8

A

Haemophilia A acquired

18
Q

What could be the cause of iron deficiency anaemia?

A

Bleeding until proven otherwise - menorrhagia in pre-menopausal women, or blood loss in men and post menopausal women

19
Q

Identify key sites of blood loss

A

GI loss - ulcer, gastric cancer
IBD, colon cancer

Renal tract
- Renal cell carcinoma
- Bladder cancer

20
Q

What does leucoerythroblastic anaemia mean? What does this look like on a blood film?

A

Where there are leucocyte and erythrocyte precursors in the blood.

RBCs are nucleated
Myeloblasts present
Teardrop shaped - poikilocytes

21
Q

Differentials for leucoerythroblastic anaemia

A

Leucoerythroblastic = think infiltration of the bone marrow

Cancer or mets
Infection - miliary TB or severe fungal infection
Myelofibrosis (splenomegaly + dry tap on BM aspirate)

22
Q

Haemolytic anaemia - what would you expect to find on lab results?

A

Raised LDH
Bilirubinemia (unconjugated/pre-hepatic)
Reticulocytosis with mild MCV raise (just above 100)
Reduced haptoglobins

23
Q

Pernicious anemia MCV

A

above 120

24
Q

Normal MCV range

A

80-100

25
Q

MCV of 105

A

Reticulocytosis
Mild myelodysplasia????

26
Q

Why is LDH released?

A

LDH is an intracellular enzyme, so it gets released in haemolysis

27
Q
A

Thalassemia
Acquuired haemolytic anamies

28
Q

What are haptoglobins?

A

Haptoglobins mop up free haemoglobin in the blood

29
Q

When would you see haemolytic anaemias?

A

Acquired haemolytic anaemia - immune haemolytic anaemia cause by systemic disease

Non acquired haemolytic anaemia

30
Q

Immune haemolytic anaemia - what is positive and what is seen on blood film?

A

Spherocytes seen on blood film
DAT positive (direct antiglobulin test)

31
Q

What systemic diseases might result in immune haemolytic anaemia?

A
  • Cancers of the immune system e.g. lymphoma or chronic lymphocytic leukemia
  • Autoimmune conditions like SLE
  • Infections - mycoplasma
  • Idiopathic
32
Q

What cancers can cause coombs positive haemolytic anaemia?

A

Lymphomas and CLL

33
Q

What is the other cause of haemolytic anaemia besides acquired immune causes? (Overall branch)

A

Acquired non-immune

34
Q

List some acquired non-immune causes of haemolytic anaemia

A

Malaria
MAHA

35
Q

What is MAHA associated with? Explain the mechanism.

A

Adenocarcinoma - low grade DIC, fibrin deposition and platelet use up; shearing of RBCs as they’re forced through the tiny vessels.
HUS

36
Q

What can myoplasma cause?

A

Acquired immune haemolytic anaemia - coombs positive

37
Q

What can miliary TB cause?

A

Leucoerythroblastic anaemia

38
Q

Name another infection that can cause leucoerythroblastic anaemia

A

Severe fungal infection

39
Q

What is HUS?

A

MAHA, thrombocytopenia and AKI

Usually occurs in kids with shiga-toxin producing e-coli diarrhoae