Intro to haematology

Question 1

what is the 6 step protocol for breaking bad news?

Answer 1

SPIKES 
setting and listening skills 
patients perception 
invitation or indication 
knowledge 
empathise and sympathise 
strategy and summary

Question 2

what is polychromasia?

Answer 2

an abnormally high reticulocyte count in the blood stream (premature RBC) due to premature release from the bone marrow during formation

Question 3

what hormone drives RBC formation?

Answer 3

erythropoietin

Question 4

where is erythropoietin formed?

Answer 4

kidney

Question 5

what drives the kidney to produce erythropoietin?

Answer 5

hypoxia

Question 6

what is polycythaemia?

Answer 6

a disorder in which there is too much RBC found in the blood stream

Question 7

what are the myeloid cells?

Answer 7

all cells except lymphoid cell s

Question 8

what are the white blood cells?

Answer 8

all cells except platelets and erythrocytes

Question 9

what are the haematinics and what results if there is a deficiency in one of them?

Answer 9

iron
folate
vitamin B12

= anaemia

Question 10

what hormone regulates the production of platelets?

Answer 10

thrombopoietin

Question 11

where is thrombopoietin produced and what is its function?

Answer 11

produced from the liver

drives production of platelets

Question 12

if someones platelet count is too low what can be given therapeutically to correct this?

Answer 12

platelet agonists;
romiplostim
eltrombopag

platelet transfusion

if immune cause - give corticosteroids

Question 13

what features are characteristic of thrombocytopenia?

Answer 13

platelet type bleeding;

• petechial rash
• mucosal bleeding
• ecchymosis (bruising)
• epistaxis
• GI bleed
• menorrhagia

Question 14

what is the function of neutrophils?

Answer 14

ingest and destroys pathogens particularly bacteria and fungi (rather than viruses)

Question 15

what is responsible for regulating the production of neutrophils?

Answer 15

granulocyte-colony stimulating factor (G-CSF)

Question 16

what change in neutrophil count would you observe on FBC if there was an infection?

Answer 16

left shift

Question 17

what is G-CSF used for therapeutically?

Answer 17

neutropenia

Question 18

what drugs can cause a low neutrophil count / neutropenia?

Answer 18

furosemide 
NSAIDS
penicillin 
quinine 
ranitidine (H2 recetor blocker)

Question 19

what is the function of monocytes?

Answer 19

to ingest and destroy pathogens particularly bacteria and fungi

Question 20

what is the function of eosinophils?

Answer 20

ingest and destroy parasites

also involved in allergies

Question 21

what are causes of lymphocytosis?

Answer 21

viral infection (HIV, Hepatitis, CMV…)
lymphoma
lymphoid malignancies

Question 22

what are causes of lymphocytopenia?

Answer 22

autoimmune i.e. SLE, RA, myaesthenia gravis
lymphoma
HIV/AIDS
chemo & radiatiotherapy
AKI / CKD
drugs i.e. dimethyl fumarate, azathioprine

Question 23

where does B and T lymphocytes mature?

Answer 23

T cells mature in thymus

B cells mature in bone marrow

Question 24

what are the 3 types of T lymphocytes?

Answer 24

cytotoxic
helper
regulatory

Question 25

what's the difference between class I and class II HLA?

Answer 25

class I display internal antigens on all nucleated cells class II displays antigens rated by antigen presenting cells

Question 26

what diseases is felty's syndrome associated with?

Answer 26

RA | lymphoma

Question 27

what are the main features of felty's syndrome?

Answer 27

``` severe disease defined by the presence of 3 conditions; - rheumatoid arthritis - neutropenia - splenomegaly causes repeated infections ``` ``` features; Splenomegaly Arthrits (RA) Neutropenia Thrombocytopenia Anaemia ```

Question 28

what is the normal range of haemoglobin in a male and female?

Answer 28

male: 135-170 g/L female: 120-160 g/L

Question 29

what is the normal range of platelets?

Answer 29

150-400 X 10 (9)/L

Question 30

what is the normal range of WCC?

Answer 30

4-10 X 10/L

Question 31

what is the normal range of RBC?

Answer 31

4-5 X 10(9) /L

Question 32

with regards to blood count what does splenomagely indicate?

Answer 32

pancytopenia

Question 33

what are the antigen presenting cells?

Answer 33

dendritic cells macrophages B-cells

Question 34

what diagnostic test can you perform to investigate platelet function?

Answer 34

bleeding time

Question 35

what diagnostic test can you perform to investigate clotting factors?

Answer 35

clotting time tests prothrombin (PT) measures extrinsic factors activated partial thromboplastin time (APTT)

Question 36

what are causes of splenomegaly?

Answer 36

``` leukaemia's and lymphoma's myeloproliferative disorders thalassaemia megablastic anaemia autoimmune haemolytic disease felty's syndrome SLE portal hypertension sarcoidosis amyloidosis malignancy acute infection i.e. EBV, CMV chronic bacterial infection i.e. TB, brucella chronic parasitic infection i.e. malaria, schistosomiasis, leishmaniasis storage pool disorders; - gauchers - neimann pick ```

Question 37

what can cause neutropenia?

Answer 37

``` drugs i.e furosemide sepsis autoimmune chronic granulomatous disease bone marrow failure ```

Question 38

what can cause neutrophillia?

Answer 38

``` bacterial infections tissue inflammation i.e. rheumatoid arthritis tissue infarct i.e. MI post-op drugs i.e. steroids malignancy i.e. lymphoma ```