Introduction to Haematology Flashcards
How many cells do we have in our body?
35-40 trillion cells
How many white and red cells do we produce in a minute?
White 5-7 million/minute
Red 100-150 million/minute
How many cells in total divide in a minute?
Somewhere between 200-300 million cells
What are the cells involved in haematopoiesis from the multipotent stem cell?
Multipotent stem cell - haematopoietic stem cell
Primitive progenitor cells - common myeloid progenitor & common lymphoid progenitor
Committed precursor cells - (CMP) megakaryocyte and erythroid progenitor, granulocyte and macrophage progenitor; (CLP) T-cell and natural killer cell progenitor, B-cell progenitor
Lineage committed cells - (MEP) megakaryocyte->platelets, erythrocyte progenitor->erythrocytes; (GM) monocyte progenitor->macrophage/monocyte/dendritic cell, granulocyte progenitor->neutrophil/basophil/eosinophil; (TNK) T-cell progenitor->T-cell, natural killer cell progenitor->NK cell; (BCP) B-cell; (CLP) dendritic cell
Which components of the blood are seen in a normal FBC?
Platelets
Neutrophils/WBC
Red cells
What condition is seen in iron deficiency anaemia?
Angular stomatitis
What determines iron deficiency anaemia?
Microcytic hypochromic RBCs (pale/small)
Low haemoglobin (Hb)/Mean corpuscular volume (MCV)/Ferritin levels
What are the causes of iron deficiency?
Dietary deficiency
Malabsorption
Blood loss
GI tract conditions eg coeliac and Crohn’s
Menorrhagia
What deficiency is a smooth tongue an indication of?
B12 deficiency
What type of anaemia is caused by vitamin B12 or B9 (Folate) deficiency?
Macrocytic anaemia
How long does folate stored in the body usually last?
4 months
What are the main sources of folate?
Leafy vegetables
Fruits
Liver
What are the main sources of B12?
Meat
Fish
Eggs
Dairy
Fortified breakfast cereals
Where are folates usually absorbed?
Duodenum and jejunum (small intestine)
Where is B12 usually absorbed?
Ileum (small intestine)
How long does the body supply of B12 usually last?
2-6 years
What protein is involved in the absorption of B12?
Intrinsic factor (IF)
Apart from a smooth tongue, what may occur in B12 deficiency?
Macroglossia
What do neutrophils and red cells look like in macrocytic anaemia?
Hypersegmented (extensive lobing) neutrophils and large red cells
What will the blood test results of a patient with macrocytic anaemia show?
Low Hb
High MCV (large RBCs)
Low B12 and folate
What can cause folate deficiency?
Reduced intake
Increased requirements/demands eg pregnancy
Malabsorption eg coeliac disease
Alcoholism
Drugs eg septrin & methotrexate
What can cause B12 deficiency?
Inadequate intake
Low gastric acid (10-30% patients with partial gastrectomy)
Intrinsic factor antibodies against parietal cells (pernicious anaemia)
Abnormal terminal ileum
How to diagnose B12 and folate deficiency?
Measure red cell folate levels
Measure vitamin B12 levels
Measure intrinsic factor antibodies
How to treat B12 and folate deficiency?
Identify underlying cause
Oral folate replacement
Lifelong injections of B12 (every 3 months)
Apart from B12/folate deficiency, what can cause macrocytic anaemia?
Drugs eg methotrexate
Alcohol
Myelodysplasia
What is myelodysplasia?
A type of rare blood cancer where blood cells are poorly formed or don’t function properly
What are petechiae?
Small red dots on the hard palate
Where may petechiae manifest on apart from hard palate?
Legs (bruises)
Can we give dental treatments to patients with petechiae?
No as patient will bleed excessively
What causes petechiae?
Immune thrombocytopenia (ITP)
Disseminated intravascular coagulation (DIC)
Recent infection eg mononucleosis/glandular fever
Bone marrow infiltration eg acute leukaemia
Bone marrow failure syndromes eg aplastic anaemia, myelodysplastic syndrome (MDS)
Petechiae presents due to reduced _________
Platelets
What disease is gingival hyperplasia seen in?
Acute leukaemia
What do primary marrow disorders such as acute leukaemia usually present with?
Bruising
Bleeding
Infection
Skin rash
Lymphadenopathy
Gum hypertrophy
What may primary marrow disorders treatment include?
Bone marrow transplantation
What is the 5-year-prognosis/survival rate depending on leukaemia type and treatment?
30-70%
Which patients have a poorer leukaemia prognosis?
Elderly
What treatment is osteonecrosis of the jaw associated with?
Bisphosphonate
Osteonecrosis of the jaw is a severe ____ disease affecting the jaws leading to ______, probably _______ related
Bone, necrosis, ischaemia
_________-containing bisphosphonates, especially ________ and __________, are associated with worse osteonecrosis.
Nitrogen, pamidronate, zoledronate
Should bisphosphonates be stopped if dental extraction or root canal treatment is required?
Yes
What should be given to patients treated with oral and intravenous bisphosphonates prior to oral surgery and why?
Antibiotics eg augmentin to avoid osteonecrosis and promote healing of the affected area
Nearly all ________ patients are on bisphosphonates
Myeloma (bone marrow cancer)
What is the median age of presentation of myeloma?
67 y/o
What symptoms are present in myeloma patients?
Anaemia
Bone pain
Infection
Constipation
Stomach upsets secondary to hypercalcaemia
What are the lab findings for myeloma?
Normochromic normocytic anaemia
Paraprotein
Bence Jones proteinuria
High plasma viscosity or erythrocyte sedimentation rate (ESR)
What would a myeloma skull present in an X-ray?
Bare punched out holes
Where does lymphomatous lesion affect?
Hard palate
What is the clinical feature of lymphoma parotid?
Parotid swelling
Axillary lymphadenopathy could be a more benign form of lymphoma or __________ ________ ________ (CLL)
Chronic lymphocytic leukaemia
What are the 2 types of lymphoma?
Non-Hodgkin lymphoma
Hodgkin’s lymphoma
What are the two different types of non-Hodgkin lymphoma?
High-grade or aggressive non-Hodgkin lymphoma
Low-grade or indolent non-Hodgkin lymphoma
What is the cancer growth of high-grade non-Hodgkin lymphoma?
Quickly and aggressively
What is the cancer growth of low-grade non-Hodgkin lymphoma?
Slowly and may not experience any symptoms for many years
How common is non-Hodgkin lymphoma compared to Hodgkins?
3 to 4 times as common as HD
How many different subtypes are there under non-Hodgkin lymphoma?
~50
Treatment of non-Hodgkin lymphoma depends on ___ and ______. It may be anything from innocuous oral chemotherapy to _________ chemotherapy and transplant. In terms of outcome, some subtypes are incurable but _________ for long periods, whereas others have a 5-year survival rate of ____ to ____%
Age, subtype, intensive, controllable, 30 to 40%
What is mucositis?
Inflammation of the mucosal surfaces throughout the body
What are the clinical manifestations of oral mucositis?
Erythema, inflammation, ulceration, haemorrhage in the mouth and throat
When is oral mucositis frequently seen?
Post-chemotherapy and radiotherapy
What can be used to get some relief from oral mucositis?
Mouthwashes
Anti-inflammatories
According to the World Health Organisation’s Oral Toxicity Scale, what are the grades for severe mucositis?
Grade 3 and 4
What are the 4 conditions that can coexist in immunocompromised patients and require differential diagnosis?
Petechiae or local, denture-related lesions
Oral thrush
Aphthous ulcer
Oral mucositis
What can oral candidiasis be treated with?
First line - nystatin
Severe cases - oral fluconazole
What can be used to treat reactivated herpes simplex?
Topical aciclovir
What is herpes simplex virus 3 also known as?
Herpes zoster
What does herpes zoster or HSV3 cause?
Shingles
Chickenpox/varicella
How to treat shingles?
Oral aciclovir
How are shingles distributed?
Dermatomal/centripedal distribution (more in trunks than limbs)
What is the normal range of Hb in female?
11-18 g/dl
What is the normal range of Hb in male?
13-18 g/dl
What are the main types of anaemia and their indications?
- Iron deficiency - microcytic hypochromic RBCs
- Anaemia of chronic disease eg rheumatoid arthritis and chronic kidney disease - normocytic RBCs
- B12 & folate deficiency - macrocytic RBCs
What is the normal white cell count?
4-11 x 10^9 per litre
When will white cell count increase past the normal?
During infections or leukaemia
When will white cell count decrease outside the normal?
Viral infections
What is the normal platelet count?
150-400 x 10^9 per litre
