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MD2 Pathology > Introduction to Haematology > Flashcards

Introduction to Haematology Flashcards

1
Q

When might manual methods be used for FBE and blood films?

A

For samples that have unusual characteristics (e.g. ETDA can cause clumping of platelets mimicking thrombocytopaenia)

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2
Q

What is measured in an FBE?

A 
Hb
WCC (and differential assessing neutrophils, lymphocytes, monocytes, eosinophils, basophils)
Platelets
RCC
PCV
MCV
MCH
MCHC
RDW
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3
Q

What is a blood film used for?

A

Explain FBE abnormalities by assessing morphology, colour, etc
Confirm white cell differential

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4
Q

What changes are seen on blood film that are indicative of oxidative haemolysis in anaemia?

A

Blister cells
Irregularly contracted cells
Polychromatic cells

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5
Q

What are haematinics? Give 3 examples

A

Vitamins and minerals important for normal haematopoiesis

E.g. iron, B12, folate

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6
Q

List 4 investigations to confirm haemolysis

A

Bilirubin
LDH
Haptoglobin
Reticulocyte count

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7
Q

List 2 enzyme deficiencies which may cause haemolysis

A

G6PD deficiency

PK deficiency

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8
Q

What investigations should be performed where a haemoglobinopathy is suspected?

A

FBE and film
High performance liquid chromatography (HPLC)
Hb electrophoresis
Genetic testing

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9
Q

List 4 causes of haemolysis related to abnormalities of the RBC membrane

A

Hereditary spherocytosis
Hereditary eliptocytosis
Hereditary stomatocytosis
Paroxysmal noctural haemoglobinuria (PNH)

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10
Q

What tests should be performed where a RBC membrane abnormality is suspected?

A

Flow cytometry assessing eosin-5-maleimide and FLAER

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11
Q

List 3 AI causes of haemolysis

A

AIHA
Cold haemagglutinin disease (CHAD)
Paroxysmal cold haemaglobinuria (PCH)

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12
Q

What tests should be performed where an AI cause of haemolysis is suspected?

A

Direct antiglobulin test (DAT)
Cold agglutinin screen
Donath-Landsteiner

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13
Q

List 4 causes of fragmentation haemolysis

A

Thrombotic thrombocytopaenic purpura/HUS
Cancer
DIC
Valve haemolysis

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14
Q

What tests should be performed where fragmentation haemolysis is suspected?

A

ADAMTS13
Coagulation profile
Renal function

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15
Q

List some indications for BM biopsy

A

Investigation of unexplained anaemia, abnormal RBC indices, cytopaenias, cytoses
Investigation of abnormal blood smear suggestive of BM pathology
Diagnosis, staging, follow-up for cancers involving BM, or of suspected mets
Investigation of PUO
Investigation of lipid/glycogen storage disorders
Evaluation of potential transplant donors
Evaluation of iron stores

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16
Q

TFPI

A

TF pathway inhibitor

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17
Q

APTT

A

Activated partial thromboplastin time

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18
Q

What does the APTT measure?

A

Factors in the intrinsic pathway (VIII, IX, XI, XII)

Factors in the common pathway (X, V, II/thrombin, fibrinogen)

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19
Q

What does the PT/INR measure?

A

Factors in the extrinsic pathway (VII)

Factors in the common pathway (X, V, II/thrombin, fibrinogen)

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20
Q

What is not measured by either the APTT or PT?

A

Factor XIII

21
Q

What are the 3 major drawbacks of APTT and PT?

A

Don’t measure anticoagulant/haemolytic pathway
Amount required for normal test may not be sufficient for normal haemostasis
Results are very sensitive to sample variation (factors very labile)

22
Q

What are the 3 main tests used for investigation of bleeding disorders?

A

Routine coags (APTT, PT/INR, fibrinogen)
Platelet count and morphology
Specialised tests

23
Q

Give 4 examples of specialised tests used in the investigation of bleeding disorders

A

Factor assays
Inhibitor assays
Von Willebrand disease testing
Platelet aggregometry

24
Q

What 3 tests should be ordered to investigate thrombotic tendency?

A

Assess for antiphospholipid Abs
Antithrombin, protein C and protein S levels
Genetic tests

25
Q

What are the 2 ways to test for antiphospholipid Abs?

A

Directly (anticardiolipin and anti-B2GP1 Abs)

Indirectly via clotting assays (e.g. lupus anticoagulant)

26
Q

What abnormalities are looked for in a genetic test investigating thrombotic tendency?

A

Factor V Leiden

Prothrombin gene mutation

27
Q

What is the underlying disorder in Factor V Leiden?

A

Leiden variant of factor V cannot be inactivated by activated protein C

28
Q

How is heparin monitored?

A

APTT

29
Q

How is warfarin monitored?

A

INR

30
Q

When and how should clexane be monitored?

A

In bleeding pt, pre-operatively, and in pt with renal impairment
Measured using anti-Xa assay

31
Q

What are the 5 main anticoagulants used clinically?

A 
Heparin
Warfarin
Clexane
Dabigatran
Riveroxaban
32
Q

Dabigatran

A

Direct thrombin inhibitor

33
Q

Riveroxaban

A

Xa inhibitor

34
Q

If a prolonged APTT is corrected with a 1:1 mix with normal plasma, what does this indicate about the cause of the abnormality? What further tests should be done in this case?

A

Factor deficiency

Perform assay of intrinsic factors and von Willebrand tests

35
Q

If a prolonged APTT is not corrected with a 1:1 mix with normal plasma, what does this indicate about the cause of the abnormality? What further actions should be taken in this case?

A

Factor inhibitor

Correct heparin dose or perform lupus anticoagulant assay

36
Q

List 3 common causes of multiple factor deficiency

A

Reduced production due to vitamin K deficiency or liver disease
Increased consumption due to DIC

37
Q

What is the most common single factor deficiency?

A

VIII

38
Q

List 4 non-specific factor inhibitors

A

Heparin
Lupus anticoagulant
Paraprotein

39
Q

What is the major Hb in adults?

A

a2B2

40
Q

What is HbA2?

A

a2d2

41
Q

What is HbF?

A

a2y2

42
Q

What is the most common class of haemoglobinopathies?

A

Thalassaemias

43
Q

What are thalassaemias?

A

Reduced production of a or B chain resulting in imbalance

44
Q

What does HPLC do?

A

Measures proportions of different types of Hb

45
Q

What blood group testing should be done prior to a transfusion?

A

ABO and D testing

Red cell Ab testing

46
Q

How long does blood grouping take?

A

20-30 mins

47
Q

MTP

A

Massive transfusion protocols (team approach involving treating clinicians, blood bank staff and transfusion specialist)

48
Q

What 2 bodies should a transfusion-related adverse event be reported to?

A

Australian Red Cross Blood Service

Serious Transfusion Incident Reporting (STIR) scheme

MD2 Pathology (28 decks)

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