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MEH > Lecture 11 > Flashcards

Lecture 11 Flashcards

1
Q

What is the lifecycle of a RBC?

A

Bone marrow (haemopoiesis)
Peripheral blood cells
Removal (RES)

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2
Q

What is methotrexate used to treat?

A

Rheumatoid arthritis (folate antagonist)

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3
Q

Why does anaemia develop in anaemia of chronic disease due to inflammatory cytokines?

A
  • iron dysregulation (available iron not released for use in bone marrow)
  • marrow shows lack of response to EPO
  • reduced lifespan of RBC’s
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4
Q

Is iron recycled?

A

Yes, by macrophages phagocytosing the old RBC’s (recycling is main source of iron)

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5
Q

What happens in anaemia of chronic disease?

A

Hepcidin is regulated by inflammatory cytokines (IL-6)
-this increases production of hepcidin from liver
-increased inhibition of ferroportin
-decreased iron release from RES/decreased iron absorption in gut
= plasma iron reduced (inhibition of erythropoiesis in bone marrow leading to anaemia)

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6
Q

What are some chronic diseases causing anaemia of chronic disease?

A
  • Rheumatoid arthritis
  • inflammatory bowel disease (Crohns disease/ulcerative colitis)
  • chronic infections (TB)
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7
Q

What is anaemia of chronic kidney disease?

A
  • reduced EPO production due to damage to kidneys
  • reduced clearance of hepcidin + increased hepcidin due to imfammtory cytokines
  • dialysis induced damage to RBC’s
  • high levels of urea= uraemia (which reduces lifespan of RBC)
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8
Q

What is an underlying cause of chronic kidney disease?

A

Raised cytokines

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9
Q

What does uraemia cause?

A

Inhibits megakaryocytes leading to low platelet count

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10
Q

How do you treat anaemia of chronic disease? (CKD)

A

Treat underlying cause
(Renal failure- recombinant EPO injected + vit B12/folate/iron levels are adequate asall of these are required for EPO therapy to work)
-transfuse red cells if all else fails

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11
Q

What is reticulocyte Hb content used to assess?

A

CHr: Assess for functional iron deficiency

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12
Q

Give some haematological abnormalities in kidney disease:

A

Red cells

  • anaemia (CKD, blood loss,dietary causes)
  • secondary polycythemia (renal transplant/tumour)

Neutrophils

  • neutropenia (autoimmune kidney disease, immunosupression)
  • neutrophilia (inflammation, infection, drugs-steroids)

Platelets
-thrombocytopenia (uraemia, drugs, haemolytic uraemic syndrome-Ecoli)
-High (inflammation, bleeding, iron deficiency)
-

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13
Q

What is rheumatoid arthritis + what is it treated by?

A

Chronic immune mediated inflammatory condition
(see high neutrophils/platelets)
Treated by:
-pain relief (NSAIDS)
-disease modifying agents (DMARDS): drug to slow down process e.g. corticosteroids, chemotherapy, biological agents- monoclonal antibodies against cytokines that mediate inflammation (block cytokines)

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14
Q

Give examples of disease modifying agents:

A
  • steroids
  • methotrexate
  • monoclonal antibodies against cytokines (block cytokines and stop damage being done)
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15
Q

Is anaemia in RA mutlifactorial?

A

Yes

  • anaemia of chronic disease
  • GI loss of blood due to chronic NSAID use
  • increased risk of autoimmune haemolytic anaemia as RA is an autoimmune disease
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16
Q

What is Felty’s syndrome?

A

Combination of RA, splenomegaly, neutropenia
Neutropenia due to:
-spleen is large so destruction takes away neutrophils
-failure of bone marrow to produce neutrophils (myeloid cells in marrow become insensitive to stimulator GCSF)

17
Q

What is liver disease?

A

Nodules and reduced function of liver (cirrhosis)

18
Q

What does chronic liver disease cause?

A
  • Portal hypertension (includes oesophagus) (back pressure leading to splenomegaly-leading to low blood count)
  • leads to oesophagus/gastric varices (dilated veins which can burst causing massive acute blood loss)
  • clotting factors are made in liver and some are dependent on vit K (in liver disease= low level of clotting factors)
  • endothelial dysfunction
  • low platelet count (platelets around don’t work well)
19
Q

What are some haematological features of liver disease?

A
  • target cells (due to increased cholesterol to phospholipid ratio so membrane is ‘baggy’)
  • low platelet count (thrombocytopenia, as hormone thrombopoietin is mainly made in liver)
  • splenic pooling
20
Q

How does liver disease caused by alcohol excess cause haematological features?

A

Alcohol excess

  • toxic to bone marrow cells (causing low platelet/pancytopenia)
  • secondary malnutrition common (less money spent on food-especially folic acid deficiency-megaloblastic anaemia)
21
Q

What does viral hepatitis cause?

A

Bone marrow failure

22
Q

What are some post operative/ major trauma changes to blood?

A

RBC’s
-anaemia (blood loss pre/post op)
-temporary polycythaemia (anaesthetist not keeping patient hydrated)
White cells
-severe sepsis (neutropenia)
-post op to help with healing/post op infection/severe bleeding (neutrophilia)

Platelets

  • drugs/sepsis (thrombocytopenia)
  • thrombocytosis- common after operation (post-op, infection, bleeding): if doesn’t settle later look for blood loss
23
Q

What are some haematological changes with infection?

A
  • infection with malaria causes haemolytic anaemia
  • bacterial infection (neutrohphilia), sepsis/severe bacterial infection (all neutrophils used up- neutropenia)
  • parasitic infections (eosinophilia)
  • viral infection (lymphocytosis/neutropenia)
  • infection can cause a reactive thrombocytosis
24
Q

What is DIC?

A

Disseminated intravascular coagulation
(Lots of fragmented blood cells, immature RBC’s with nuclei, low platelets)
-pathological activation of coagulation
-clots in vascular system
-many small clots in circulation (using platelets/fibrinogen), RBC’s get stuck getting through clots causing microangiopathic haemolytic anaemia

=long clotting times
=low fibrinogen
=risk of bleeding/thrombosis

25
Q

What are some haematological changes in cancer?

A

Cancers not affecting bone marrow
INCREASED RISK OF VENOUS THROMBOSIS IN PEOPLE WITH CANCER - can break off and form clots in lungs (pulmonary emboli)

Anaemia

  • ACD
  • chronic bleeding causing iron deficiency
  • chemotherapy (causing temporary stop in blood cell production)
  • some EPO producing tumours = polycythaemia

Neutropenia (chemotherapy- neutropenic sepsis, marrow infiltrated bone marrow)
Neutrophilia- inflammation/infection

Thrombocytopenia (chemo, sepsis, DIC, marrow infiltrated)
Thrombocytosis (inflammation, infection, bleeding, iron deficiency)

26
Q

What is a leucoerythroblastic film & what causes it?

A

Blood film showing immature white and red cells circulating in peripheral blood (spill out of bone marrow when it is under stress)
(Granulocyte precursors/ nucleated RBC’s seen)

  • sepsis
  • shock
  • bone marrow infiltrated by carcinoma causing marrow to push out anything it has in it
  • primary myelofibrosis (if has tear drop RBC’s)
  • leukaemia
  • severe megaloblastic anaemia (folate/B12 deficiency-often has oval RBC’s)
27
Q

What is anaemia of chronic disease caused by?

A

Chronic inflammation

28
Q

What is ‘functional’ iron deficiency?

A

There is sufficient iron in the body, but not available to developing erythroid cells

29
Q

What is needed to recycle iron from macrophages?

A

Ferroportin is main exporter of iron out of the macrophage & gut cell

30
Q

What is an important inflammatory cytokine released involved in iron regulation?

A

Interleukin 6 which are cytokines released from immune cells

31
Q

When do you give your patient iron in anaemia of chronic renal failure?

A

If ferritin/CHr is low.

Iron given as IV form as absorption is imparied due to high levels of hepcidin.

32
Q

What changes do you see to a patients hand with RA?

A

Swan neck deformity of fingers
Ulnar deviation
Boutonnière deformity of thumb

33
Q

What do you see when RA is active?

A

High platelets and neutrophils
CRP (acute phase protein) will also be high

(Low platelets/neutrophils can occur due to treatment of disease/autoimmune reactions/hypersplenism)

34
Q

How do viruses cause haematological features of liver disease?

A

Viral hepatitis

-bone marrow failure

35
Q

How are clotting tests affected in DIC?

A

Clotting times are long as all the clotting factors have been used up
(Low fibrinogen/fibrin degredation products)

Therefore risk of bleeding AND thrombosis

MEH (22 decks)

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