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Haematology > Other Topics > Flashcards

Other Topics Flashcards

1
Q

What is mean cell volume?

A

Average volume of each red cell

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2
Q

What is mean cell haemoglobin?

A

Average mass of Hb in each RBC

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3
Q

What is mean cell haemoglobin concentration?

A

Average concentration of Hb in each RBC

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4
Q

How is mean cell volume calculated?

A

Haematocrit/RBC in L

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5
Q

How is mean cell haemoglobin calculated?

A

Hb/RBC in g

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6
Q

How is mean cell haemoglobin concentration calculated?

A

Hb/Hct in g/L

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7
Q

What is haematoxylin used to visualise?

A

Purple-blue component that binds to acidic components of cells. In particular it binds DNA and shows up the nucleus. Leishman’s stain also does this.

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8
Q

What is eosin used to visualise?

A

pinkish stain that binds protein components, particularly in the cytoplasm.

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9
Q

What 5 factors affect perfomance of light microscope?

A
  1. Wavelength of light
  2. Optical quality of lenses
  3. Refractive index of medium that light passes through
  4. Physical properties of the objective lens
  5. Geometry of illuminating cone of light provided by condenser lens
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10
Q

What are the 4 main fluid compartments of body and percentages of these?

A

Intracellular fluid 55%. Interstitial fluid 36%. Blood plasma 7%. Transcellular fluid (CSF, synovial fluid) 2%.

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11
Q

What is apherisis?

A

Technique in which the blood of a donor is collected and passed through a centrifuge to separate a particular cellular component, with the remained returned to the donor.

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12
Q

What can therapeutic apherisis be used for?

A
  1. Plasma exchange - treatment if multiple sclerosis and myeloma.
  2. Low Density Lipid Removal - treatment of patients prone to atherosclerosis
  3. Red cell exchange - treatment of sickle cell disease
  4. Platelet depletion - treatment of disorders of homeostasis
  5. White blood cell depletion - treatment of leukaemia
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13
Q

What are 6 functions of plasma?

A
  1. Clotting
  2. Immune defence
  3. Osmotic pressure maintenance
  4. Metabolism
  5. Endocrine
  6. Excretion
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14
Q

How abundant is albumin and what are 2 main functions?

A

55% of total plasma protein is albumin and has several key functions including transport of lipids, hormones and ions + maintaining osmotic pressure of plasma.

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15
Q

What is the role of alpha-1 globulins?

A

Alpha-1 antitrypsin is an example. Produced by liver and inhibits proteases such as neutrophil elastase. Defective or deficient A1AT can compromise the lung where degradation of lung tissue leads to a loss of elasticity and respiratory problems.

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16
Q

What are the types of alpha-2 globulins and what do they do?

A

Haptoglobin and 𝛂2 -macroglobulin. Haptoglobulin binds to haemoglobin released from erythrocytes and the resulting haptoglobin-haemoglobin complex is removed by the spleen. Its levels help diagnose haemolytic anaemia. Alpha-2 macroglobulin is a protease inhibitor which stops fibrinolysis (clot breakdown).

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17
Q

What are beta globulins?

A

Complement C3 and 4. Transferrin also.

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18
Q

What are gamma globulins?

A

Immunoglobulins and C-reactive protein. Increase in these indicates increased immune activity.

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19
Q

Why is the ABO blood group system important?

A

People have naturally occurring antibodies against any antigen NOT present on own red cells, from birth. Antibodies are IgM class, reactive at 37ºC and capable of fully activating complement, so are able to cause potentially fatal haemolysis

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20
Q

Describe the blood types

A

A - anti-B antibodies in plasma and A antigens
B - anti-A antibodies in plasma and B antigens
O - anti-AB antibodies in plasma and no antigens
AB - no antibodies and A+B antigens

21
Q

How are the blood groups formed?

A

O only has the H-stem. A formed by the A gene which codes for an enzyme that adds N-acetyl galactosamine to the common H antigen. B formed by B gene which codes for enzyme which adds galactose. AB co-dominant, O is recessive.

22
Q

How is antigen D expression classified?

A

RhD indicates positive and Rhd is negative as d is recessive and D is dominant.

23
Q

What can Rhd negative people do?

A

Make anti-D antibodies AFTER they are exposed to the RhD antigen - either by transfusion of RhD positive blood, or in women if they are pregnant with an RhD positive foetus. Anti-D antibodies are IgG class antibodies.

24
Q

What are 2 complications of RhD mismatch?

A
  1. Delayed haemolytic transfusion reaction - if they receive RhD positive blood, antibodies will react (anaemia, high bilirubin, jaundice)
  2. Haemolytic disease of newborn - if RhD neg mother has anti-D, then in the next pregnancy, if fetus is RhD positive: mother’s IgG anti-D antibodies can cross the placenta, attach to red cells and cause haemolysis. If severe: hydrops fetalis. If less severe: high bilirubin after birth can cause brain damage
25
Q

What is an antibody screen?

A

Performed to exclude any clinically significant immune antibodies. Patient serum added to some screening red cells which have all clinically important antigens and if no reaction occurs, can go ahead. If screen is positive, antibody must be identified using large panel of red cells. Then donor blood lacking that antigen is selected for transfusion.

26
Q

What is compatibility testing?

A

First test patient serum for ABO group, RhD status and antibody screen. Then, cross-match to see if patient serum reacts with donor blood - if no agglutination, can transfuse.

27
Q

What is prion disease?

A

Prion proteins have been found in membranes of lymphocytes and platelets and the prions of variant Creutzfeldt-Jacob disease (CJD) are found in lymphoreticular tissues. No blood test available yet.

28
Q

What are the fractions of blood?

A

Red cells, Platelets and Plasma. Plasma can be FFP (Fresh, frozen plasma), Cryoprecipitate, Albumin.

29
Q

What are symptoms/signs of leukaemia?

A
  1. fatigue, lethargy, pallor (anaemia)
  2. fever and infections (neutropenia)
  3. bruising and petechiae (thrombocytopenia)
  4. bone pain (bone marrow expansion)
  5. abdominal enlargement (hepatomegaly, splenomegaly)
  6. lumps and swellings (lymphadenopathy)
30
Q

What do symptoms/signs results from?

A

Direct effects of proliferation like bone pain, enlarged spleen etc. Indirect effects are replacement of other normal bone marrow cells by leukaemic clone.

31
Q

What is flow cytometry?

A

Cytogenetic/molecular analysis of blood and bone marrow. FBC and blood film taken + cell surface markers found to determine whether its a T or B lymphocyte.

32
Q

What are 4 mechanisms of anaemia?

A
  1. Reduced production
  2. Loss of blood
  3. Reduced survival time (haemolysis)
  4. Pooling in the spleen
33
Q

What are 3 common causes of microcytosis?

A

Usually accompanied by hypochromia.

  1. Iron deficiency
  2. Anaemia of chronic disease
  3. Thalassemia (reduced globin synthesis)
34
Q

What are 3 causes of iron deficiency?

A
  1. Increased loss (hookworm, menstruation menorrhagia) - GI bleeds also possible
  2. Increased requirement (myeloproliferative disorder, polycythaemia, pregnancy)
  3. Insufficient intake (diet, malabsorption Coeliac disease)
35
Q

What are 3 stages of iron depletion?

A

Depletion: Storage iron absent/reduced
Deficiency: low serum iron and transferrin saturation
Anaemia: low haemoglobin and haematocrit

36
Q

What are 5 causes of anaemia of chronic disease?

A 
Rheumatoid arthritis
Autoimmune disease
Malignancy
Kidney  disease
Infections such as TB or HIV
37
Q

What are 5 diagnostic clues of anaemia of chronic disease?

A

C-reactive protein is high (unlike iron deficiency)
Erythrocyte sedimentation rate (ESR) is high (unlike iron deficiency)
Ferritin is high
Transferrin is low
Acute phase proteins increase

38
Q

What is normal number of red cells?

A

3.5 - 5 x 10^12 cells

39
Q

Where is haemoglobin synthesised?

A

Haem synthesised in mitochondria. Globin synthesised in ER.

40
Q

What are normal haemoglobin levels?

A

120-165g/L is normal concentration in adults. Each gram of Hb contains 3.4mg Fe.

41
Q

What are the diff haemoglobins separated based on during electrophoresis?

A

Based on charge.

42
Q

What conditions is electrophoresis carried out under?

A

Electrophoresis will be carried out on cellulose acetate gel strips, in a Tris-glycine buffer at pH 9.5. Under these conditions, the haemoglobin has an overall negative charge and will migrate towards the anode (positive electrode).

43
Q

How is oxygen removed from haemoglobin?

A

Sodium dithionite added

44
Q

What is Beer Lambert law?

A

The absorbance of a solution is proportional to the concentration of the absorbing material within it and to the distance (or path length) travelled by the light through the sample.

45
Q

What are spectrophotometry results for oxygenated and deoxygenated haemoglobin?

A

Oxygenated blood has 2 peaks at 540nm and 580nm. Deoxygenated blood has one at 560nm.

46
Q

What is carboxyhaemoglobin?

A

Carbon dioxide binding haemoglobin which has a greater affinity for CO compared to O2. CO outcompetes O2 so dangerous.

47
Q

What is methaemoglobin?

A

Generated when the Fe2+ ion is oxidised to the Fe3+ (ferric) state which results in greatly impaired oxygen binding. This gives the blood a bluish/chocolate colour. Causes left shift and anoxia as oxygen not released.

48
Q

Why is methaemoglobin not normally present?

A

The enzyme methemoglobin reductase reduces​ methaemoglobin back to ​haemoglobin. The disorder methaemaglobinaemia can be hereditary, for example as a deficiency in methemoglobin reductase or production of a mutant form of haemoglobin known as haemoglobin M, which is resistant to reduction.

49
Q

What causes methaemoglobin?

A

Acquired following exposure to chemicals including aniline dues such as p-chloroaniline, nitrates, and local anaesthetics such as benzocaine.

Haematology (6 decks)

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