Random facts - haem Flashcards
What diseases are Schistocytes found in?
Microangiopathic haemolytic anaemias (MAHA)
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP)
Haemolytic uraemic syndrome (HUS)
What diseases are Heinz bodies found in?
G6PD deficiency and alpha thalassaemia
What diseases are Howell-Jolly bodies found in?
Hyposplenism or following splenectomy
What diseases are Spherocytes found in?
hereditary spherocytosis and autoimmune haemolytic anaemia
What diseases are the Target cells found in?
iron deficiency anaemia, sickle cell disease, thalassaemia, and hyposplenism
What should be done in the case of major bleeding in a patient on anticoagulants with a high INR?
(1) Stop anticoagulants
(2) Administer IV vitamin K
(3) Give prothrombin complex (preferred over FFP)
What is the management for minor bleeding in a patient with a high INR?
(1) Stop anticoagulants
(2) Administer IV vitamin K
(3) Repeat INR after 24 hours
(4) Further vitamin K may be needed
What should be done for a patient with an INR > 8 but no bleeding?
(1) Stop anticoagulants
(2) Administer IV or oral vitamin K
(3) Repeat INR after 24 hours
How should a patient with an INR > 5 but no bleeding be managed?
(1) Withhold 1-2 doses of anticoagulant (2) Review the maintenance dose of the anticoagulant
What would Initiation of ciprofloxacin do?
It would lead to increased levels of warfarin, thus increasing its effect. This would increase the INR and increase the risk of bleeding
A 69-year-old man is seen in the anticoagulation clinic for a routine INR check. He takes warfarin 8mg daily for AF but he recently forgot to collect his repeat prescription and so missed 2 days. In an attempt to correct this, he took 3 tablets of warfarin in one morning.
His INR comes back as 5.4 but he is haemodynamically stable and reports no episodes of bleeding. What would be the best step next in management?
Hold warfarin for 1-2 days until INR <5 and decrease the dose
An 81-year-old man is brought in by ambulance to A&E with a head injury. He informs you that he takes warfarin for atrial fibrillation. He also reports feeling nauseous.
CT head demonstrates a subdural haemorrhage.
His INR is found to be 4.5.
What is the most appropriate pharmacotherapy to reverse the effects of warfarin in this patient?
IV vitamin K and prothrombin complex concentrate
A 45-year-old man presents with fatigue, pallor, and dizziness. He describes occasional tingling and numbness in his lower limbs. A blood film is ordered to assess his condition further.
What is this describing and what blood film findings are most associated with the likely underlying cause?
vitamin B12 deficiency anaemia
= Hypersegmented neutrophils and macrocytic red blood cells
Cabot rings suggests what. What investigations do you do for this disease?
Pernicious anaemia
= Methylmalonic acid and anti-intrinsic factor antibody
A 42-year-old man with G6PD deficiency presents to the emergency department with acute onset shortness of breath shortly after taking ciprofloxacin, prescribed by his GP for a lower urinary tract infection. A blood count and film are reviewed.
The blood film shows a population of red blood cells of normal size and morphology (with scattered cytoplasmic Heinz bodies); and a population of larger, immature red cells.
The blood film has a blue tinge to it. What is the single best description of the presence of these immature red cells?
Reticulocytosis
A 65-year-old alcoholic is brought to A&E following a collapse in the street. He is resuscitated successfully and started on the trust’s detoxification protocol. His observations are now stable. He is examined by the A&E registrar who notes clubbing, scattered spider angiomas on the patient’s precordium, and a distended abdomen with shifting dullness but no palpable liver edge. Routine blood tests are sent.
The blood count shows a macrocytic anaemia. Examination of the film reveals evidence of non-megaloblastic macrocytosis (no reticulocytes) and acanthocytes.
What is the single most likely cause of this patient’s blood results? And why?
Chronic liver disease
= This patient has strong clinical evidence of chronic liver disease secondary to alcoholism
A 72-year-old man presenting to his GP with fatigue and recurrent respiratory tract infections (including a recent course of antibiotics for suspected bacterial pneumonia) is found to have nucleated red blood cells, immature neutrophils and tear drop poikilocytes on blood film.
On examination he is well, but an enlarged spleen is noted extending from the left hypochondrium as far as the right iliac fossa.
What is the single most likely underlying diagnosis?
Primary myelofibrosis
What is a non-specific abnormality which may be seen in patients post-splenectomy?
Target cells
A 28-year-old female attends the cardiology clinic for a routine follow-up. She suffered from severe infective endocarditis aged 24, requiring mitral valve replacement with a mechanical valve. Routine bloods, including a peripheral blood film, are taken.
Which finding would be expected based on her history?
Schistocytes
A 26-year-old man involved in a road traffic accident undergoes a successful emergency splenectomy for a traumatic splenic rupture. During his post-op recovery on the surgical ward, he has daily blood tests
What finding would you expect to see on his blood film? and why?
Howell-Jolly bodies
= are seen when the spleen is absent or not functioning properly
Blasts with high nucleus-to-cytoplasm ratio
ALL
Auer rods in cytoplasm
AML
Smudge cells
CLL
Basophilia + Philadelphia chromosome (t9;22)
CML
Deletion of 13q
CML
Reed-Sternberg cells (“owl eyes”)
Hodgkin’s lymphoma
Rouleaux formation + Bence Jones proteins
Multiple Myeloma
Increased platelets + JAK2 mutation
Essential Thrombocythemia
JAK2 mutation, high hematocrit
Polycythemia Vera
Teardrop RBCs + massive splenomegaly
Myelofibrosis
Hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia
Tumor Lysis Syndrome
Apple-green birefringence under polarized light with Congo red staining
amyloidosis
What is the difference between monoclonal and polyclonal hematopoiesis?
Monoclonal
= Cells originate from a single parent cell, seen in malignancy
Polyclonal
= Cells arise from multiple parent cells, normal hematopoiesis
What activates the intrinsic pathway of the coagulation cascade?
Contact with a damaged surface
What is the Embden-Meyerhof pathway?
It is the glycolysis pathway, where glucose is broken down into pyruvate to produce ATP
What is the sequence of factors in the intrinsic pathway?
(1) Factor XII
(2) Factor XI
(3) Factor IX (+ Factor VIII + vWF)
(4) Common pathway
= 12 → 11 → 9 + (7 + vWF)
What activates the extrinsic pathway?
The release of tissue factors (TF)
What is the sequence of factors in the extrinsic pathway?
Tissue factor (TF) + Factor VII → Common pathway
=
TF + 7
What is the final common pathway of coagulation?
(1) Factor X (+ Factor V)
(2) Factor II (prothrombin)
(3) Factor I (fibrinogen) + Factor XIII
(4) fibrin mesh
= 10 (+5) → 2 → 1 (+ 13 → fibrin mesh)
A 28-year-old man with a known diagnosis of sickle cell anaemia presents to his GP for review. He complains that, over the past 12 months, he has had an increased burden of minor infections, particularly upper respiratory tract infections (URTI). He is currently well, his examination is normal and he is taking only hydroxyurea prophylaxis. The GP orders blood tests for routine monitoring.
A blood film is performed, which shows a small, single, peripherally located, rounded inclusion in 50-60% of the erythrocytes.
What is the single most likely underlying diagnosis, and what is the above description?
Howell Jolly bodies
= Functional hyposplenism
ADAMTS13 is associated with what disease?
TTP
A 45-year-old man presents with fatigue, pallor, and dizziness. He describes occasional tingling and numbness in his lower limbs. What Is this describing?
Vitamin B12 deficiency
A 25-year-old woman presents to the GP complaining of fatigue. On examination, the GP notes conjunctival and mucosal pallor. Anaemia is suspected. A full blood count is requested which reveals: a low haemoglobin at 95 g/L, a low mean corpuscular volume (MCV) at 77 fL, a low mean cell haemoglobin concentration (MCHC) and an elevated red cell distribution width (RDW)
What is the single most likely cause of her anaemia?
Iron deficiency anaemia
What blood finding would you most expect to see on a blood film post-splenectomy
Target cells
Pencil cells are found where?
Iron deficiency anaemia
A 65-year-old woman presents to her GP with new onset back pain, polyuria and gastrointestinal upset.
On examination the GP finds tenderness along the lumbar spine, but nothing else of note. A urine dip performed in the surgery reveals glycosuria, but a capillary blood glucose is normal.
What would you expect to find on the blood film?
Rouleaux
A 28-year-old female attends the cardiology clinic for a routine follow-up. She suffered from severe infective endocarditis aged 24, requiring mitral valve replacement with a mechanical valve. Routine bloods, including a peripheral blood film, is taken.
Which finding would be expected based on her history?
Schistocytes
= mechanical heart valve
A 50-year-old man is admitted to hospital with community-acquired pneumonia. He has a CURB-65 score of 3 and is requiring 1L of oxygen to maintain target oxygen saturations.
His regular medications have been added to his drug chart and include warfarin 5 mg daily with a target INR of 3.5. The patient’s nurse is concerned that this is an error and says most patients have a target INR of 2.5.
What is an indication for a target INR of 3.5?
Mechanical mitral valve
A 6-month-old infant is brought to the emergency department by his parents due to cyanosis and difficulty breathing. Upon examination, the infant appears lethargic and has bluish discolouration of the skin and mucous membranes. The medical team suspects methaemoglobinaemia and begins immediate treatment.
What physiological process is primarily involved in this condition?
oxidation of Fe2+ in haemoglobin to Fe3+
A 26-year-old man with schizophrenia who started clozapine 3 weeks ago comes in for his weekly blood test. What is an established life-threatening side effect of clozapine?
Agranulocytosis/neutropenia
Neutropenia sepsis FIRST THING TO DO
refer to hospital
What gives a falsely high HbA1c level due to the increased lifespan of RBCs
Splenectomy
14-year-old boy is seen in clinic for his homozygous sickle cell disease status. He has managed with his condition well, and has not had any acute crises for the last three years. However, he has been feeling more tired than usual over the last 6 months, and the doctor decides to organise some routine blood tests.
What combination of blood results are most likely to be seen in sickle cell patients?
Low haemoglobin, normal MCV, raised reticulocytes
A 24-year-old woman presents to her general practitioner with a 7-month history of fatigue, abdominal cramping, and abdominal bloating. It is suspected that she may have coeliac disease and the following blood test result is obtained:
Tissue transglutaminase IgA +ve
What immune cell would be responsible for the production of this result?
plasma cells
A 45-year-old man presents to the emergency department with a persistent cough, low-grade fever, and fatigue. He reports a history of travel to Pakistan. Chest X-ray reveals bilateral infiltrates in the upper lobes of the lungs. Further diagnostic tests confirm the diagnosis of pulmonary tuberculosis.
What subset of T cells is responsible for the chest X-ray findings?
Th1 cells
= involved in the cell-mediated response
A 42-year-old woman with known Sjogren’s syndrome presents to her general practitioner with recurrent oral and vaginal candidiasis. In the past, these episodes have been managed with nystatin and clotrimazole pessaries, though the patient requests further investigations to understand the cause of these recurrent infections.
A full blood count subsequently shows lymphopenia and flow cytometry demonstrates a particular deficiency of CD8+ cells.
What type of lymphocyte is this patient most deficient in?
Cytotoxic T cells
A 34-year-old woman presents to her primary care physician with complaints of seasonal allergies, including sneezing, nasal congestion, and itchy eyes. She reports a history of similar symptoms during the spring and fall seasons. On further questioning, the patient mentions that she also experiences asthma exacerbations triggered by environmental allergens.
What subset of T cells are primarily involved in this process?
Th2 cells
What is the reversal agent for dabigatran - Direct thrombin inhibitor?
Idarucizumab
What is the mechanism of action of Rivaroxaban?
Direct factor Xa inhibitor
You are working on a surgical team. One of your patients is a 34-year-old male found to have pigmented gallstones. What condition is this most commonly seen in?
Sickle cell anaemia
