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Haematology > Scope of Haematology > Flashcards

Scope of Haematology Flashcards

1
Q

What does Haematology pertain to?

A
  • Investigation of blood and bone marrow, and the management of disease of the blood and bone marrow too.
    • It is imoportant to remember that these both also link in with other organ systems.
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2
Q

Generally outline the different components of blood.

A
  • RBC – 50% of blood volume
  • Plasma
    • clotting and coagulation factors, antibodies and albumin
  • Buffy coat
    • platelets, WBC (Leucocytes)
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3
Q

Outline the transport function of blood.

A

Blood is responsible for the transport of:

  • Gases (Oxygen and Carbon Dioxide) – in the RBC
  • Whereas in the plasma there is transport of:
    • Nutrients
    • Waste
    • Messages (hormones)
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4
Q

Outline how the blood helps maintain vascular integrity.

A
  • Prevention of leaks in the BV – through platelets and clotting factors.
  • Prevention of blockages in the BV – via anticoagulants and fibrinolytics.
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5
Q

Outline how the blood helps protect against pathogens?

A
  • Phagocytosis and killing by granulocytes and monocytes.
  • Antigen recognition and antibody formation - by Lymphocytes.
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6
Q

What is the basic pathogenesis of haematological abnormalities?

A

Basically the diseases can be characterised by:

  • high levels of a consitiuent (where there is increased rate of production or decreased rate of loss)
  • low levels of a consitiuent (decreased rate of production or increased rate of loss.

Or more basically where there is altered function.

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7
Q

From what cells do all blood cells originate from?

A
  • All blood cells originate from hematopoietic stem cells. ​
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8
Q

What are the WBC in the blood?

A
  • Neutrophils
  • Monocytes
  • Basophils
  • Eosinophils
  • Lymphocytes
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9
Q

Generally outline stem cells.

A
  • Totipotent – meaning there can differentiate into other cells.
  • They are capable of self renewal.
  • The can flux through different cell pathways, and this flux itself is regulated by hormones and growth factors (such as erythropoietin, thrombopoeitin agonists)
  • Stem cell properties can now be induced – meaning that they can be used in therapeutics.
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10
Q

Where is bone marrow found?

A
  • Bone marrow is obviously found in the bones.
  • We have most of our both marrow at children, and as we age it decreases, with the majority of bone marrow in the elderly found in the axial skeleton.
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11
Q

What does bone marrow look like?

A

Consisting of stroma and sinusoids. ​

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12
Q

What is the shape of RBC? Why?

A

Biconcave discs, this shape is better suited to optimising surface area for gas exchange. ​

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13
Q

What is anaemia?

A

-Condition where there is a deficiency of red cells or haemoglobin. ​

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14
Q

What are the consequences of anaemia?

A
  • -Poor gas transfer
  • -Dysponea (SOB)
  • Fatigue
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15
Q

What are the causes of anaemia?

A

Decreased production

  • Deficiency in “haematinics”– iron, folate or B12 deficiency.
  • Congenital: thalassaemias

Increased loss

  • Bleeding
  • Haemolysis
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16
Q

What are some of the red cell disorders you can get?

A
  • Microcytes – unusually small RBC
  • Macrocytes – unusually large RBC
  • Polychromasia – abnormally high number of immature RBCs
  • Also Burr cells? in renal failure
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17
Q

What are platelets function?

A
  • Involved in blood clotting.
  • Immune function
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18
Q

-What is platelet production regulated by?

A
  • Thrombopoeitin
  • Produced in the liver
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19
Q

Platelets:

-Produced where? Regulated by?

A

Bone marrow

Regulated by platelet mass feedback.

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20
Q

Platelet agonists?

A
  • Romiplostim
  • Eltrombopag
    • These can be used therapeutically
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21
Q

Platelets lifespan?

A

7 days

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22
Q

What is thrombocytosis?

A
  • High platelets in the blood​
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23
Q

What is Thrombocytopenia?

A
  • Low blood platelet count, due to bone marrow failure.
24
Q

What drugs alter platelet function?

A
  • Aspirin
  • Clopidogrel
  • Abciximab
25
Q

What is the function of neutrophils?

A
  • -Ingestion and destruction of pathogens, especially bacteria and fungi.
  • -Interleukins and CFSs (colony stimulating factors)
26
Q

What regulates neutrophils?

A
  • -Regulation is by immune responses.
  • -Macrophages, IL-17
27
Q

Neutrophils

What is the lifespan? And speed of response?

A
  • -Lifespan is 1-2 days
  • -Speed of response is a few hours.
28
Q

What is neutrophilia?

A

-a high number of neutrophils in the blood.

29
Q

What regulates the production of neutrophils?

A

Production is regulated by granulocyte-colony stimulating factor (G-CSF)

But also produced in

  • -Infection
    • -Left shift, toxic granulation
  • -Inflammation
    • -MI, post op, RA
  • G-CSF can be used therapeutically
    • -Neutropenia
    • -Mobilisation of stem cells
30
Q

What is neutropenia?

A
  • a low level of neutrophils
31
Q

What causes decreased production of neutrophils?

A
  • -Drugs
  • -Marrow failure
32
Q

What causes increased consumption of neutrophils?

A
  • -Sepsis – neutrophils in tissue rather than blood.
  • -Autoimmune issues??
33
Q

When is there potentially “altered function” of neutrophils?

A
  • Chronic Granulomatous disease​
34
Q

What are monocytes? What system do they make up?

A
  • -They are the largest type of leukocyte and can differentiate into macrophages and myeloid lineage dendritic cells.
  • -They make up the reticuloendothelial system.
35
Q

What is the function of monocytes?

A
  • -Ingestion and destruction of pathogens, especially bacteria and fungi.
  • -A subset of monocytes migrate into tissues and become macrophages.
  • -Lifespan of many months.
  • -Some populations of macrophages are self-maintaining.
36
Q

What are macrophages?

A
  • -a large phagocytic cell found in stationary form in the tissues or as a mobile white blood cell, especially at sites of infection.
  • -Macrophages names are different depending on the tissues they are in, such as Kuppfer cells – Liver and Langerhans cells in the skin.
37
Q

What are eosinophils?

A
  • -White blood cells that fight against parasites.
  • -They also cause disease in allergies. – linked to the lack of parasites as to why allergies are so prevalent.
38
Q

What is a lymphocyte?

A
  • White cells that are crucial to our immune systems.
  • There are three main types known as T cells, B cells, and natural killer cells.
  • Lymphocytes are part of our immune defence and act to recognize antigens, produce antibodies, and destroy cells that could cause damage.

SURFACE ANTIGENS ARE USED TO DIFFERENTIATE

39
Q

What is lymphocytosis? Causes?

A
  • -Increased number of lymphocytes in the blood.
  • -Causes include:
    • -Infectious mononucleosis
    • -Pertussis
40
Q

What is Lymphopenia? Causes?

A
    • Abnormally low numbers of lymphocytes in the blood.
  • -Causes include
    • -Post-viral
    • -Lymphoma
41
Q

What are the main subtypes of lymphocytes? And their functions?

A
  • -B cells – make antibodies
  • -T cells – Helper, cytotoxic, regulatory
    • -NK cells (natural killer)
42
Q

Where are lymphocytes produced? Where do they mature?

A
  • -In bone marrow
  • -B cells mature in the Bone.
  • -T cells mature in the Thymus.
43
Q

Where do lymphocytes circulate?

A
  • -Blood
  • -Lymph
  • -Lymph nodes – here they differentiate into secondary lymphoid organs
44
Q

What are antibodies?

A

-proteins produced mainly by plasma cells that is used by the immune system to neutralize pathogens such as pathogenic bacteria and viruses.

45
Q

What is opsonisation?

A
  • Process by which pathogens are marked by antibodies to be eliminated by phagocytes.
46
Q

What is complement?

A
  • part of the immune system that enhances (complements) the ability of antibodies and phagocytic cells to clear microbes and damaged cells from an organism, promotes inflammation, and attacks the pathogen’s plasma membrane.
47
Q

What is positive and negative selection of B cells?

A
  • In the bone marrow
    • if gene rearrangement results in a functional receptor the cell is selected to survive – positive selection
  • If the receptor recognises ‘self’ antigens - the cell is triggered to die – negative selection: tolerance
  • B cells that survive this selection are exported to the periphery
48
Q

What is the HLA moleclue?

A

Human leukocyte antigen

Class 1:

  • displays internal antigens on all nucleated cells.

Class 2:

  • displays antigens eaten by professional antigen presenting cells.

Adaptive immune system function depends on this.

49
Q

What is HLA?

A

HLA is the antigen looked for in cells, if recognised as foreign will get attacked.

50
Q

How do cells of the body react to HLA?

A

immune cells read the HLA barcode on cells to help identify if the cell is self or non self/ infected or uninfected.​

51
Q

What is haemophillia?

A

-Too little clotting factors

or the clotting factors have abnormal function.

52
Q

In a Full Blood Count:

-What are the usual blood counts for

  • -Haemoglobin
  • -Platlets
  • -WBC
A
  • Male haemoglobin – 135-170 g/L
  • Female haemoglobin – 120-160 g/L
  • Platelets – 150-400 109/L
  • WBC – 4-10 109/L
53
Q

Outside of FBC what other diagnostic tools can be used in regards to the blood?

A
  • Clotting times – Clotting Factors
  • Bleeding time for platelets
  • Chemical assays
    • Iron (anaemia)
    • B12
    • Folate
  • Marrow aspirate and trephine biopsy
  • Lymph node biopsy
  • Imaging
54
Q

What are the mainstays of treatment in haematology?

A

Replacement

  • Blood
  • Haematinics
  • Coagulation factors
  • Plasma exchange

Transplantation

Drugs

  • Cytotoxics
  • Monoclonal antibodies
  • Inhibitors or cellular proliferation
  • Immunosuppressants
  • Inhibitions of coagulation
  • Inhibitors of fibrinolytics
55
Q

Function of the red and white pulp in the spleen?

A
  • Red pulp - RBC maturation
  • White pulp – important in immune function.
56
Q

If your spleen in removed what vacciantions should you receive?

A

If spleen removed – vaccinations against the relevant (encapsulated) bacteria.

57
Q

What are the causes of splenomegaly?

A

Infectious

  • -Acute and Chronic

Malignancy

  • Leukaemias & Lymphomas

Portal Hypertension

Haemolytic Disorders

  • Autoimmune, megaloblastic anaemia.

Connective Tissue Disorders

  • SLE
  • Felty

Miscellaneous

  • Sarcoid
  • Malignant
  • Amyloid

Stoage pool disorders

-

Haematology (16 decks)

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