Session 12 - Lecture 1 - Review Flashcards
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1 - Year 2 Haematology Revision Lecture
3 - Physiological Life Cycle of a Red Blood Cell
BONE MARROW - Erythropoiesis - Haemoglobin Synthesis --> PERIPHERAL RED BLOOD CELLS - Function - Structure --> REMOVAL - Reticulo-endothelial System
{So if you are faced with somebody who’s anaemic – low Hb – then one of the ways to think about why they might be deficient (anaemic) is to think about the normal physiological life span of a RBC – being produced in BM, going out to periphery, ~120 days later taken up by RES – predominantly spleen and also liver most important areas.
Think mechanisticically allows you to work out potential causes.
-BM, how things can go wrong:
– erythropoiesis e.g. anaemic of chronic disease
– problem with Hb synthesis e.g. thalassemia or sickle cell disease.
- something wrong with structure of red cells - fantastically organised membrane has been damaged in some way – cells breaking down too quickly and not lasting 120 days.
- Something wrong with function, enzyme cells – not able to keep its proteins – keep proteins in reduced form – thinking that cell doesn’t look right.
– overactive RES – big spleen, overactive spleen – cells are sequestering, going there for a little rest. Or spleen’s taking them up – something wrong – taking them out of circulation too quickly.
So essentially, is it lack of production, or is it that the cels are being produced properly, getting out to the circulation and being taken out too quickly. So that’s a really simple way of trying to think about it.}
4 - Case 1
- A 60 year old presents with gradual onset lethargy. His GP arranges for some blood tests.
- Hb 83 (135-180g/L), WCC 3.5 (4-11 x 109/L), Plt 156 (140-450 x 109/L), MCV 112 (80-99 fL), retics 10 (80-120 x 109/L)
Describe his blood results.
- Low haemoglobin (Hb)
- Slightly low white cell count (WCC)
- Platelets normal (Plt)
- High MCV (mean corpuscular volume) (cells are larger than they should be)
- Retics (reticulocytes) v low at 10
5 - Case 1
- A 60 year old presents with gradual onset lethargy. His GP arranges for some blood tests.
- Hb 83 (135-180g/L), WCC 3.5 (4-11 x 109/L), Plt 156 (140-450 x 109/L), MCV 112 (80-99 fL), retics 10 (80-120 x 109/L)
What signs or symptoms might the patient have?
- Symptoms: shortness of breath, tiredness, palpitations, headache, cardiac failure
- Signs: pallor, tachycardia, tachypnoea, hypotension
- Other signs and symptoms specifically associated with the cause of anaemia
{Pts with anaemia will present classically with symptoms above, may describe palpitations, significantly anaemic may go into cardiac failure.
They’ll be pale although pallor is not a particularly good identifier of pts who are anaemic – tachycardia, tachypnoea – breathing quickly when their HR is fast, and significantly anaemic or anaemic v quickly may become hypotensive.}
6 - Name some signs specific to the cause of anaemia and explain what causes them.
- Iron deficiency- Koilonychia
- Iron deficiency- oesophageal webs (Plummer vinson syndrome)
- Iron deficiency- Angular stomatitis
- Vit B12 deficiency - Glossitis
- Thalassaemia- abnormal facial bone development
{Other signs and symptoms may specifically relate to the type of anaemia that they have, and we v rarely see these nowadays (but you need to be aware of them) bc the diet of pts that you will be treating is pretty good but
- sign iron def for a period of time - spoon nailed.
- soreness at edges of the mouth – sev students might have these if you’re not eating particularly well.
- or folate def – v swollen, sore, shiny tongue.
- v rarely see this due to ante-natal screening and good postnatal tests to identify pts with thalassaemia, but other parts of the world where pts have thalassaemia - where BM is over-producing cells but they’re all abnormal start to get haemopoiesis in some of the other bones of their body including facial bones to get abnormal faces – so would be terrible if we had a pt that presented like this bc it should’ve been picked up and dealt with a lot earlier prior to them getting like this.}
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