Week 4: Haematology Flashcards
1
Q
What is a full blood count?
A
A set of data that tells you information about the RBC, WBC, platelets and other blood components?
2
Q
What are some important pieces of information to do with RBC?
A
Haemoglobin levels
Cell size (MCV: Mean Corpuscular Volume)
Number of cells
Haematocrit (% of blood that is cellular)
3
Q
Why are bone marrow examinations performed?
A
To investigate blood count
4
Q
What is Haematopoeisis?
A
The process of blood cell formation
5
Q
__________ stem cells are the primitive precursor cells that differentiate under control of ___________ and ___________ to form blood cells
A
Pluripotent Stem cells
Growth Factors and Cytokines
6
Q
What are the 3 components of coagulation (aka Virchow’s Triad)?
A
Clotting factors - circulating proteins
Platelets - derived from megakaryocytes
Endothelium - blood vessel lining
7
Q
What is Haemostasis?
A
The process of stopping bleeding
8
Q
Primary Haemostasis disorders are associated with _______________________.
A
Platelet malfunction
9
Q
Secondary Haemostasis disorders are associated with _______________________.
A
Clotting factor malfunction
10
Q
What are the primary Haemostasis disorders?
A
vWF Deficiency
Haemophillia
Platelet Dysfunction
11
Q
What are the secondary Haemostasis disorders?
A
DIC Anticoagulation Vitamin K Deficiency Hepatic Failure Renal Failure
12
Q
What is Haemophilia A?
A
An inherited X-linked deficiency in Factor VIII that causes spontaneous or after trauma bleeding and bleeding into the joints (Haemarthroses)
13
Q
How do we diagnose Haemophilia A?
A
Family history (Females are carriers) Factor VIII levels
14
Q
How do we treat Haemophilia A?
A
Prophylaxis
Factor VIII replacement
15
Q
What is Thrombocytopenia?
A
Low thrombocyte levels
16
Q
What is Thrombocytosis?
A
Elevated thrombocyte levels, it has an increased risk of clotting
17
Q
What is platelet dysfunction?
A
A disorder where you can’t aggregate your platelets
18
Q
What is Thrombosis?
A
The formation of a blood clot that obstructs blood flow in a vessel
19
Q
What are some causes of thrombosis
A
Obesity Oral contraceptives/Pregnancy Prolonged immobility Surgery Malignancy Inheritance
20
Q
If you have type A blood you have __ antigens and __ antibodies
A
A
B
21
Q
If you have type B blood you have __ antigens and __ antibodies
A
B
A
22
Q
If you have type AB blood you have __ antigens and __ antibodies
A
A+B
No A or B
23
Q
If you have type O blood you have __ antigens and __ antibodies
A
No A or B
A + B
24
Q
Haemoglobin is made in the ____________
A
Mitochondria
25
___________ regulates RBC production. __% is made in the ________. It's release is stimulated by __________.
Erythropoetin
90% made in the kidney
Low blood O2
26
What are the requirements for Erythropoeisis?
Iron, cobalt
Vitamin B12, folate, thiamine
Amino acids
Other cytokines
27
RBC are removed in the ________. Iron is stored as _______ and Globin is ________________. Haem is broken down to ________ which is excreted by the ________.
Spleen
Ferritin
Degraded to AAs
Billibrubin, excreted by the liver
28
Define Anaemia:
Reduction in haemoglobin, Also reduced red cell count & haematocrit:
Males:
29
What causes anaemia?
Reduced bone marrow production
Increased loss of RBC
Premature destruction (haemolysis)
30
What are the symptoms of anaemia?
```
Shortness of breath
Fatigue
Tachycardia / chest pain
Generalised weakness
Pale: mouth mucosa (Hb
```
31
Anisocytosis is?
Variation in red cell size
32
Poikilocytosis is?
Variation in RB cell shape
33
Hypochromasia is?
RBC are Pale (reduced colour)
34
Polychromasia is?
RBC have Many colours
35
Microcytic is?
Small red cells
36
Macrocytic is?
Large red cells
37
Schistocyte is?
Fragmented red cell
38
Spherocytes is?
Spherical red cell
39
Acanthocyte is?
Spiculated RBC membrane
40
State the primary causes of anaemia related to reduced bone marrow production:
Bone marrow failure - erythropoeisis fails to occur
| Red cell aplasia - erythropoeisis fails to occur properly
41
State the secondary causes of anaemia related to reduced bone marrow production:
```
Infection
Drugs
Infiltration
Absence of “ingredients”
BM hypoxia
```
42
How do we classify anaemia based on cell size?
Microcytic
Normocytic
Macrocytic
43
What are some causes of microcytic anaemia?
Iron deficiency
Thalassaemia
Haemoglobinopathies
Anaemia of chronic disease
44
What are some causes of normocytic anaemia?
```
Blood loss
Haemolytic
- RBC membrane
- Enzyme defects
- Extrinsic
Stem cell defects
```
45
What are some causes of macrocytic anaemia?
```
Megaloblastic
Excess alcohol
Liver disease
Reticulocytosis
Drug therapy
Marrow failure
```
46
What does a low reticulocyte count suggest?
Failure of Erythropoeisis
47
What does a high reticulocyte count suggest?
Appropriate Bone marrow erythroid response
48
What are the causes of Iron Deficiency Anaemia?
Poor iron intake
Poor iron absorption
Chronic blood loss (Gut, uterine bleeding (menorrhagia) )
Increased iron utilisation (Neonates; puberty; pregnancy)
49
What is the Pathology of Iron Deficiency Anaemia?
Hypochromic and microcytic RBC with low MCV
50
How do we treat iron deficiency?
Iron Supplementation or Intravenous/Muscular if severe continuing until levels normalise
51
What are Haemoglobinopathies?
Genetic disorders of Hb synthesis that causes reduced or abnormal globin chains
i.e. Thalassaemia, Structural Haemaglobinopathies
52
What is Thalassaemia?
Reduced production of α or β globin chains
53
What are Structural Haemaglobinopathies?
Abnormal globin chain structure
| i.e. HbS (Sickle Cell Anaemia)
54
What is β-Thalassaemia?
Mutations in the β-globin gene which causes reduced β-globin chain production .'. reduced haemoglobin
55
What are the 2 types of β-Thalassaemia?
Homozygous (thalassaemia major)
| Heterozygous (thalassaemia minor)
56
What is thalassaemia major?
Homozygous form of β-Thalassaemia:
– Inherited defective gene from both parents
– Present at 3-6 months with severe anaemia
– Transfusion dependent; bone marrow transplant
57
What is thalassaemia minor?
Heterozygous form of β-Thalassaemia:
| – Asymptomatic
58
There are __ genes involved in making the α-globin chains.
4 genes
59
What are the possible outcomes for α-Thalassaemia?
– α / αα and – α / – α = Τhalassaemia minor
– – / αα = Τhalassaemia minor
– – / – α = Haemoglobin H disease
– – / – – = Hb Barts hydrops fetalis
60
Structural Haemaglobinopathies are ussually caused by _______________ that cause a __________________. They are most common in the __ chain.
Point Mutations
Structural Abnormality
β
61
List the 3 most common types of Structural Haemaglobinopathies:
HbS: Occurs in Negro race;
βS gene
- Homozygous: HbS forms crystals: sickle shaped
RBC resulting in sickling crises (painful)
HbE: Thailand;
βE gene; target cells; common
HbC: West Africa;
βC gene; target cells
62
Megaloblastic Anaemia is a type of _________ anaemia that is caused by _______________________________.
Macrocytic
| Deficiency of Vitamin B12 or folate
63
List some possible causes of Megaloblastic Anaemia other that B12/Folate deficiency:
– Liver disease
– Excess alcohol consumption
– Hypothyroidism
– Drug effects (e.g. chemotherapy drugs)
64
What is the pathology of Megaloblastic Anaemia?
• high MCV
• Hypersegmented neutrophils
• Hypercellular bone marrow
• Reduced serum vitamin B12 or RBC folate
• Intrinsic factor or Parietal cell antibodies (auto-
antibodies)
65
What is Normocytic Anaemia and what causes it?
Anaemia where the MCV is normal 80fL
66
Hereditary Haemolytic Anaemia can be caused by:
Red cell membrane defect
| Biochemical (enzyme) defect
67
Acquired Haemolytic Anaemia can be caused by:
```
Immune haemolytic anaemia (antibodies)
Drugs
“Hole in the heart” fracturing red cells
Multi-organ failure: kidney, liver
Infections: malaria, Clostridial sepsis
```
68
RBC in Haemolytic anaemia are _________ they are ______ and have ____________.
Spherocytes
| Small and have lost their central palour
69
Leukocytes can be classed as __________ or ________ and have an absolute count of ________.
Phagocytes or Leukocytes
| 4 - 11 x 10^9
70
Summarise Neutrophil Specs:
```
40-75% of WBC (count = 2.5-7.5 x10^9/L)
Develop from primitive myeloblast in BM
– Neutrophil migrates to tissue: Phagocytic function
– Acquire specific granules
– 2-5 nucleus segments
– 6-10 hrs in blood
```
71
Summarise Eosinophil Specs:
1-5% of leucocytes (0.1-0.4 x10^9/L)
• 2-lobed nucleus; large orange granules
• Circulation time 3-8 hours
• Involved in allergy, parasitic infection
72
Summarise Basophil Specs:
73
Summarise Monocyte Specs:
* 2 - 8% of white cells (0.2-0.8 x10^9/L)
* Maturation from monoblast
* 20 -40 hrs in blood
* Mature to macrophage in tissue (mths-yrs)
* Grey cytoplasm; horseshoe-shaped nucleus
* Produce cytokines
74
With respect to leukocytes these mean?
- cytosis
- phillia
- cytopenia
Increased numbers
Increased numbers
Decreased numbers
75
List some reactive White Cell disorders
– Neutrophilia and neutropenia
– Lymphocytosis
– Monocytosis
– Eosinophilia
76
List some malignant White Cell disorders
– Leukaemias: acute and chronic
– Multiple myeloma
– Lymphoma
– Myeloproliferative neoplasms
77
Neutropillia is _______________________. It is usually caused by _________________________________________.
Increase in neutrophil count ( >8x10^9 )
| Infection, Fever, Inflammation, Steroid therapy and neoplasms
78
Neutrophillia is often accompanied by left shift, which is __________________________________, and toxic granulation, which is _________________.
Presence of precursor neutrophils in the blood
| Increase in granules
79
What are some causes of Neutropenia?
Congenital (rare
Drug-induced: Antibiotics; cytotoxics
Infections: Viral or bacterial
Bone marrow failure (pancytopenia)
80
Neutropenia is associated with an increased risk of __________ and ________________________, especially in the _______ and _______.
Severe and recurrent Bacterial Infection
Mouth
Throat
81
Lymphocytosis is commonly secondary to _________________. The morphology of the cells is ________.
Viral Infections
| Altered
82
Monocytosis is _________ and is caused by ____________________, _________ and _______.
Uncommon
| Chronic infections, Tuberculosis and Malaria
83
Eoisinophillia is common in ________ and ________ reactions and __________________.
Allergic and Drug Reactions
| Parasite infection
84
Basophillia is very ________ as it is a manifestation of ________________________.
Rare
| Chronic myeloid leukaemia
85
What is acute leukaemia?
Malignancy of the Precursors in the bone marrow, bone marrow gets replaced by leukaemic cells which causes a reduction in normal cells
86
Leukaemia blast cells ____________ but do not __________.
Proliferate
| Mature
87
What are the 2 types of acute leukaemia?
Lymohoblastic ALL
| Myeloblastic AML
88
Acute leukaemia affects ________. Lymphoblastic leukaemia predominately affects ___________.
All ages
| Children
89
What are the symptoms of acute leukaemia?
```
Anaemia = Lethargy etc
Leucopenia = Infections, fevers
Thrombocytopenia = Bleeding, bruising
```
90
How do we treat acute leukaemia?
Aggressive Chemotherapy and Bone Marrow Transplant
91
B-Lineage ALL is the commonest in _________ (__% of cases). It is characterised by ______________. It has a poor prognosis for ________ and good prognosis for ________.
Children 85% of cases
Small "blast" cells
Adults
Children
92
What is Acute Myeloblastic Leukaemia and how do we treat it?
A clonal defect in the myeloblast
| Treated with Chemotherapy and Transplantation
93
What is Chronic Leukaemia?
Malignant proliferation of mature lymphoid
| or myeloid cells
94
What are the 2 types of Chronic Leukaemia?
Chronic lymphocytic leukaemia
| Chronic myeloid leukaemia
95
Summarise Chronic lymphocytic leukaemia:
Disease of the elderly >60yo
Malignant proliferation of mature B lymphocytes
Progressive anaemia, thrombocytopenia & neutropenia
Treated with oral chemotherapy
96
Summarise Chronic myeloid leukaemia:
Disease of the middle ages 30-60yo
Characterised by:
• Leucocytosis: neutrophilia and precursors
• Blast cells (
