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CMS > Week 6 - Haematology > Flashcards

Week 6 - Haematology Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

3 main functions of the blood?

A
  • transport
  • immune system
  • coagulation
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2
Q

what does blood transport?

A

oxygen
nutrients
hormones
waste

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3
Q

blood is composed of?

A

plasma and cells

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4
Q

in blood: what is plasma composed of?

A

proteins, lipids, nutrients, hormones, electrolytes, water

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5
Q

in blood: what type of cells are there and what are their functions?
where are these cells produced?

A
  • red blood cells: oxygen and carbon dioxide transport
  • white blood cells: immune system
  • platelets: clotting

cells are produced in the bone marrow

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6
Q

full blood count - what does it test for?

A

the number and size of cells

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7
Q

full blood count: what does WBC stand for? what is its normal value? what is indicated if too high or too low?

A
  • white blood cells
    4. 00 - 11.00
  • too high: leukocytosis
  • too low: leukopaenia
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8
Q

full blood count: what does RBC stand for? what is its normal value?

A
  • red blood cells

3. 80 - 5.30

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9
Q

full blood count: what does Hb stand for? what does it reflect? what is its normal value? what happens when below normal value?

A
  • Haemoglobin
  • reflects quantity and quality of red blood cells
    115-165
  • lack of haemoglobin indicates anaemia
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10
Q

full blood count: what does Hct stand for? what does it reflect? what is its normal value?

A
  • Haematocrit
  • ratio of the volume of RBCs to the total volume of blood
    0. 370-0.470
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11
Q

full blood count: what does MCV stand for? what does it reflect? what is its normal value? what is indicated when MCV is too high or too low?

A
  • mean cell volume
  • reflects the size of red blood cells
  • 78.0- 99.0
  • too big = macrocytic
  • too small = microcytic
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12
Q

full blood count: what does MCH stand for? what does it reflect? what is its normal value?

A
  • mean corpuscular hemoglobin
  • calculation of the average amount of hemoglobin contained within each of a person’s red blood cells
  • 27.0-32.0
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13
Q

full blood count: what does Plts stand for? what is its normal value? what is indicated if count is too low or too high?

A
  • platelet count
  • 150-400
  • if too high: thrombocythaemia
  • if too low: thrombocytopaenia
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14
Q

full blood count: what does Neut stand for? what is its normal value?

A
  • neutrophil count

- 2.00-7.50

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15
Q

full blood count: what does Lymph stand for? what is its normal value?

A
  • lymphocyte count

- 1.50-4.00

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16
Q

describe blood film of patient with neutrophilia?

A

increased neutrophil presence - sign of infection

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17
Q

describe blood film of patient with malaria?

A

RBCs infected, parasites visible within cells

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18
Q

bone marrow sample: taken from?

A

iliac crest or sternum

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19
Q

tests for coagulation?

A
  • activated partial thromboplastin time
  • prothrombin time (PT)/ international normalized ration (INR)
  • test the function of coagulation
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20
Q

anaemia: deficiency of? how does it occur?

A

anemia is a haemoglobin deficiency

caused by either the lack of cells or lack of hemoglobin itself

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21
Q

anaemia: causes?

A
  • lack of raw materials
  • problem with red cell production
  • longevity problem (normal RBC lifespan 120 days)
  • losses from circulation
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22
Q

anaemia: what goes into the production of red cells?

A
  1. raw materials (iron, B12, folate)
  2. erythropoetin (increases RBC production in response to falling o2 lvls
  3. production in bone marrow
  4. circulation
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23
Q

anaemia due to lack of raw materials:

name the raw materials lacking and why they may be lacking

A
  • iron & folic acid: dietary, rarely malabsorbtion
    more likely during periods of increased demand e.g. pregnancy
  • vitamin B12: pernicious anaemia - autoimmune disease. antibodies attack intrinsic factor which aid absorption of B12
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24
Q

describe blood film of patient with iron-deficiency anaemia

A

size of red cells reduced, pale in color

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25
Q

anaemia due to production problem: name a hormone that could contribute to anaemia if lacking. reason for this?

A
  • lack of erythropoietin

- could be due to renal failure, since kidneys produce erythropoietin

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26
Q

anaemia due to production problem: bone marrow failure due to? x4

A
  • aplastic anaemia: all cells affected, loss of function
  • chemotherapy/immunosuppresants
  • haematological malignancy
  • anaemia of chronic disease: chronic disease changes the way iron is managed in body
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27
Q

anaemia due to losses from circulation: name 2 examples that could result in a loss of circulating blood, leading to anaemia

A
  • blood loss

- haemolysis: destruction of cells in circulation

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28
Q

anaemia due to losses from circulation: blood loss is the most common cause of anaemia. name 4 reasons for blood loss?

A
  • GI bleeding: possibly due to ulcers and polyps
  • menstruation: menorrhagia
  • trauma/post operative bleeding
  • from other organs: unusual
29
Q

anaemia due to losses from circulation: what is haemolysis? what are examples of it?

A

haemolysis: destruction of cells in circulation
- autoimmunity: antibodies attacking RBCs
- abnormal RBCs: sickle cell anaemia, thalassaemia

30
Q

describe blood film of patient having sickle cell anaemia

A

RBC has obvious sickle shape, will not pass through spleen or capillary beds -> anaemia

31
Q

type of anaemia influences? and what will this affect in the blood count?

A
  • type of anaemia influences the cell size

- cell size affects mean cell volume in the FBC

32
Q

microcytic: caused by what type of anaemia?

A
  • iron deficiency anaemia
33
Q

macrocytic: caused by what type of anaemia?

A
  • B12/ folate deficiency

- autoimmune

34
Q

normocytic: what is it? caused by what time of anaemia?

A
  • anaemia without change in volume of cells

- marrow, renal failure leading to anaemia

35
Q

signs and symptoms of anaemia?

A

symptoms:

  • tired, weak
  • breathless
  • dizzy
  • palpitations
  • those specific to cause e.g. blood loss

signs:

  • pale
  • rapid pulse
  • may be oral features (depending on type)
36
Q

anaemia: management?

A
  • history and examination
  • establish type of anaemia
  • establish cause
37
Q

how to establish type of anaemia?

how to establish cause of anaemia?

A
  • simple blood tests - FBC, blood film, Iron, B12, folate

- may require more complex tests i.e. identify bleeding source, cause of hemolysis

38
Q

anaemia: treatment?

A
  • replace what’s missing:
    1. iron sulphate, folic acid, B12
    2. erythropoietin
    3. blood transfusion if severe and symptomatic
  • address underlying cause
39
Q

anaemia - dental aspects:

  • oral abnormalities from what deficiencies will present to dentists?
  • how will undergoing GA be affected?
A
  • iron, B12, folate deficiency
  • O2 capacity affected in anaemia,
  • need to verify sickle cell status in all patients of black-african or carribean descent before GA
40
Q

name 2 white cell disorders?

A
  • neutropenia

- haematological malignancy

41
Q

neutropenia: caused by?

A
  • bone marrow failure

- auto-immune causes (viral infection)

42
Q

neutropenia - clinical features?

there is risk of?

A
  • infection of the mouth and throat: candida, virus (herpes), commensal bacteria
  • risk of life threatening disseminating infection: from oral infection, from other source
43
Q

neutropenia - dental aspects:
take note high risk of?
what to avoid?

A
  • high risk of serious disseminated infection

- avoid invasive treatment when suspected i.e. patients on chemotherapy, clinical suspicion

44
Q

heamatological malignancies: caused by?

name and describe 2 examples

A
  • majority caused by uncontrolled proliferation of white cells
  1. leukaemia: proliferation of immature cells in blood and bone marrow
  2. proliferation of cells within lymphoreticular system - nodes, liver, spleen, bone marrow
45
Q

leukaemia: caused by?

name the 2 forms?

A
  • proliferation of primitive blood cells

- acute (common in children) and chronic

46
Q

acute leukaemia: presentation?

chance of 5 year survival?

A
  • marrow failure: anaemia, infection, bleeding
  • lymphadenopathy
  • soft tissue infiltration
  • chance finding
  • 50% overall
47
Q

describe the blood film of a patient with leukaemia?

A

reduced proportion of RBCs

increased presence of lymphocytes

48
Q

chronic leukaemia:

  • affects who?
  • may transform to?
  • presentation?
A
  • adults
  • may transform to acute (blast transformation)
  • anaemia, lymphadenopathy
49
Q

describe the blood film of a patient with chronic leukaemia?

A

lymphocytes more normal looking - darker and denser

not as low proportion of RBCs

50
Q

lymphoma: state the 2 main types?

A
  • hodgkin’s lymphoma

- non-hodgkin’s lymphoma

51
Q

hodgkin’s lymphoma

  • mainly affects?
  • presentation? (physical and systemic)
  • prognosis?
A
  • young adults
  • presentation: lymphadenopathy
    systemic:
    fever, weight loss, severe night sweats, itch, anaemia
  • 5 year survival - 80%
52
Q

non-hodgkin’s lymphoma

  • presentation in older adults?
  • prognosis?
A
  • lymphadenopathy
  • systemic: fever, weight loss, anorexia
  • prognosis: variable, 50% 5 year survival
53
Q

haematological malignancies - treatment?

A
  • supportive: transfusion, infection management
  • chemotherapy
  • radiotherapy
  • bone marrow transplant: autologous, allogenic
  • novel therapies
54
Q

haematological deficiencies - what are the primary presentations to dentist?

A
  • atypical infections
  • bleeding
  • lymphadenopathy
  • gum infiltration
55
Q

coagulation: depends on?

A
  • number and function of platelets

- coagulation cascade

56
Q

what happens at the site of bleeding after vessel injury? how does it lead to the clot formation?

A

vessel injury leads to:

  1. vasoconstriction
  2. platelet aggregation
  3. coagulation cascade

clot formation is due to the coagulation cascade and platelet aggregation

57
Q

platelet problems:

how can they occur? give an example of each

A
  • deficiency: lack of raw materials, e.g. B12, folate
  • production problem: bone marrow failure
  • destruction:
    immune related: autoimmune thrombocytopaenic purpura
    portal hypertension: spleen sequestration
58
Q

platelet aggregation problems: commonly due to?

A

commonly due to impairment in function because of medical therapy
- aspirin, clopidogrel, dipyridamole

59
Q

platelet aggregation problems: management?

A
  • treat underlying cause

- platelet transfusion may be necessary

60
Q

coagulation cascade problems: example of a generalised deficiency?

A
  • protein deficiency:

e. g. liver disease, severe malnutrition

61
Q

coagulation cascade problems: examples of specific deficiencies?

A
  • congenital problems:
    haemophilia, von Willebrand’s disease
  • drugs: warfarin and heparin + other new agents replacing warfarin and heparin
62
Q

haemophilia A & B:

  • what type of genetic disorder?
  • what is each type of haemophilia characterized by?
  • severity?
A
  • X-linked genetic disorder
  • absent/low clotting factors
    VIII - Haemophilia A
    IX - Haemophilia B
  • severity varies
63
Q

von Willebrand’s disease:

  • what kind of genetic disorder?
  • characterized by what problem?
A
  • autosomal dominant (males and females affected)

- platelet/ factor VIII function problem

64
Q

haemophilia/von Willebrand disease: treatment? how does each method work?

A
  • factor replacement: early or prophylactic
  • DDAVP (desmopressin): helps body release factor VIII stored within vessel linings
  • tranexamic acid: inhibits clot breakdown
65
Q

haemophilia/von Willebrand’s disease dental considerations - risk management? associated conditions?

A

risk management:

  • avoid trauma
  • preparation for bleeding i.e. operations

associated conditions:

  • HIV
  • hepatitis
66
Q

coagulation: what is the most common drug prescribed?
what else does it treat?
mechanism?
how to monitor progress?

A

warfarin

  • atrial fibrillation, prosthetic heart valves, DVT, pulmonary embolisms
  • interferes with clotting activity
  • monitor by INR

warfarin replacements

  • increasing usage
  • no need for INR testing
67
Q

coagulation - other drugs?

how are they administered?

A

heparin + other low weight molecular heparins (dalteparin)

  • injectable anticoagulants
  • usually in hospital, sometimes community
68
Q

coagulation - manifestation of problems?

A

cutaneous bleeding:

  • petechiae
  • purpura
  • ecchymoses

mucosal surface bleeding:

  • oral
  • GI: either by vomiting blood, melaena, rectal bleeding
  • menorrhagia
  • haematuria

traumatic bleeding

  • post-operative
  • on minor trauma
  • joints: haemarthroses (haemophilia)
69
Q

coagulation - dental aspects?
what to look out for?
what happens if there is suspected bleeding disorder?
what if there is a known bleeding disorder?

A
  • identify in history: specific diseases, drugs, symptoms (post-op bleeding, mucosal bleeding)
  • do not proceed with treatment, refer patient to GP or hospital first
  • liase with GP/haematologist, be aware of specific guidelines for anticoagulants

CMS (16 decks)

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