Week 6 - Haematology 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
anaemia due to production problem: name a hormone that could contribute to anaemia if lacking. reason for this?
- lack of erythropoietin | - could be due to renal failure, since kidneys produce erythropoietin
26
anaemia due to production problem: bone marrow failure due to? x4
- 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
27
anaemia due to losses from circulation: name 2 examples that could result in a loss of circulating blood, leading to anaemia
- blood loss | - haemolysis: destruction of cells in circulation
28
anaemia due to losses from circulation: blood loss is the most common cause of anaemia. name 4 reasons for blood loss?
- GI bleeding: possibly due to ulcers and polyps - menstruation: menorrhagia - trauma/post operative bleeding - from other organs: unusual
29
anaemia due to losses from circulation: what is haemolysis? what are examples of it?
haemolysis: destruction of cells in circulation - autoimmunity: antibodies attacking RBCs - abnormal RBCs: sickle cell anaemia, thalassaemia
30
describe blood film of patient having sickle cell anaemia
RBC has obvious sickle shape, will not pass through spleen or capillary beds -> anaemia
31
type of anaemia influences? and what will this affect in the blood count?
- type of anaemia influences the cell size | - cell size affects mean cell volume in the FBC
32
microcytic: caused by what type of anaemia?
- iron deficiency anaemia
33
macrocytic: caused by what type of anaemia?
- B12/ folate deficiency | - autoimmune
34
normocytic: what is it? caused by what time of anaemia?
- anaemia without change in volume of cells | - marrow, renal failure leading to anaemia
35
signs and symptoms of anaemia?
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
anaemia: management?
- history and examination - establish type of anaemia - establish cause
37
how to establish type of anaemia? | how to establish cause of anaemia?
- simple blood tests - FBC, blood film, Iron, B12, folate | - may require more complex tests i.e. identify bleeding source, cause of hemolysis
38
anaemia: treatment?
- replace what's missing: 1. iron sulphate, folic acid, B12 2. erythropoietin 3. blood transfusion if severe and symptomatic - address underlying cause
39
anaemia - dental aspects: - oral abnormalities from what deficiencies will present to dentists? - how will undergoing GA be affected?
- 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
name 2 white cell disorders?
- neutropenia | - haematological malignancy
41
neutropenia: caused by?
- bone marrow failure | - auto-immune causes (viral infection)
42
neutropenia - clinical features? | there is risk of?
- infection of the mouth and throat: candida, virus (herpes), commensal bacteria - risk of life threatening disseminating infection: from oral infection, from other source
43
neutropenia - dental aspects: take note high risk of? what to avoid?
- high risk of serious disseminated infection | - avoid invasive treatment when suspected i.e. patients on chemotherapy, clinical suspicion
44
heamatological malignancies: caused by? | name and describe 2 examples
- 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
leukaemia: caused by? | name the 2 forms?
- proliferation of primitive blood cells | - acute (common in children) and chronic
46
acute leukaemia: presentation? | chance of 5 year survival?
- marrow failure: anaemia, infection, bleeding - lymphadenopathy - soft tissue infiltration - chance finding - 50% overall
47
describe the blood film of a patient with leukaemia?
reduced proportion of RBCs | increased presence of lymphocytes
48
chronic leukaemia: - affects who? - may transform to? - presentation?
- adults - may transform to acute (blast transformation) - anaemia, lymphadenopathy
49
describe the blood film of a patient with chronic leukaemia?
lymphocytes more normal looking - darker and denser | not as low proportion of RBCs
50
lymphoma: state the 2 main types?
- hodgkin's lymphoma | - non-hodgkin's lymphoma
51
hodgkin's lymphoma - mainly affects? - presentation? (physical and systemic) - prognosis?
- young adults - presentation: lymphadenopathy systemic: fever, weight loss, severe night sweats, itch, anaemia - 5 year survival - 80%
52
non-hodgkin's lymphoma - presentation in older adults? - prognosis?
- lymphadenopathy - systemic: fever, weight loss, anorexia - prognosis: variable, 50% 5 year survival
53
haematological malignancies - treatment?
- supportive: transfusion, infection management - chemotherapy - radiotherapy - bone marrow transplant: autologous, allogenic - novel therapies
54
haematological deficiencies - what are the primary presentations to dentist?
- atypical infections - bleeding - lymphadenopathy - gum infiltration
55
coagulation: depends on?
- number and function of platelets | - coagulation cascade
56
what happens at the site of bleeding after vessel injury? how does it lead to the clot formation?
vessel injury leads to: 1. vasoconstriction 2. platelet aggregation 3. coagulation cascade clot formation is due to the coagulation cascade and platelet aggregation
57
platelet problems: | how can they occur? give an example of each
- 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
platelet aggregation problems: commonly due to?
commonly due to impairment in function because of medical therapy - aspirin, clopidogrel, dipyridamole
59
platelet aggregation problems: management?
- treat underlying cause | - platelet transfusion may be necessary
60
coagulation cascade problems: example of a generalised deficiency?
- protein deficiency: | e. g. liver disease, severe malnutrition
61
coagulation cascade problems: examples of specific deficiencies?
- congenital problems: haemophilia, von Willebrand's disease - drugs: warfarin and heparin + other new agents replacing warfarin and heparin
62
haemophilia A & B: - what type of genetic disorder? - what is each type of haemophilia characterized by? - severity?
- X-linked genetic disorder - absent/low clotting factors VIII - Haemophilia A IX - Haemophilia B - severity varies
63
von Willebrand's disease: - what kind of genetic disorder? - characterized by what problem?
- autosomal dominant (males and females affected) | - platelet/ factor VIII function problem
64
haemophilia/von Willebrand disease: treatment? how does each method work?
- factor replacement: early or prophylactic - DDAVP (desmopressin): helps body release factor VIII stored within vessel linings - tranexamic acid: inhibits clot breakdown
65
haemophilia/von Willebrand's disease dental considerations - risk management? associated conditions?
risk management: - avoid trauma - preparation for bleeding i.e. operations associated conditions: - HIV - hepatitis
66
coagulation: what is the most common drug prescribed? what else does it treat? mechanism? how to monitor progress?
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
coagulation - other drugs? | how are they administered?
heparin + other low weight molecular heparins (dalteparin) - injectable anticoagulants - usually in hospital, sometimes community
68
coagulation - manifestation of problems?
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
coagulation - dental aspects? what to look out for? what happens if there is suspected bleeding disorder? what if there is a known bleeding disorder?
- 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