Week 8 Flashcards
In neonates it is normal to see NRBC before day ____ after that it would suggest haemolysis, hypoxia or infection
5
In neonates is the RDW elevated or decreased?
Elevated RDW at birth
Anisocytosis on film
Do Neonates have a high or low haematocrit in days after birth?
High
In neonates at birth is the WBC elevated or decreased
Elevated - Wide reference range
What are the Vit K dependent factors?
- II, VII, IX & X
* Protein C, S & Z
Do elderly people have similar or lower tolerance of anaemia?
Lower
At birth, what is extremely cellular?
red marrow
At birth what lineages are multiplying and differentiating
all
In a full term infant there is little scattered haemopoiesis in ______ which ceases soon after birth
liver
Extra-medullary haemopoiesis may be common in ________ liver, spleen, lymph nodes, thymus
pre-term babies
What type of Hb predominates at birth
Hb F (alpha 2 + Gamma 2)
What type of Hb predominates from 2-adulthood?
Hb A1 (Alpha 2 + Beta 2)
Full term =
Premature/Preterm =
Postterm =
37 -42 weeks gestation
<37 weeks gestation
>42 weeks gestation
In newborns does the Hb and MCV begin high or low?
high
Ranges for pre-term infants depends on what two things?
level of prematurity and birth weight
Neonatal (≤ 4weeks) haematological values are affected by:
o Gestational age o Birth weight o Age after delivery o Presence of illness o Sampling site (Capillary, venous or arterial)
What causes “Polycythaemia of the newborn”
• Degree of hypoxia in utero stimulates increased erythropoietin
Following birth, oxygenation increases which suppresses what?
Suppresses erythropoietin level
In newborns erythrocytes are macrocytic until day ___
Orthochromatic normoblasts in film until around day ____ (Persist longer in premature infants)
NRBC after day _____ suggests haemolysis, hypoxia or infection
5, 3, 5
Capillary samples may have higher _____ and _____than venous
Hb, and Hct
The more premature the baby the higher the MCV or lower?
Higher
Is the RDW raised or lowered in newborns?
Elevated
At birth is the WCC elevated or lowered? Which white cell predominates? Are there increased band forms?
Elevated WCC
Predominance of neutrophils
Yes - Increased band forms
Would you expect to se a greater left shift with prematurity?
Yes • Myelocytes, metamyelocytes, band forms
What would indicate an infection in neonates?
Neutropenia or neutrophilia, vacuoles, hypergranulation, dohle bodies
Describe why neonates should get a vit K injection.
Neonates have ~ 30% of adult levels of Vit K dependent factors
• because their intestines have not been colonised by bacteria needed to synthesize Vit K
• Vit K poorly transported across placenta (stores depleted quickly after birth)
• human breast milk contain relatively low conc of vit K
→Risk vit K deficiency bleeding (VKDB)
Reach adult values around 2 to 6 months
What is the most common cause of anaemia in children?
iron deficiency
Most cases of Haemolytic Uraemic Syndrome are associated with what?
Shigella dysenteriae or E. coli O157:H7 infection in gut
In children Haemolytic Uraemic Syndrome resembles what other condition?
Thrombotic Thrombocytopenic Purpura (TTP)
What are the 5 main features of HUS and TTP
- fever
- anaemia (microangiopathic haemolytic anaemia)
- thrombocytopenia
- renal problems more in HUS
- neurological problems more in TTP
Which White Blood Cell has decrease in function and which functions are affected?
Neutrophil function : chemotaxis, phagocytosis, superoxide generation
B cells rely on _____ interaction to produce antibodies.
T cell
What are the contributing factors of anaemia in the elderly.
Contributing factors: • ↓ BM function • ↓ physical activity • Nutritional deficiencies • Cardiovascular Disorders • Chronic inflamm disorder
Anaemia of chronic inflammation depends on severity of underlying disease what can happen to the RBC’s?
▪ Proinflammatory cytokines may impair erythropoiesis
▪ ↓ RBC survival
Iron deficiency anaemia in the elderly is often associated with what other conditions? (6)
▪ Chronic GI bleed ▪ Long term use of NSAID ▪ Gastritis ▪ Peptic ulcer ▪ Colon cancer ▪ May be asso with poor diet
Do plasma concentrations of many coagulation factors increase or decrease with aging?
Increase
Incidence of venous thromboembolism (VTE) ↑ with aging.
What does HELLP syndrome stand for?
(Haemolysis, Elevated Liver enzymes, Low Platelet count)
What are some common causes of DIC in obstetrics? (6)
Amniotic fluid embolism HELLP syndrome Pre-eclampsia Placental abruption Septic abortion Postpartum haemorrhage
What is the most severe form of Haemolytic Disease of the New Born and what is the most common?
Rh HDNB is most severe (IgG Ab)
ABO HDNB – more common but less severe (mostly IgM Ab)
How does pregnancy affects RBC and WBC?
Decreased Hb - no symptoms
Increased WBC, mostly neutrophils, may have hypergranulation & left shift
