wk 4- haemotological

Question 1

define anaemia, symptoms,

Answer 1

decrease in hemoglobin, red cells or haematocrit

Question 2

symptoms of anaemia

Answer 2

pallor,
fatigue,
dyspnoea,
palpitations,
headache,
loss of appetite,
skin and nail changes (koolonychia, spoon shaped- iron deficiency anaemia)

Question 3

how can anaemia develop (3)

Answer 3

1. blood loss (acute: trauma, childbirth, surgery or chronic: menorrhagia, GI bleeding)
2. inadequate red cell production (iron deficiency, chronic disease, alcohol)
3. excessive red cell destruction (red cell disease- sickle cell, conditons, infections)

Question 4

what causes abnormal bleeding

Answer 4

1. abnormal coagulation (hereditary- haemophilias, acquired- liver disease, immune thromboctopenia purpura)
2. or platelets (hereditary- von willebrand disease)
3. or blood vessels (hereditary haemorrhagic telengiectasia, ehlers-danlos syndrome)

Question 5

define Von Willebrand disease, symptoms, diagnosis and treamtnet

Answer 5

hereditary deficiency of von willebrand factor (VWF)

VWF is synethesised by vascular endothelium and promotes platelet adhesion at the site of vascular injury

Question 6

symptoms of VWD

Answer 6

symptoms:
easily bruised
mucosal bleeding
excessive bleeding from small cuts
menorrhagia
abnormal bleeding after surgery

Question 7

diagnosis of VWD

Answer 7

-measurement of VWF antigen on blood testing

Question 8

VWD management

Answer 8

1. desmopressin or
2. VWF replacement
   usually only necessary for surgery or excessive bleeding

Question 9

define haemophilia, who it most likely affects, symptoms, treatment

Answer 9

2 types
hemophilia A (common), deficiency in factor VIII
hemophilia B, deficiency in factor IX

effects males the most as it is on the X chromosome

Question 10

symptoms of haemophilia

Answer 10

bleeding into tissues frollowing minimal trauma
hemarthroses
muscle haematomas
retroperitoneal haemorrhage

Question 11

treatment for haemophilia

Answer 11

for surgery
replacement clotting factor given

Question 12

define immune thromboctopaenia purpura, common in, symptoms, diagnosis, treatment

Answer 12

easy bruising, purpura and bleeding from mucous membranes

common in children

Question 13

symptoms of immune thromboctopenia purpa

Answer 13

muocutaneous bleeding
possibly post viral infection

Question 14

diagnosis of ITP

Answer 14

diagnosis through FBC, isolated low platelets normal peripheral blood cells and smear

Question 15

ITP management

Answer 15

usually not needed but
1. cortciosteroids,
2. IV immunoglobulin
3. anti-D

Question 16

how can liver disease cause abnormal bleeding

Answer 16

1. vitamin K deficiency due to cholestasis
2. reduced synthesis of clotting factors
3. thrombocytopaenia due to hypersplenism
4. functional abnormalities in platelets and fibrinogen

Question 17

what causes abnormal clotting

Answer 17

1. inherited procoagulation disorder (factor V leiden)
2. acquired procaogulation disorders

Question 18

how does factor V leiden occur and treatment

Answer 18

Factor V is mutated to become resistant to degradation by activated protein C which results in excessive activation of coagulation cascade and tendency to thrombosis- typically causes unprovoked DVT

Question 19

treatment for factor V leiden

Answer 19

anticoagulants

Question 20

types of haematological malignancy (3)

Answer 20

1. leukaemia
2. lymphoma
3. multiple myeloma

Question 21

define leukaemia

Answer 21

Malignant white blood cells (myeloid and lymphoid lineages) formed in the bone marrow, and which can circulate in the blood and to other tissues

Question 22

acute and chronic symptoms of leukaemia

Answer 22

acute symptoms:
anaemia
recurrent infections
easy bruising
bleeding

chronic symptoms:
-asymptomtic or
anaemia
recurrent infections
lymph node/liver/spleen enlargment

Question 23

diagnosis of leukaemia

Answer 23

peripheral blood examination and confirmed bone marrow biopsy

Question 24

leukaemia management

Answer 24

chemo

for chronic
2. monoclonal antibodies
3. bone marrow stem cell transplantation

Question 25

define lymphoma

Answer 25

tumours of malignant white cells (lymphoid lineages) arising in the reticuloendothelial and lymphatic systems

2 types:
1. hodgkin lymphoma (reed-sternberg cells)
2. non hodkin lymphoma

Question 26

symptoms of lymphoma

Answer 26

painless lymphadenopathy
fever, night sweats, weight loss

Question 27

diagnosis of lymphoma

Answer 27

lymph node biopsy

Question 28

treatment for lymphoma

Answer 28

chemo/radiotherapy

Question 29

define multiple myeloma

Answer 29

A cancer of abnormal bone marrow plasma cells (those that produce antibodies)

Question 30

symptoms of multple myeloma

Answer 30

fatigue/ anaemia
bone pain
recurrent infections

Question 31

diagnosis of multiple myeloid

Answer 31

serum and urine electrophoresis and immunofixation, bone marrow biospy

Question 32

treatment for multiple myeloid

Answer 32

1. chemotherapy
2. monoclonal antibody therapy
3. radiotherapy
4. autologous stem cell transplantation

Question 33

drugs used in haematology (3)

Answer 33

1. anticoagulants (warfarin and heparin)
2. antiplatelets (aspirin and clopidogrel)
3. fibrinolysis (streptokinase and tissue plasminogen activators)

Question 34

normal haemostasis (3)

Answer 34

1. primary haemostasis: formation of a haemostatic
   platelet plug which stops the bleeding
2. Secondary haemostasis: activation of the clotting
   cascade, resulting in a fribin-reinforced platelet plug
3. Fibrinolysis: clot is dissolved once injury has healed

Question 35

define thrombosis

Answer 35

formation of a haemostatic plug within the vasculature in the absence of bleeding

Question 36

what is the virchows triad

Answer 36

increased risk of clotting
1. Vessel wall injury (e.g. secondary to hypertension, smoking, dyslipidaemia)
2. Alterations in blood flow (turbulent or slowed) and
3. Abnormal coagulability of the blood

Question 37

heparin, how do they work

Answer 37

immediate acting injectable that inhibits coagulation by activation of antithrombin III

Question 38

Warfarin how does it work

Answer 38

oral tablet that takes several days to take effect but it interferes with production of functional vitamin K dependent clotting factors (II, VII, IX, X)

Can be reversed with Vitamin K antidote

warfarin has a narrow therapeutic range which varies depending on the condition it is prescribed for

Question 39

what would u use antiplatelets for

Answer 39

ischaemic heart disease
post acute coronary syndrome, stroke,
peripheral vascular disease

Question 40

what does aspirin do

Answer 40

1. alters the balance between thromboxane A2 which promotes platelet aggregration and prostaglandin I2 which inhibits it,
2. inactivates COX to reduce TXA2 synthesis in platelets

7-10 days for new platelets

Question 41

what does clopidogrel do

Answer 41

inhibits platelet responses to adenosine biphosphate = inhibits aggregation

Question 42

high INR means

Answer 42

bleeding risk

Question 43

full blood count levels