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Hematology

Introduction to anemia & data interpretation

What is the definition of anemia? Anemia is a clinical state where the hemoglobin, total RBC count or hematocrit is below the normal limit for sex and age Consequence of another underlying disease Decrease in O2 delivery capacity

What factors regulate erythropoiesis? Erythropoiesis= RBC formation Hypoxia= lox O2 more brc neede kidney secrete erythropoietin Inc. erythropoiesis Altitude= high altitude inc erythropoietin Androgen= inc erythropoietin ERYTHROPOIETIN controls ERYTHROPOIESIS!!!

What is the difference between true & relative anemia?True Anemia Decrease in red cell mass Due to Decreased RBC production Increased RBC destruction Both simultaneously

Relative Anemia Increase in plasma volume Dilution Seen in pregnancy Due to introduction of iv fluids

What do each of the following measure? Which type of anemia show the results below?MCV raised Macrocytic Megaloblastic anemia B12 deficiency Folic acid deficiency

MCH & MCHC decreased Microcytic hypochromic

Iron deciriency Thalassaemia Chronic renal failure Sideroblastic anemia

Give 2 examples of normocytic and normochromic anaemia Normocytic= rbc normal size Normochromic= normal rbc color Normocytic normochromic anemia= anemia with normal rbc size and color MCH & MCV normal

Hemolysis, Acute blood loss, Marrow infiltration

Nutritional deficiency anemia

What is needed for the transport of iron in the blood? What is needed for the absorption of vit. B12? Iron Transferrion for transport

B12 Intrinsic factor + transcobalamin II

What are the causes of iron deficiency anemia? Name two. Chronic blood loss GI bleeding: most common anemia cause worldwide Poor diet intake Malabsorption Gastric resection Pancreatic insuffiency GIT infection Crohon s disease Short bowel syndrome

Menstruation Childbirth Pulmonary: haemoptysis Urinary: renal disease Rapid growth with insuffiecient Fe: premature infants, children, teenagers Pregnancy Lactation

What is the aetiology of megaloblastic anaemia? Megaloblastic anemia Deficiency of cobalamin (vit B12) and/or Folate (folic acid)

What is pernicious anaemia? What is the main morphological change seen?

What complication is seen in vit. B12 deficiency and not in folate deficiency?

Blood, blood products & transfusion service

What are the major blood groups

Match the following RBC antigens with the appropriate added sugars

Antigen O A B AB

Sugar Added

What does Fresh Frozen Plasma contain? Give 3 conditions where FFP is used

Match the following to their appropriate uses.Blood Product A. Whole Blood B. Packed Cells C. Cryoprecipitate D. Cryosupernatant Uses Liver failure, vit. K deficiency, warfarin overdose Chronic anemia, thalassemia Von Willebrand disease Blood volume replacement, exchange transfusion

What are donated blood tested for?

How is ABO cell grouping done?

How is ABO serum grouping done?

List 3 possible agents of transmission of infection by transfused blood.

Hemostasis and bleeding disorders

Name the steps in hemostasis

What are the 2 main functions of thrombin?

Name the Coagulation factorsCoagulation factor I II III IV V VII VIII IX X XI XII XIII Name

What is hemophilia A & ? Give a characteristic sign of hemophilia.

What is von Willebrand disease?

List 3 causes of thrombocytopenia

Give 2 causes of Disseminated Intravascular Coagulation? What are the effects of IDC?

List 2 screening tests for vascular and platelet disorders

List 3 screening tests for coagulation disorders

What is Prothrombin time? What deficiencies can it detect?

What is partial thromboplastin time? What deficiencies can it detect?

What is thrombin time?

Hematinics

Name 4 substances that chelate with iron

State 4 ways iron can be lost from the body

How is iron poisoning treated?

Fill in the blanks about vit. B12Absorbed complexed with Location of absorption Bound in plasma with Deficiency in

Thalassemia

B-thalassemia is cause by mutations in the genes of the affected individuals. Name one type of gene mutation that can lead to b-thalassemia.

Regarding b-thalassemia: explain why the red blood cells are hypochromatic

Explain why the rbc have a chortened life span

State 3 clinical features b-thalassemia. Explain why iron overlaod may occur in b-thalassemia patients.

Gice 2 investigations and their expected findings for patients with bthalassemia.

State 2 common forms of treatment for b-thalassemia

Deletions of the a-globin gene loci result in a-thalassemia. State the number of a-globin genes deleted in the following conditions:Silent carrier state A-thalassemia trait HbH HbBart

Explain how fetal death due to hydrops fetalis occurs

Chronic fatigue syndrome

True/ false Patients with CFS suffer severe fatigue that can be reduced with sufficient rest Disturbed sleep, muscle pain, & impaired memory are among the diagnostic criteria for CFS Anti-depressant & anxiolytic agents are among the medication treatment for CFS Cognitive behavioural therapy can be used to cure patients with CFS A doctor can facilitate the treatment outcome of CFS by being empathetic to the patient and educate them about this condition

Aplastic anemia

Describe the morphology of the bone marrow in a patient with aplastic anemia

Give 3 possible causes of aplastic anemia

Give 2 medical treatment for aplastic anemia

What occurs during myelodysplastic syndromes & what medical condition can it predispose to?

Hemoglobinopathies

State the pathogenesis of sickle cell anemia. Include the changes that happen to the haemoglobin and blood flow in response to low oxygen

State 3 factors that affect RBC sickling

What are the main consequences of HbS

What are the 3 main characteristics of Sickle cell anemia?

Is x-ray important for the diagnosis of sickle cell anemia?

State the 3 morphologies of organs found in sickle cell anemia

State 5 clinical signs and symptoms in sickle cell anemia

Explain why is there autosplenectomy

What are the complications in Sickle cell anemia? Name 4

State 6 investigations that can be carried out other than RBC smear. Include positive and negative findinds

Why homozygous sickle cell trait is more ganderous that the heterozygous cell trait?

Apart from the patient experiencing tiredness and breathlessness due to anemia, what other clinically important signs and symptoms that can be picked up?

Why does the sickle cell trait protect against malaria?

Name ove virus that can cause aplastic crisis in sickle cell anemia

Haemopoiesis II

Name 3 chemicals that influence platelet production and elaborate on how each chemical affects platelet production

Explain the development steps of granulocyte cells

What are the differences between granulocytes and agranulocytes?

Name 2 chemmicals that control the development of granulocytes

In which from do monocytes appear in bone marrow and in the periphery

In which form are neutrophil granulocytes seen in the bone marrow and in peripheral blood

Platelet biology and Hemostasis

Name the 3 major steps in hemostasis

Name the 3 functions of platelets

Name 2 substances that is released from the surface endothelium

Name 1 stimulatory substance for each of the following processesVasoconstriction Platelet aggregation Blood coagulation

Describe the roles of thromboxane A2 and Prostacyclin in the process of platelet aggregation

Name 2 clotting factors for each of the following 3 categoriesContact factors Vik. K dependant factors Fibrinogen factors

What are the factors that will trigger the following pathway?Intrinsic pathway Extrinsic pathway

Give an example of a prothrombin activator

Name an anti-clotting system and briefly describe its process

Name a fibrinolytic system and briefly describe its process

Abnormalities of haemostasis

Write down the effects of Hemophilia A and von Willebrand Factor deficiencyHemophilia A Bleeding time Platelet count Clotting time APTT Prothrombin time Von Willebrand Factor deficiency

What are the 2 functions of the von Willebrand factor?

Define the following temrBleeding time Clotting time Plateled count Prothrombin time Thrombin time Activated Partial

Hemolytic Anemia

A young boy, aged 6, was admitted into the hospital for lethargy. The doctor who examined him found the patient to be slightly jaundiced and pale. Splenomegaly was also present. The following are a few of the test results: Peripheral blood smear: microcytic, hyperchromic RBCs. Presence of spherocytes Reticulocyte count: increased Plasma bilirubin: increased Mean cell hemoglobin concentration: inceased

On further questioning, the doctor discovered that the boy s uncle and two other cousings also had the same condition. The doctor later concluded that the boy has hereditary spherocytosisName another important test which is used to diagnose the pathology. What would the results be if the person has such condition, and what would you say?

The following statements make up the pathogenesis of hereditary spherocytosis. Arrange them in the proper chronological order.The cells assume the smallest possible diameter for a given volume. They become spheres Mutations in the ankyrin molecule cause a secondary deficiency of spectrin, which

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