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Haematology > 1: Iron Deficiency Anaemia, INR Reversal and Emergencies > Flashcards

1: Iron Deficiency Anaemia, INR Reversal and Emergencies Flashcards

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1
Q

What is the most common anaemia

A

Iron-Deficiency

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2
Q

How can aetiology of IDA be divided

A
  • Insufficient intake
  • Increase need
  • Increase loss
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3
Q

What can lead to insufficient oral intake

A

Vegan

Eating Disorder

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4
Q

What are 3 causes of insufficient absorption

A

Whipple’s procedure
Coeliac disease
Hypochlorhydria (H.Pylori induced gastritis)

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5
Q

What are 2 causes of increased need to iron

A
  • Pregnancy

- Puberty

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6
Q

What are the categories of increased loss

A

Occult and Overt

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7
Q

What can cause overt blood loss

A
  • Menses
  • Haematemesis
  • Haematuria
  • Trauma
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8
Q

What can cause occult blood loss

A
  • GI Bleed
  • Peptic Ulcer
  • Haemorrhoids
  • Hookworm
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9
Q

What are the likely causes of IDA in children

A
  • Meckel’s diverticulum

- Malnutrition

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10
Q

What are the likely causes of IDA in adolscents

A

Menarche

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11
Q

What can cause IDA in 20-50 year-olds

A
  • Menorrhagia
  • Pregnancy
  • Peptic ulcer
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12
Q

What is the commonest cause of IDA in over-50’s in developed countries

A

Colorectal cancer

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13
Q

What is the commonest cause of IDA in over-50’s in developing countries

A

Hookworm

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14
Q

How does IDA present clinically

A
  • Dyspnoea
  • Pallour
  • Lethargy
  • Dizziness and Syncope
  • Cardiac Failure
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15
Q

What are signs of IDA

A
  • Angular stomatitis
  • Glossitis
  • PICA
  • Brittle nails
  • Kolonychia
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16
Q

What is plummer-vinson syndrome

A
  1. Glossitis
  2. IDA
  3. Dysphagia - due to oesophageal webs
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17
Q

How will FBC present in IDA

A
  • Low Hb
  • Low MCV
  • Low MCHC
  • High RDW
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18
Q

How will iron studies present in IDA

A
  • Low Ferritin
  • Low transferrin saturation
  • High TIBC
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19
Q

Explain TIBC in IDA

A

Low iron concentration means more free sites on transferrin to bind

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20
Q

What is the problem with using ferritin as a marker for anaemia

A

Ferritin is an acute phase protein and increases with inflammation

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21
Q

What will be seen on blood-film in microcytic anaemia

A
  • Anisocytosis
  • Poikilocytosis
  • Target cells
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22
Q

What is anisocytosis

A

cells unequal in size

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23
Q

What is poikilocytosis

A

cells unequal in shape

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24
Q

What are target cells

25
What is used to test for coeliac disease
anti-TTG
26
If IDA in males or non-menstruating females what should be ordered
gastroscopy and colonoscopy
27
when is stool microscopy for ova ordered
recent foreign travel
28
what are ova used to detect
hookworm
29
when should individuals be referred to a gastroenterologist if over 60
IDA
30
when should individuals be referred to a gastroenterologist if over 50-60
- FH Colorectal cancer - Marked anaemia - Rectal bleeding
31
when should individuals under 50 be referred to gastroenterology
- Symptoms colorectal cancer - Persistent IDA despite treatment - FH
32
How is IDA managed
Oral Ferrous Sulphate
33
How long should ferrous sulphate be continued
3 months after stores have replenished
34
What advice is given to individuals with IDA
Increase intake of dark-green leafy vegetables
35
What are 3 requirements to stop warfarin/ other anti-coagulation
1. High INR 2. Bleeding 3. Surgery
36
If an individual has an INR >8 what is done
- Stop warfarin | - 1-5mg vitamin K PO
37
When is warfarin re-started if stopped due to an INR >8
When less than 5
38
How is INR 5-8 managed
Withhold 1-2 doses of warfarin and re-start at a subsequent lower maintenance dose
39
what is the risk with stopping warfarin for surgery
Risk VTE
40
what is the risk of continuing warfarin during surgery
Bleeding
41
If a major surgery, how many days before should warfarin be stopped
5-days
42
what anticoagulation is given as a bridging method
LMWH
43
how long is LMWH continued for
Stop 24-hours before surgery
44
what are the indications for bridging LMWH
- AF - Mechanical heart valve - High risk of VTE
45
what is measured the day before surgery
INR
46
if INR is >1.5 the day before surgery what is done
Oral vitamin K
47
when is warfarin resumed following surgery
Evening or next-day
48
how long after surgery should heparin be started
24-48h
49
explain changes in anti-coagulation prior to minor surgery
Advise INR between 1.5-2. | No change in anti-coagulation required unless more than 3
50
how long before surgery are DOACs stopped
24-48h before
51
if a person is on warfarin and requires emergency surgery that can be delayed 6-12h, what is done
IV Vitamin K to reverse anti-coagulation
52
if a person is on warfarin and requires emergency surgery that cannot be delayed, what is done
IV Prothrombin complex and IV Vitamin K
53
if an individual has a major bleed what is done
- Stop warfarin - IV Vitamin K - Prothrombin Complex
54
what is vitamin K called
phytomenadione
55
what factors are in prothrombin concentrate
2 7 9 10
56
if an individual has a INR > 8 and a minor bleed what is done
- Stop warfarin | - IV Vitamin K
57
when is warfarin re-started if above 8 and minor bleed
- When less-than 5
58
if INR is 5-8 and minor bleed, what is done
Stop warfarin | IV Vitamin K
59
what is given for a major bleed
protamine sulphate

Haematology (19 decks)

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