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CP3 Medicine > HAEM - Normocytic Anaemia > Flashcards

HAEM - Normocytic Anaemia Flashcards

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1
Q

How would blood results look in bone marrow failure?

A 
Hb 
Reticulocytes 
WBC
Platelets 
All equally low
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2
Q

If there are no abnormal blasts in pancytopenic marrow - what is the diagnosis?

A

Aplastic anaemia

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3
Q

Which infecction can cause cessation of marrow erythropoesis

A

Parovirus

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4
Q

Def haemolysis

A

The breakdown of RBC before the end of their normal life span

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5
Q

Intrinsic causes of haemolysis (3)

A

Haemoglobinopathies - Sickle cell/thalassaemia
Membranopathies - spherocytosis, eliptocytosis
Enzymeopathies

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6
Q

Extrinsic causes haemolysis (5)

A 
Autoimmune - warm/cold
Alloimmune - Rhesus, transfusion/transplant
Dx - pencillins 
Parasites - plasmodium 
Microangiopathic - DICq
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7
Q

Ix normocytic haemolysis

A 
FBC 
Blood film 
Coomb's 
Hb electrophoresis 
Enzyme assays 
Plasma haptoglobin and urinary haemosiderin
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8
Q

Signs of haemolysis on blood count

A

Anaemia w/ incr MCV
Raised bilirubin
Raised se LDH
Reticulocyte count >2%

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9
Q

What are you looking for: haemolysis and Coomb’s test

A

RBC coated in ab/complement –> immune cause

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10
Q

Use of Hb electrophoresis in haemolysis

A

ID different haemoglobinopathies

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11
Q

Use of plasma haptoglobin + urinary haemosiderin in haemolysis

A

If plasma haptoglobin = reduced
And
Urinary Haemosiderin = present
== intravascular haemolysis

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12
Q

Genetic linkage Sickle cell anaemia

A

Autosomal recessive

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13
Q

What type of Hb is produced in Sickle cell

A

HbS

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14
Q

Who gets Sickle cell

A

people of African origin

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15
Q

What are the 2 Sickle cell genotypes

A

HBSS

HBAS

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16
Q

Which genotype –> Sickle Cell phenotype

A

HBSS

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17
Q

What positive is there to having the Sickle cell trait?

A

Protection from Malaria

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18
Q

Diagnosis Sickle Cell anaemia (3)

A

Guthrie
Sickle cells blood film
Hb electrophoresis (confirms)

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19
Q

Sx SIckle cell anaemia - first few m of life

A

Anaemia

Acute haemolytic crisis –> bone infarcts + painful dactylitis

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20
Q

What can happen if Acute haemolytic crisis is not treated in SickleCell disease

A

Splenic infarction –> hyposplenism

Repeated renal infarction –> CKD + CVA

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21
Q

Complications of having Sickle cell disease (6)

A 
Hyposplenism 
CKD
Bone necrosis 
Chronic leg ulcers 
Fe overload 
LT pulmonary damage
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22
Q

Chronic treatment for Sickle Cell disease

A

Lifelong folate
Pneumococcal vaccine + prophylactic penicillin
Hydroxcarbamide
Life long transfusions + Fe chelate

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23
Q

Cure Sickle cell disease

A

BM transplant

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24
Q

Why do vasoocclusive crises occur in Sickle cell?

A

B/C microvascular occlusion

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25
PS vasoocclusive crises occur in Sickle cell (4)
``` SEVERE PAIN Sometimes : Mesenteric ischaemia Cerebral infarctions Priapism ```
26
Precipitants: vasoocclusive crises occur in Sickle cell (4)
Cold Infection Dehydration Hypoxia
27
Cause aplastic crisis
Parovirus B19
28
mx aplastic crisis
Usually self limiting | +/- transfusion
29
Who gets sequestrian crises
Mainly children
30
Sequestrian crises
Pooling of blood in spleeen/liver --> organomealy, anaemia + shock
31
Mx sequestrian crises
Urgent transfusion
32
2 examples of enzymopathies
G6PD deficiency | PK deficiency
33
genetic linkage G6PD deficiency
X linked
34
Which population suffers from G6PD deficiency?
African/med
35
Precipitants - G6PD attacks (5)
``` Aspirin Primaquine Sulphonamides Broad beans Illness ```
36
Diagnosis G6PD deficiency
Enzyme assay 3 m after crises
37
Tx G6PD defic
Ppt avoidance | Transfusion if severe
38
Cells on film G6PD deficiency
Bite cells + blister cells
39
Genetic linkage PK deficiency
Autosomal recessive
40
PS PK deficiency
Neonatal jaundice --> chronic jaundice + HS megaly
41
Diagnosis PK deficiency
Enzyme assay
42
Mx PK deficiency
Well tolerated | Hence not needed
43
Genetic linkage Hereditary spherocytosis
Autosomal dominant
44
RBC appearance Hereditary spherocytosis
Spherical
45
Why do you get Sx in Hereditary spherocytosis
Spherical RBC = < deformable | Get trapped in spleen --> haemolysis, jaundice and splenomegaly
46
Genetic linkage Hereditary Eliptocytosis
Autosomal dominant
47
RBC appearance Hereditary Eliptocytosis
Ellipse/oval shaped
48
Sx Hereditary Eliptocytosis
Mostly asymp
49
Mx for membranopathies
Folate | Splenectomy - curative but only in severe cases
50
e.g.s of Coomb's +ve extrinsic causes of haemolysis (2)
Autoimmune haemolytic anaemia AHA | Drug induced haemolysis
51
Cause AHA
Commonly idiopathic Or 2' to lymphoproliferative disorders
52
How are AHA's classified
On optimal Temp antibodies bind to RBC in vitro
53
What are the 2 types of AHA
Warm AHA | Cold AHA
54
Binding temperature warm AHA
37'
55
Which immune Ig is warm AHA mediated by?
IgG
56
Mx warm AHA
steroids +/- immunosuppressants +/- splenectomy
57
Binding temperature cold AHA
4'
58
What condition is cold AHA associated with?
Raynauds
59
Which immune Ig is cold AHA mediated by?
IgM
60
Mx cold AHA
Cold avoidance | Chlorambucil
61
Drug induced haemolysis - pencillins
Formation RBC antibodies
62
Drug induced haemolysis - quinine
Production of immune complexes
63
Infection --> Coomb's -ve haemolysis
Malaria/Parasites
64
E.g.s of microangiopathic anaemia (6)
``` Malig HTN/pre-eclampsia HUS TTP DIC SLE/vasculitis Mechanical heart valve ```
65
Blood film appearance microangiopathic anaemia
Schistocytes
66
Which category do alloimmune reactions haemolysis fall into?
Immune mediated But Coombs negative
67
What anaemia levels before surgery req transfusion?
<60g/L

CP3 Medicine (29 decks)

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