Haematology Flashcards
(42 cards)
Results of which of the following will identify that a patient is iron deficient?
-Hb
-MCV
-MCH
-ferritin
-transferrin saturation
Ferritin
Ferritin corresponds to iron storage. Low ferritin tells you a patient has iron deficiency.
When do ferritin levels not correspond to iron deficiency?
If the person has inflammation e.g. pneumonia, they can have ferritin in the normal range, but this doesn’t actual mean they haven’t got iron deficiency. Test again when patient has recovered.
Which of the following would be used to treat iron deficiency in an adult?
Ferrous fumarate 210mg od
Note: in children you can use ferrous edetate bc they might not tolerate tablets but this can stain teeth.
All patients with iron deficiency should also be screened for coeliac disease
If patient has surgery of proximal jejunum, what type of anaemia would you expect in this patient?
Microcytic anaemia
- Iron is transported to the red cytosol
2.Iron combines with porphyrin ring - The formation of haem
- Combines with globin (alpha or beta)
- Globulin subunits combine to form tetrameric haemoglobin
Which of the following tests help you distinguish between poor compliance and blood loss?
-ferritin
-reticulocyte count
-MCV
-erythropoietin level
Reticulocytosis count
If reticulocytosis is occurring you know compliance is occurring in patients with low iron, even if they are losing blood.
Reticulocytosis count would be low in poor compliance.
A 50 year old man presents with a macrocytic anaemia, he has positive intrinsic factor antibodies and a diagnosis of pernicious anaemia is made. Is this correct?
Yes
positive intrinsic factor antibodies in a patient with macrocytic anaemia indicates that the patient has pernicious anaemia
Where does the absorption of B12-intrinsic factor complex take place?
Ileum
The gastric parietal cells produce intrinsic factor
How do you treat pernicious anaemia?
IM B12
What causes pernicious anaemia?
autoantibodies target either the parietal cells or intrinsic factor, resulting in a lack of intrinsic factor and a lack of absorption of vitamin B12
Other than pernicious anaemia, what else causes B12 deficiency?
-dietary intake (vegan/veggie)
-pancreatitis
-malabsorption/coeliac
-high dose of PPIs
Where is folate absorbed?
Jejunum
A patient with liver disease has a prolonged prothrombin time (PT). Which factor of the coagulation cascade is most likely to be deficient?
Factor 7
PT measures the extrinsic pathway of the coagulation cascade which is activated when there’s tissue injury or damage. Factor 7 is the first clotting factor activated in this pathway and it has the shortest half life of all the factors in the coagulation cascade.
What measures the time taken for fibrin to clot via the intrinsic pathway of the coagulation cascade?
Activated partial thromboplastin time (APTT)
The intrinsic pathway is activated when there is endothelial injury or damage.
What is the most likely cause of her symptoms?
-anaemia of chronic disease
-Megaloblastic anaemia
-Sideroblastic anaemia
-haemolytic anaemia
-iron deficiency anaemia
Which of the following is the most likely cause of his acute haemolytic anaemia?
-auto immune haemolytic anaemia
-acute lymphoblastic anaemia
-haemophilia A
-G6PD deficiency
-sickle cell anaemia
What is the most likely cause of the examination and investigation findings?
-folate deficiency anaemia
-haemochromatosis
-alpha thalassemia
-iron deficiency anaemia
-B12 deficiency
Increased haemoglobin, increased ferritin and decreased total binding capacity would present in what haematological condition?
Haemochromatosis
This is caused by increased intestinal iron absorption and subsequent iron deposition in nearly all organs over the body
Options:
IV paracetamol
-oral chlorphenamine
-IM adrenaline
-IV furosemide
-IV fluid resuscitation
Answer: IV fluid resuscitation
Options:
-strep penumoniae
-e coli
-staph aureus
-enterobacter cloacae
-moraxella catarrhalis
Answer;
strep penumoniae - gram positive diplococcus, encapsulated
E. coli- gram negative, rod shaped, not encapsulated
Staph aureus- gram positive, spherical shaped, not encapsulated
enterobacter cloacae - gram negative, rod shaped, not encapsulated
Moraxella catarrhalis- gram negative diplococcus, not encapsulated
Options:
-autoimmune haemolysis
-microangiopathic haemolytic anaemia
-splenic phagocytosis and lysis of abnormal red cells
-complement mediated red cell lysis
-internal oxidative stress causing intrinsic cell rupture
Options:
-he should be started on B12 and folate at the same time
-support with alcohol dependency is all that he requires to correct his deficiencies
-his folate should be replaced before his low B12
-support with nutrition is all that he requires to correct his deficiencies
-his B12 should be replaced before his folate
B12 should be replaced before his folate
If B12 and folate deficiency are both present, B12 must be given first to prevent subacute degeneration of the spinal cord. This condition is caused by inadequate B12 levels and folate metabolism requires B12 so B12 stores will be further depleted when folate is administered. As such, must administer B12 first.
