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Flashcards in Haematology Deck (73)
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1

What are the general S+S of anaemia (7 +4)

Asymp
Non specific: fatigue / headache / weakness

CV: angina / SOB on exertion / palpitations / IC

Pallor
Cardiac failure
Tachycardia
Systolic murmur

2

List some specific signs of certain types of anaemia (4)

Koilonychia - Fe defc
Jaundice - haemolytic
Leg ulcers - sickle
Bone marrow expansion (abnormal facies + fractures) - thalassaemia

3

When is transfusion indicated in anaemia + how should it be given?

If anaemia is severe

Caution of heart failure: transfuse slowly + w. furosemide

4

List the causes of microcytic anaemia (4)

Fe defc (blood loss unless proven otherwise)
Thalassaemia
Lead poisoning
Sideroblastic anaemia

5

List the causes of normocytic anaemia (8)

Acute blood loss
Anaemia of chronic disease
Pregnancy
Dimorphic blood film (micro+macro)
Renal anaemia
Haemolytic anaemia
Marrow failure
Connective tissue disorders

6

List the causes of macrocytic anaemia (6)

Alcohol excess (or severe liver disease)
B12 defc (Pernicious / Crohn's)
Folate defc (coeliac)
Myelodysplastic syndromes
Severe hypothyroidism
Reticulocytosis haemolytic

7

What are the normal Hb levels in men + women

What is the normal range for MCV

Men: Hb >13.5
Women: Hb >11.5

MCV Normal range: 80–96fL

8

List some specific peripheral stigmata of microcytic anaemia (3)

Koilonychia
Angular stomatitis
Brittle hair/nails

9

What would Iron studies show in Fe defc anaemia

Reduced Fe
Reduced Ferritin
Raised TIBC
Raised transferrin receptors

10

List some causes for Fe defc anaemia (8)

Hookworm (worldwide)
Menorrhagia
GI bleed
Coeliac (reduced absorption)
Post-gastrectomy
Growth / Pregnancy
Premature infants
Prolonged breast fed

11

What further Ix should be done in microcytic anaemia (2)

Blood film
Iron studies

12

What are the features of Paterson-Brown-Kelley (Plummer-Vinson) syndrome (5)
How is it treated

Dysphagia
Odynophagia
Oesophageal webs
Fe defc anaemia
Glossitis / Chelitis

Fe supplementation + Oesophageal widening

13

What are the features of:
B minor (trait) thalassmia
B major (Cooley's) thalassaemia
Alpha thalassaemia

Trait: Asymp/Worsens in preg, mild microcytic (confused w. Fe defc)

Major, presents in 1st yr:
Severe anaemia / FTT
Hepatosplenomegaly / Abnorm facies

Alpha: Barts hydrops (4) / haemolytic sx / asymp

14

What Ix can be done into thalassaemia?

Blood film:
Targets cells + Nucleated RBCs

15

What diseases are usually responsible for anaemia of chronic disease (ACD)

Due to predominate WBC prodn:

Chronic infection
Rheumatoid disorders
Malignancy
CKD

16

What further Ix should be done in normocytic anaemia

NB if clear h/o menorrhagia – NONE

Iron studies
Coeliac screen
Recent travel – stool microscopy
No obvious source – OGD/Colonoscopy
Bone marrow biopsy

17

List the causes for bone marrow failure (6)

Aplastic anaemia
Haematological malignancies
Metastasis
Myelofibrosis
Myelodysplasia
Parvovirus (stops marrow erythropoiesis)

18

What further Ix should be done in macrocytic anaemia + why (5)

What further Ix should be done if B12 is shown to be low (2)

Blood film:
Hypersegmented neutrophils = B12/Fol defc
Target cells (liver disease)

LFTs:
Liver cause
Raised bili B12/Fol

TFTs: severe hypothyroid

Bone marrow biopsy:
Megaloblasts = B12-Fol // Myelodysplasia

Serum B12-Fol

If B12 low:
Anti-parietal Ab / anti-IF Ab
Schilling (gold standard) (pernicious vs small bowel)

19

List some causes for B12 defc (10)

VEGANS

Impaired stomach binding:
Pernicious anaemia
Gastrectomy
Congenital IF absence

Small bowel:
Crohn's
UC backwash ileitis
Bacterial overgrowth

On mild defc:
Pancreatitis
Coeliac
Metformin

20

List some causes for Folate defc (9)

Dietary: defc/anorexia
Alcohol excess
Malabs: Coeliac

Anti-folates (trimethoprim, MTX)

Pregnancy
Premature

Malignancy
Inflamm conditions
XS RBC prodn e.g. haemolysis

21

List the differentials for haemolytic anaemia (2: 3+5)

Intrinsic (hereditary):
Haemoglobinopathies – sickle / thalassaemia
Membranopathies – spherocytosis / eliptocytosis
Enzymopathies – G6PD / PK defc

Extrinsic (acquired):
Autoimmune – lymphproliferatives // others e.g. SLE
Alloimmune – Rh / transfusion / transplant
Drugs – e.g. penicillins
Parasites – plasmodium
Microangiopathic – DIC

22

What Ix results (FBC+LFTs) would suggest a haemolytic picture? (4)

Increased breakdown:
Macrocytic
Raised bilirubin
Raised LDH

Increased prodn:
Raised reticulocytes

23

What further Ix should be done if suspect haemolytic anaemia? (6)

Blood film
Coombs'

Hb electrophoresis
Plasma haptoglobin
Urinary haemosiderin
Enzyme assays

24

What occurs in a sequestration crisis?

Organomegaly
Severe anaemia
Shock

25

What is seen on blood film of:
Thalassaemia
G6PD
Microangiopathic

Thalassaemia: hypochromic / microcytic

G6PD: Heinz bodies / 'bite/blister' cells

DIC: schistocytes

26

List some complications of sickle cell anaemia (8)

Bone infarction (necrosis)
Renal infarction (CKD)
Splenic infarction (hyposplenism)
Painful dactylitis
Chronic leg ulcers
Chronic lung damage
Fe overload (transfusions)
CVA

27

How does a sickle cell crisis present?
(Sickle Cell Acute Presentation) (4)

List some precipitating factors (4)

Severe bone pain**
CVA (Cerebral infarct)
Acute abdo (acute mesenteric ischaemia)
Priapism

Dehydration
Hypoxia
Cold
Infection

28

What is an aplastic crisis?
What is it due to?
How is it managed?

Sudden reduced bone marrow prodn

Due to parvovirus

Self-resolves 2wks but may need transfusion

29

Outline the acute management of sickle cell crises

A–E (inc. high flow O2 / fluids)
Strong analgesia
FBC / X-match / Reticulocytes
Infection screen (culture/MSU/CXR)
LMWH (prophylaxis)
Transfusion

30

Outline the long-term management of sickle cell anaemia

Lifelong transfusions
Lifelong folate supplements
Pneumococcal vx / Pen V (hyposplenism)
Hydroxycarbamide/hydroxyurea if freq crises (HbF prodn)
Bone marrow transplant (curative)