Haematology Flashcards
(49 cards)
Macrocytic anaemia 3 DDx
deficiencies of folate and vitamin B12, liver disease alcohol excess untreated hypothyroidism myelodysplastic syndromes
macrocytic anaemia 3 Ix
B12/folate
thyroid functions tests
liver function tests
blood film to confirm macrocytosis and exclude myelodysplastic syndrome
Diet that often -> b12 deficiency?
vegan
[b12 in meat and dairy]
Pernicious anaemia is?
mx?
autoimmune condition with antibodies directed
against gastric parietal cells or intrinsic factor itself,
-> prevents absorption and binding of B12 from the diet
intramuscular hydroxycobalamin
Mx sickle cell crisis
high-flow oxygen, intravenous
fluids, thromboprophylaxis, antibiotics
consider transfusion
Why abx in sickle cell crisis
sickle cell patients will have autoinfarcted their spleen
in childhood, rendering them functionally
asplenic
3 causes of pleuritic chest pain
- Pleural inflammation secondary to bacterial or viral chest infections
- Pulmonary embolus
- Asthma
- Rib fractures/pathology
- Subphrenic abscess/intra-abdominal sepsis
- Lung masses
- Connective tissue disorders/autoimmune disorders
Biochem common findings with upper GI bleed
acute - raised platelets
Urea raised - [more than creatinine]
Anaemia
Initial Mx of upper GI bleed ? After resus? Scoring system for upper GI bleed mortality?
good venous access (minimum of two large-bore cannulae),
Bloods FBC, LFT, clotting tests,
Group and save, and a cross-match for four units of packed red cells.
Volume replaced with colloid
After resus
All anticoagulants, antiplatelets, NSAIDs stopped
High dose PPI
Endoscopy within 24hrs
Rockall score
Name 3 causes of upper GI bleed
–– Peptic ulcer disease –– Oesophagogastric varices –– Arteriovenous malformations –– Mallory–Weiss tears –– Tumours and erosions
Main DDx in an older person with normocytic anaemia
• Anaemia of chronic disease
• Most haemolytic anaemias
• Mixed causes of anaemia
- [If Iron and folate/b12 deficient it is possible that they ‘cancel’ each other out leading to a normal MCV]
Name 2 congenital causes of haemolytic anaemia
sickle cell disease,
thalassaemia,
glucose-6-phosphate dehydrogenase deficiency,
hereditary spherocytosis
Name 3 acquired causes of haemolytic anaemia
Autoimmune infections – particularly Mycoplasma pneumoniae or Clostridium perfringens sepsis, drugs, burns, metallic heart valves
Basic bloods / Hx make you suspicious of autoimmune anaemia - what further Ix do you want?
blood film, reticulocyte count, Coombs’ test, unconjugated bilirubin LDH
In autoimmune haemolytic anaemia, what provokes
their uptake by the reticuloendothelial system and promote red cell haemolysis
RBCs are coated in either
antibodies (IgG) or complement (C3d)
2 main DDx in rapid onset anaemia
bleeding
autoimmune
Mx of autoimmune haemolytic anaemia
remove any precipitating cause, and immunosuppression
with high-dose steroid therapy
[can add ciclospoin / azathioprine….. transfusion may be indicated]
Name 3 DDx of pancytopenia
Post-chemotherapy (transient) • Haematinic deficiency (B12 or folate) • Autoimmune conditions • Sepsis • Bone marrow infiltration from lymphoma or other metastatic malignancy • Myelodysplastic syndrome • Acute or chronic leukaemias • Acute viral infections • Drug induced
Peripheral lymphocytosis DDx
ALL, CLL, Lymhoma
EBV, CMV
three most common causes for bilateral hilar lymphadenopathy
Sarcoidosis
lymphoma
TB
name 3 causes of raised LDH
- Myocardial injury
- Malignancy (especially lymphoma)
- Liver disease
- Lung disease
- Haemolysis
DDx of thrombocytopenia
- Immune thrombocytopenic purpura
- Drug-induced thrombocytopenia
- Acute viral infection (e.g. HIV, hepatitis C)
- Sepsis
- Underlying haematological malignancy/myelodysplastic syndrome
Immune thrombocytopenic purpura
Lab findings?
Mx?
Low platelets - all other results normal [unless bleeding -> anaemia]
Steroids
-transfusion not indicated unless major haemorrhage
Treatment of DVT in pregnancy
LWMH - usually continue throughout pregnancy
