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EBM > Haematology lectures > Flashcards

Haematology lectures Flashcards

1
Q

What is haemopoiesis?

A

Formation of blood and immune cells

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2
Q

What is Erythropoiesis?

A

Formation of red blood cells

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3
Q

What stimulates Erythropoiesis?

A

Kidneys detect a drop in circulating oxygen and secrete the hormone erythropoietin

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4
Q

What is the WHO definition for anaemia (Hb levels)

A

Men: below 130g/L
Women: 120g/L
Pregnant: 110g/L

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5
Q

What are the main types of anaemia?

A

Iron Deficiency Anaemia; Anaemia of Chronic Disease; megaloblastic - folate or VitB12 deficiency

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6
Q

How is anaemia classified?

A

Microcytic
Normocytic
Macrocytic

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7
Q

What are the limits for normocytic anaemia?

A

80-99fL

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8
Q

What type of anaemia is macrocytic?

A

Megaloblastic anaemia

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9
Q

What type of anaemia is microcytic?

A

Iron deficiency anaemia; AoCD (can also be normocytic)

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10
Q

What are the general clinical features of anaemia?

A

Tiredness; Pale; Fainting; SOB; Increased HR; worsening angina, cardiac failure, leg cramping

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11
Q

What causes Iron Deficiency Anaemia?

A

Poor nutrition; malabsorption; blood loss; increased need for iron

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12
Q

Specific symptoms of IDA

A

Painless glossitis; Angular stomatitis; Koilonychia (spoon nails); Pica; Atrophic gastritis

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13
Q

First Line treatment for IDA

A

Ferrous sulphate, 100mg-200mg/day

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14
Q

Patient counselling for oral iron

A

Take on empty stomach; black stools; N&V, constipation, diarrhoea; interactions; dietary sources; importance of treatment

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15
Q

Oral iron absorption reduced by

A

Calcium, magnesium, bisphosphonates, tetracycline, PPI

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16
Q

How is IDA treatment assessed?

A

Hb should increase by 20g/L every 3-4 weeks. Check after 4 weeks, then every 3 months for 1 year

17
Q

What is hepcidin?

A

Hepcidin causes ACD, and is produced in the liver to reduce iron absorption, prevent utilisation of available iron, and prevent release from iron stores

18
Q

What is the mechanism of ACD?

A

Cytokine-mediated production of hepcidin, reduced production of erythropoietin

19
Q

How can we differentiate IDA and ACD?

A

IDA: low serum iron and ferritin, normal or increased serum transferrin, increased serum transferrin receptors.
ACD: low serum iron, normal or increased ferritin, normal or decreased serum transferrin and receptor.
Summary: in ACD, the body thinks it has plenty of iron

20
Q

When can erythropoietin analogues be used in ACD?

A

Chronic renal failure, cytotoxic chemotherapy, to increase yield of autologous blood in major surgery

21
Q

What is megaloblastic anaemia?

A

Abnormality in haematopoietic cell maturation in the bone marrow leading to macrocytic RBCs

22
Q

When should folate / VitB12 deficiency be suspected?

A

1+ of: Oval, macrocytic RBCs; hyper-segmented neutrophils; pancytopenia; unexplained neurological symptoms

23
Q

What is pancytopenia?

A

Deficiency of RBS, WBC, and platelets

24
Q

What causes folate deficiency?

A

Nutritional Deficiency
Malabsorption
Medication eg phenytoin
Increased requirement

25
Q

How long does it take to replenish folate stores?

A

4 months

26
Q

How is folate deficiency managed?

A

5-15mg folic acid daily for 4 months if due to diet, over 4 months if irreversible cause. Monitor FBC and reticulocytes after 10 days and 8 weeks. Exclude VitB12 deficiency before starting.

27
Q

Folate deficiency prophylaxis

A

400mcg daily before pregnancy and for first 12 weeks, 5mg if established deficiency or previous neural tube defects.

28
Q

What causes VitB12 deficiency

A

Dietary restriction (meat, diary, eggs, fish); Gastric abnormalities; small bowel disease; medication

29
Q

How long can VitB12 stores last?

A

4 years

30
Q

What is pernicious anaemia?

A

Autoimmune disorder causing reduced intrinsic factor needed for absorption in distal ileum

31
Q

How is VitB12 deficiency without neurological involvement treated?

A

1mg IM hydroxocobalamin

1 injection 3x per week for 2 weeks, then one every 3 months. FBC and reticulocytes after 10 days and 8 weeks

32
Q

How is VitB12 deficiency with neurological involvement treated?

A

1mg IM hydroxocobalamin

1 injection 5x per week for 4 weeks then once every 2 months. FBC and reticulocytes after 10 days and 8 weeks.

EBM (3 decks)

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