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3B > NEW HAEM 1 > Flashcards

NEW HAEM 1 Flashcards

1
Q

Microcytic anaemia

A

TAILS

Thalassaemia
AoCD
Iron deficiency
Lead poisoning
Sideroblastic
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2
Q

Normocytic anaemia

A 
AoCD
Acute bleed
Pregnancy
CKD
Aplastic anaemia
Bone marrow infiltration

Haemolytic anaemia

  • G6PD
  • Hereditary spherocytosis
  • Sickle cell
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3
Q

Macrocytic anaemia

A

Megaloblastic

  • Folate
  • B12

Normoblastic

  • Hypothyroid
  • Alcohol
  • Reticulocytosis
  • Azathioprine
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4
Q

Iron deficiency anaemia aetiology

A

Uptake in the duodenum

Excessive blood loss

  • Menorrhagia
  • GI bleed - Colorectal cancer in men, peptic ulcers

Inadequate dietary intake

  • Meat and leafy greens
  • Veggie diet is RF

Poor intestinal absorption

  • Coeliac / Crohn’s
  • Gastrectomy

Increased iron requirements

  • Children
  • Pregnant ladies
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5
Q

Iron deficiency anaemia clinical features

A

Fatigue
SOBOE
Weakness

PICA
Restless leg syndrome
Kolionychia - Spoon nails

Glossitis
Angular stomatitis

Gastric difficulties
Hair loss

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6
Q

IDA investigations

A

FBC - Microcytic hypochromic + Low reticulocytes
Blood film - Anisopoikilocytosis - Red cells of different shapes and sizes

Iron studies

  • MCH - Low
  • Serum ferritin - Low
  • TIBC - High
  • Transferrin saturation - Low

Coeliac seriology

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7
Q

IDA history

A
  • Change in diet
  • Medication history
  • Menstrual history
  • Weight loss
  • Change in bowel habit
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8
Q

IDA management

A

Treat cause

Ferrous sulphate

  • Nausea
  • Abdo pain
  • Constipation
  • Diarrhoea
  • Black stools

Iron-rich diet

  • Leafy greens
  • Meat
  • Iron-fortified bread
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9
Q

Pernicious anaemia pathophysiology

A

B12 deficiency

Pathology

  • AI disorder
  • Antibodies to IF and/or gastric parietal cells
  • Antibodies bind to IF - Block B12 binding site
  • Gastric parietal cell antibodies - Reduce IF production

B12 important for…

  • Erythropoiesis - Megaloblastic anaemia
  • Nerve myelination - Neuropathy
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10
Q

Pernicious anaemia RFs and clinical features

A

Females > Males
AI disorders - Thyroid, DM, Addison’s, RA, etc.

Symptomatic anaemia

Peripheral neuropathy - Paraesthesia

Subacute combined spinal cord degeneration

Neuropsychiatric features

  • Memory loss
  • Poor concentration
  • Confusion
  • Depression
  • Irritability
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11
Q

Pernicious anaemia investigations

A

FBC - Macrocytic anaemia

  • WCC - Low
  • Platelets - Low

Blood film - Hypersegmented polymorphs

B12 < 200

Antibodies

  • Anti-IF antibodies
  • Anti-GP cell antibodies

Schilling test

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12
Q

Pernicious anaemia management and complications

A

B12 replacement therapy - IM Hydroxycobalamin

  • 3 injections per week for 2 weeks
  • Then 3 monthly

Folic acid supplementation

Complications - Increased risk of gastric cancer

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13
Q

Folate deficiency aetiology

A 
Dietary deficiency
Malabsorption - Coeliac/IBD
Pregnancy and breast-feeding
Prematurity
Alcohol excess

Iatrogenic

  • Phenytoin / Phenobarbitol
  • Trimethoprim
  • Methotrexate
  • Sulfasalazine
  • Pyrimethamine
  • Anticonvulsants
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14
Q

Folate deficiency clinical features and investigations

A

Symptomatic anaemia
Exfoliative dermatitis
Weight loss / LOA
Headaches

Serum folate - Low
Blood film - Hypersegmented neutrophils

FBC - Macrocytic anaemia with LOW reticulocytes

  • Hb - Low
  • MCV ^
  • MCH ^
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15
Q

Folate deficiency management

A

Folic acid - 5mg

Preventing NTD during pregnancy

  • 400mcg folic acid until 12th week of pregnancy
  • Higher risk of NTD - 5mg folic acid before conception to 12th week

Increased risk of NTD

  • Either partner has NTD
  • Previous pregnancy affected by NTD
  • Family history of NTD
  • Anti-epileptic drugs
  • Coeliac disease
  • DM
  • Thalassaemia
  • Obesity
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16
Q

G6PD deficiency

A

Haemolytic anaemia - X-linked

Clinical features - Haemolytic anaemia following a precipitant

  • Abx - Nitro
  • Anti-malarial - Chloroquine
  • Infection
  • Fava beans

Investigations - Normocytic anaemia with high reticulocytes

Blood film

  • Heinz bodies
  • Bite cells
  • Hemi-ghosts

Management - Supportive

  • Transfusion if severe
  • Avoid precipitants
17
Q

Hereditary spherocytosis

A

Haemolytic anaemia - AD

Defect in RBC membrane synthesis
Spherical RBCs removed by spleen
Reduced RBC lifespan

Patients from Northern Europe - Finland, etc.

Clinical features = Haemolytic anaemia + Splenomegaly

Investigations - Normocytic anaemia with high reticulocytes

  • Blood film - Spherocytes
  • EMA binding test

Management

  • Acute crisis - Supportive + Transfusion
  • Long-term - Folic acid + Splenectomy
18
Q

Sickle cell pathophysiology

A

Haemolytic anaemia - Autosomal recessive

Glutamate to Valine
Abnormal HbS
HbS turns sickle shaped when deoxygenated
Results in haemolysis and capillary obstruction

Precipitants

  • Hypoxia
  • Cold
  • Exercise
  • Dehydration
  • Infection
19
Q

Sickle cell crises

A

Thrombotic - Painful / vaso-occlusive crises

  • AVN femoral head
  • Hand-foot syndrome in children
  • Lungs
  • Spleen
  • Brain - CVA
  • Mesenteric ischaemia

Sequestration - Pooling within spleen or lungs

Acute chest syndrome

  • Dyspnoea
  • Chest pain

Aplastic - Infection with parvovirus

Haemolytic

20
Q

Sickle cell investigations and crisis management

A

Guthrie heel-prick test

FBC - Normocytic anaemia with high reticulocytes

Protein electrophoresis

  • HbAS/HbSS
  • HbF ^

Blood film - Howell jolly bodies

Crisis management - Treat cause

  • O2
  • IV fluids
  • Analgesia
  • Transfusion
21
Q

Sickle cell long-term management and complications

A 
Hydroxyurea - Stimulates HbF production
Vaccinations - Influenza and pneumococcal
Prophylactic abx - Penicillin
Repeated transfusions
Bone marrow transplant

Complications

  • CVA
  • Stunted growth
  • Developmental delay
  • Crises
  • Osteomyelitis - Salmonella
22
Q

Aplastic anaemia aetiology

A

Congenital - Fanconi or dyskeratosis congenita
Toxins - Benzene
Infection - Parvovirus and Hepatitis
Radiation

Iatrogenic

  • Cytotoxics
  • Chloramphenicol
  • Sulphonamides
  • Phenytoin
  • Gold
23
Q

Aplastic anaemia clinical features / investigations / management

A

Symptomatic anaemia
Neutropenia - Infections
Thrombocytopenia - Bleeding and bruising

Investigations

  • Normocytic hypochromic anaemia
  • Hypoplastic bone marrow
  • Pancytopenia
  • Reticulocytes - Low

Management - Monitoring

  • Immunosuppressants
  • Transfusions
  • Prophylactic abx
24
Q

AoCD

A

Inflammation mediated reduction in RBC production

Aetiology

  • IBD
  • RA
  • JIA
  • Malignancy

Clinical features - Symptomatic anaemia

Investigations - Normocytic anaemia with low reticulocytes

  • Iron - Low
  • TIBC - Low
  • Transferrin saturation - Low
  • Ferritin - High

Management - Treat cause

  • Transfusion
  • ESAs - Epoetin Alfa
  • Iron supplementation - Sodium ferric gluconate complex
25
Q

Sideroblastic anaemia aetiology

A

Microcytic hypochromic

Iron can’t bind haem
Free iron circulating
Leads to iron overload picture

X-linked 
or
Acquired
- Alcohol
- Lead
- Myelodysplasia
- TB medication
26
Q

Sideroblastic anaemia clinical features / investigations / management

A

Symptomatic anaemia + Iron overload

Investigations

  • FBC - Hypochromic microcytic anaemia
  • Ferritin ^
  • TIBC - Low
  • Iron ^
  • Bone marrow biopsy - Sideroblasts

Management - Treat cause

  • Desferoxamine
  • Pyridoxine
27
Q

Alpha thalassaemia

A

Hypochromic microcytic

SE Asia
Deficiency of alpha chains in Hb
2 separate alpha-globulin genes located on each Ch16

1 or 2 alleles affected - Normal Hb

3 alleles affected

  • HbH disease
  • Splenomegaly

All 4 alleles affected

  • Death in utero
  • Hydrops fetalis
  • Bart’s hydrops
28
Q

Thalassaemia clinical features / investigations / management

A

Haemolytic anaemia

Major - Hydrops fetalis

Present in first year of life

  • FTT
  • Hepatosplenomegaly

Skull bossing

Investigations - Unconjugated bilirubin ^

Hb electrophoresis

  • HbA2 ^
  • HbF ^
  • HbA - Absent in major

Management

  • Transfusion
  • Desferoxamine
29
Q

Polycythaemia aetiology

A

Congenital - JAK2 mutation

Acquired - Chronic hypoxia

  • OSA
  • COPD
  • Altitude

Associated with Budd-Chiari syndrome

30
Q

Polycythaemia clinical features

A 
Ruddy appearance - Flushed
Pruritus - Palms and soles - Worse after a bath
Headaches
Tinnitus
Angina
Dizziness
Splenomegaly
HTN - 1/3 patients
VTE risk
Haemorrhage - Secondary to abnormal platelet function
31
Q

Polycythaemia investigations / management / prognosis

A

FBC

  • Hb ^
  • Crit ^
  • Neutrophils ^
  • Basophils ^
  • Platelets ^

Mutation screen - JAK2

Management - Venesection

  • Hydroxyurea
  • Phosphorous-32 therapy
  • VTE prophylaxis - Low-dose Aspirin

Prognosis

  • VTE
  • Myelofibrosis
  • Acute leukaemia

3B (23 decks)

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