Revision Lectures Flashcards
1
Q
Paroxysmal Nocturnal Haemoglobinuria
A
- Dark coloured urine in the morning
- Lack of glycoprotein - GPI
- Increased complement sensitivity
- Lack of CD59 = platelet aggreggation
- Haemolytic anaemia +/- pancytopenia
- Increased thrombosis
- Budd- Chiari syndrome (occlusion of the hepatic veins that drain the liver)
2
Q
Sickle cell Anaemia
A
- Autosomal recessive disease - heterozygous = trait
- Abnormal Hbs –> will “sickle” with low Pa02
- Symptoms develop at greater than 6 months old (HbF)
- Small bone infarction
- Kidney necrosis + tubular damage
- Autosplenectomy - spleen self disrtuction, normally silent. Therefore immunocompromised
- Sickle crisis –> sequestration in organs or thrombotic events.
- normally triggered by infection
3
Q
Investigations for anaemia?
A
Reduction in Hb or RBC insufficient for the bodies:
- FBC
- Iron studies
- Haemotinics
- Blood films
4
Q
Iron deficiency anaemia
A
- Insufficient intake
- Dietary
- malabsorption
- increased demands
- Excess loss
- bleeding; menstruation, GI bleed, bleeding disorders.
Treatment - iron supplementation = ferrous fumerate 210mg BD. Increase dietary intake - leafy greens, meat. Treat malabsorption.
5
Q
Do iron deficiency need investigations for malignancy?
A
- Endoscopy
- Colonoscopy
- CT CAP
6
Q
G6PD
A
- Nitrofurantoin is common trigger of crisis
7
Q
Thalassaemia trait
A
- Autosomal recessive
- Mild hypochromia, microcytic anaemia
- HbA2 raised >3.5%
8
Q
Beta Thalassaemia major
A
- Chr 11
- Presents in first year of life
- Splenomegaly, failure to thrive
- Requires lifelong blood transfusions (+ iron chelation)
9
Q
Alpha thalassaemia
A
- Chr 16
- Severity depends on how many chains affected
- 1 or 2 chains = hypochromic + microcytic (but Hb normal)
- 3 chains = HbH disease
- 4 chains = fetal death (hydrops)
10
Q
Anaemia of chronic disease
A
- Cause by ongoing inflammation in the body
- Common conditions = CKD, IBD, TB, cancer etc
- May have some overlap with iron deficiency anaemia -> look at ferritin
11
Q
B12 + Folate
A
- Blood film will show megaloblastic with hypersegmented neutrophil
- Intake through diet
- Multiple causes of deficiency: alcohol, methothrexate, reduced absorption
- Folate absorbed via jejunum
- B12 absorbed via ileum.
- Intrinsic factor released from parietal cells in stomach required for binding
- Pernicious anaemia = autoimmune condition with antibodies against the intrinsic factor
- Replace B12 before folate -> risk of subacute combined degeneration of the spinal cord.
12
Q
Aplastic anaemia
A
- Hypoplastic bone marrow
- Peak incidence ~30yrs
- Causes:
- idiopathic
- congenital
- drugs (phenytoin, oral chloramphenicol)
- viral
- radiation
- Pancytopaenia
- 10% develop acute leukaemia
- 7% Develop paroxysmal nocturnal haemoglobinuria
- Treatment: supportive, immunosuppressants, bone marrow transplant
13
Q
Lead poisoning
A
symptoms = Fatigue, constipation, struggling with hands and feel numb, blue line along the gums.
Finding = microcytic anaemia.
14
Q
Alcoholic anaemia
A
- High alcohol, no nutrients.
Macrocytic anaemia
macrocytosis (raised MCV but normal Hb) - indicates too much alcohol
If patient has:
- Not eating + nutrients = B12 and folate therefore macrocytic megaloblastic picture.
- Eating/corrected = alcohol can cause macrocytic non megaloblastic anaemia
- liver disease = non megaloblastic macrocytic picture.
15
Q
Haemolytic anaemia
A
- Multiple causes; multiple ways of classifying.
- autoimmune
- inherited vs acquired
- intracorpuscular vs extracorpuscular
- haemoglobinopathies
- intravascular vs extravascualr
- Increased RBC breakdown
- Causing anaemia if there is insufficient turnover
