Blood - Level 1 Flashcards by Guy Dunbavand

Definition of iron deficiency anaemia?

IDA is due to ineffective erythropoiesis which causes reduced red cell production
o Causes small, pale RBCs

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Numerical definitions of iron deficiency anaemia in men, women, children?

o In men aged over 15 years — Hb<130 g/L.
o In non-pregnant women aged over 15 years — Hb<120 g/L.
o In children aged 12–14 years — Hb<120 g/L
o In pregnant women - Hb <110g/L
o Postpartum - Hb <100g/L

Serum ferritin level <15 micrograms/L confirms iron deficiency

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Numerical definition of iron deficiency anaemia in pregnant women and postpartum?

o In pregnant women — Hb below 110 g/L throughout pregnancy.
o Postpartum — below 100 g/L.

Serum ferritin level of less than 15 micrograms/L confirms iron deficiency

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Epidemiology of iron deficiency anaemia?

Commonest nutritional deficiency
Most common microcytic hypochromic anaemia
25% of infants with peak at 18 months

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Causes of iron deficiency anaemia?

Dietary (commonest) - Low level of dietary iron e.g. high milk intake (low iron), vegan, poverty
Malabsorption (Coeliac disease, IBD, gastrectomy, H.pylori, Hookworm, schistosomiasis)
Blood loss (Meckel’s diverticulum, oesophagitis, GI cancer. colon cancer, or secondary to drugs e.g. NSAIDs, menstruation)
Increased requirement (Iron requirement 3x higher in pregnancy)
Other (Blood donation, self-harm, medication)

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Symptoms of iron deficiency anaemia?

Mostly asymptomatic

Symptoms
o	SOB
o	Fatigue
o	Headache
o	Cognitive dysfunction
o	Restless leg syndrome
o	Vertigo
o	Syncope
o	Dizziness, weakness
o	Palpitations
o	PICA (abnormal dietary cravings (soil, pencils, ice)

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Signs of iron deficiency anaemia?

o	Nails – koilonychia
o	Dry and rough skin
o	Pallor
o	Atrophic glossitis
o	Angular stomatitis
o	Alopecia
o	Tachycardia, heart failure

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Investigations of iron deficiency anaemia?

Bloods
o FBC (low Hb, low MCV, MCH)
o Ferritin – low <15mcg/L
o B12 and folate – if normocytic

Blood film
o Small, pale red cells (central pallor)
o Anisocytosis (variation in size)
o Poikilocytosis (irregular shape red blood cells)

Diagnostic trial of iron in premenopausal women with history of menorrhagia or pregnant

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Investigations in all confirmed iron deficiency anaemia?

o Coeliac serology

o Urinalysis – blood

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When is no further testing needed in after diagnosis of iron deficiency anaemia?

o Healthy young people if history suggests cause
o Menstruating young women with no GI symptoms or FHx of colorectal cancer
o Pregnant women
o Terminally ill and unable to undergo invasive testing

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General management of iron deficiency anaemia?

Address underlying cause if apparent (menorrhagia, NSAIDs blood donations)

Dietary Advice

Increase level of iron in food
e.g. iron fortified formulas and breakfast cereals, meat, liver, oily fish (sardines, pilchards), green veg, beans, egg, yolk, foods rich in vit C (inc iron absorption)

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Iron supplementation management of iron deficiency anaemia?

Oral ferrous sulfate 200mg BDS/TDS (ferrous sulphate contains 65mg of ferrous iron - recommended 100-200mg ferrous iron)
Continued until Hb is normal and for a further 3 months
o Alternative: ferrous fumerate, ferrous gluconate
o Level starts to rise within a week so failure to do so indicates non-compliance
o Stools turn black and iron is dangerous in overdose

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Monitoring in iron supplements of iron deficiency anaemia?

o 2-4 weeks – FBC (should rise 2g/100ml over 3-4 weeks)
 If no response – refer to specialist
o Once normal – Continue for 3 months then stop
o FBC every 3 months for 1 year and then check after further year

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When to give ongoing prophylactic dose of iron in iron deficiency anaemia?

Ongoing prophylactic dose of 200mg ferrous sulfate daily if:
o Recurring anaemia and further investigation not indicated
o Iron-poor diet
o Malabsorption
o Menorrhagia
o Gastrectomy
o Pregnancy

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When to give parenteral iron in iron deficiency anaemia?

Transfusion reserved for those at risk of CV instability (SOB, chest pain, presyncope)
Parenteral Iron (iron dextran)
o If oral iron not tolerated, or rapid iron loss

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When to urgently refer iron deficiency anaemia?

Urgent if IDA and >60, IDA <50 and rectal bleeding

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When to refer to gastroenterology of iron deficiency anaemia?

o All men and postmenopausal women with IDA unless overt non-GI bleeding
o All people >50 with anaemia or FHx of colorectal cancer
o Premenopausal women <50 with colonic symptoms, FHx (2 1st degree relative or 1 before 50) or persistent IDA
o Coeliac positive serology

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When to refer to gynaecology of iron deficiency anaemia?

o Menorrhagia unresponsive to treatment
o Postmenopausal bleeding
Pregnant if significant symptoms and/or severe anaemia (<70) or >34 weeks or failure to respond

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Complications of iron deficiency anaemia?

Cognitive and behavioural impairment in children
Impaired muscular performance
Heart failure
In pregnancy:
o Lower birthweight, high morbidity/mortality, preterm delivery

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What are the types of blood products given in transfusion?

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Red Blood Cells
o 1 Unit will raise Hb by 10-15g/L
Platelets
o Stored at room temperature
o Each unit raises platelet count by 5-10x109/L
Fresh Frozen Plasma
Albumin
Cryoprecipitate

Initial management of acute-non-haemolytic reactions during transfusion?

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Monitor TPR and BP before, every 30 minutes and after transfusion
Initial management of Acute Transfusion Reactions
o STOP transfusion
o Monitor vital signs
o Check identity and name on unit of blood, call haematologist
o Send unit + FBC, U&E, clotting, cultures and urine
o If SOB – blood gas, CXR, CVP

Definition of acute haemolytic reactions (ABO incompatibility)?

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 Incompatible transfused red cells react with patient’s own IgM Anti-A/B antibodies or alloantibodies (anti-RhD/RhE/RhC/Kell)
 Complement activated and may lead to DIC
 Usually due to errors in labelling tubes/samples/forms

Symptoms of acute haemolytic reactions (ABO incompatibility)?

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 Agitation, pyrexia, low BP, flushing, abdominal/chest pain, DIC

Management of acute haemolytic reactions (ABO incompatibility)?

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 STOP transfusion
 Check identity and name on unit of blood, call haematologist
 Send unit + FBC, U&E, clotting, cultures and urine
 IV 0.9% saline
 Treat DIC

Symptoms of infective shock in transfusion?

 Acute hypotension, pyrexia and rigors

Management of infective shock in transfusion?

 STOP transfusion  Check identity against name on unit  Send unit + FBC, U&E, clotting, cultures and urine  Broad-spectrum IV Abx

Definition of non-haemolytic febrile transfusion reaction?

 Fever >1oC of baseline, due to patient antibodies to transfused white cells

Symptoms of non-haemolytic febrile transfusion reaction?

 Shivering and fever – usually 30 mins – 1 hour after starting transfusion

Management of non-haemolytic febrile transfusion reaction?

 STOP or SLOW transfusion  Paracetamol 1g  Monitor more closely  If recurrent, use WBC filter

Symptoms of allergic reaction to transfusion?

 Urticaria and itch

Management of allergic reaction to transfusion?

 SLOW OR STOP transfusion  Chlorphenamine 10mg IV  Monitor closely – IgA levels measured

Definition of transfusion-related acute lung injury? (TRALI)

 Form of ARDS due to donor plasma containing antibodies against patient’s leukocytes

Symptoms of transfusion-related acute lung injury? (TRALI)

 SOB, non-productive cough, hypoxia and frothy sputum  ABG – hypoxia  CXR shows – multiple perihilar nodules with whiteout  Usually develops within hours

Management of transfusion-related acute lung injury? (TRALI)

 STOP the transfusion  100% O2  Admit to ITU  CPAP or mechanical ventilation  Invasive haemodynamic monitoring with arterial line and Swan-Ganz catheter  Inotropes (dobutamine), vasodilators, blood transfusion  Enteral feeding  Donor should be removed from donor panel

Definition of transfusion-associated circulatory overload? (TACO)

 Occurs when too much fluid is transfused too quickly, leading to pulmonary oedema and acute respiratory failure

Symptoms of transfusion-associated circulatory overload? (TACO)

 SOB, hypoxia, tachycardia, raised JVP, basal crepitations

Management of transfusion-associated circulatory overload? (TACO)

 SLOW OR STOP transfusion  Oxygen  Diuretic (furosemide 40mg IV initially)  Consider CVP line

Indications for transfusion of red blood cells? Dose of red blood cells?

Use this threshold in patients needing RBC transfusion and not have major haemorrhage, ACS or regular blood transfusion for chronic anaemia: Hb <70g/L with target of 70-90g/L ACS Hb <80g/L with target of 80-100g/L Dose - single unit RBC transfusion if no active bleeding, reassess after each unit and check Hb

Indications for transfusion of platelets?

If severe bleeding (WHO Stage 3/4) or bleeding in critical sites (CNS) - use platelet count of <100x109/L Threshold of <50x109/L in patients having invasive procedures or surgery Clinically significant bleeding (WHO grade 2) and platelet of <30x109/L Prophylactic if <10x109/L who are not bleeding or having surgery and do not have chronic bone marrow failure, autoimmune/heparin induced/thrombotic thrombocytopenia

Dose of platelet transfusion?

Transfuse a single dose, unless severe thrombocytopenia and bleeding in critical site

Indications of fresh frozen plasma?

Clinically significant bleeding without major haemorrhage if abnormal coagulation tests (PT ratio or APTT >1.5) Major haemorrhage = loss of >1 blood volume (70ml/kg) within 24 hours, loss of >50% of total blood in 3 hours, bleeding in excess of 150ml/min, bleeding leading to BP<90 or HR >110

Indications for cryoprecipitate?

Consider when patients do not have major haemorrhage and have: Significant bleeding and fibrinogen <1.5g/L (consider <1.0 if having invasive procedure or surgery)

Dose of cryoprecipitate?

Adult dose of 2 pools and reassess, repeat fibrinogen level

Indications of prothrombin complex?

Immediate for emergency reversal of warfarin if severe bleeding or head injury with suspected intracerebral haemorrhage

Contents of RBCs?

RBC, WBC, plasma

Contents of platelets?

Platelets, RBC, WBC, plasma

Contents of FFP?

Fibrinogen, antithrombin 3, Factor 5 & 8

Contents of cryoprecipitate?

Fibrinogen, Factor 8 & 13, von Willebrand factor

Causes of microcytic anaemia?

``` Thalassaemia Anaemia of chronic disease Iron deficiency anaemia Lead poisoning Sideroblastic anaemia ```

Blood - Level 1 Flashcards

(49 cards)