What are 5 causes of iron deficiency anaemia?
- Blood loss: GI, menstruation, malignancy
- Poor diet/poverty
- Malabsorption: coeliac, H.pylori, meds
- Hook worm - GI blood loss: ask about travel
- Family History: thalassaemia, bleeding disorders, IDA
What symptoms may present with iron deficiency anaemia?
- Fatigue
- SOB
- Palpitations
- Atrophic glossitis
- Headache
- Pale
- Koilonychia
What type of anaemia is iron deficiency?
Hypochromic microcytic
What does a serum ferritin of less than 12 indicate?
Iron deficiency anaemia
What does a low MCH and MCV indicated?
Hypochromic microcytic anaemia: iron deficiency
What will the blood film display in iron deficiency anaemia?
Anisocytosis
Poikilocytosis
What signs suggest marked iron deficiency anaemia?
- Tachycardia
- Cardiomegaly
- Ankle oedema
- Flow murmur
- HF
How is iron deficiency anaemia treated?
Treat underlying cause.
Oral ferrous sulphate tablets: nausea, constipation and black stool - should rise by 10g/L/week. Normal at 3 months.
IV iron if NBM or in chronic renal failure
What is megaloblastic macrocytic anaemia due to?
B12 deficiency, folate deficiency, cytotoxic drugs
What causes non-megaloblastic macrocytic anaemia?
Alcohol, liver disease, hypothyroid, pregnancy
What are the signs and symptoms of megaloblastic anaemia?
Pallor Fatigue Dyspnoea Bowel disturbance and loss of appetite Gum hypertrophy Atrophic glossitis
How is macrocytic anaemia managed?
Address underlying cause
Give 4 months folic acid and B12
Which type of lymphoma is more common?
Non-hodgkins (5x)
How might a low grade non-hodgkin lymphoma present?
Painless slow growing lymphadenopathy
Cytopenia if bone marrow involved
Enlarged spleen and liver
How might a high grade non-hodgkin lymphoma present?
Rapid growing, bulky lymphadenopathy.
Systemic multi-organ involvement
Spleno & hepatomegaly
Skin lesions
What type of non-hodgkins lymphoma can have a mediastinal mass and CNS involvement?
Lymphoblastic
What type of non-hodgkins lymphoma may have a large abdo mass/bowel obstruction?
Burkitts
How is non-hodgkin’s lymphoma managed?
Watch and wait.
Chemo/radiotherapy
Give pneumococcal, flu and Men C vaccine and immune system compromised
Prophylactic AB with chemo - neutropenia would be severe
What type of treatment are intermediate/high grade more aggressive non-hodgkin lymphomas more responsive to?
Chemotherapy
What is an emergency presentation of lymphoma?
SVC obstruction:facial oedema, raised JVP, fullness of head, dyspnoea, blackouts
Infection
What cells characterise hodgkin’s lymphoma?
Reed sternberg cells: mirror image nuclei
What does an increased ESR and decreased Hb suggest in hodgkin’s lymphoma suggest?
A poorer prognosis
What are the symptoms of Hodgkin’s lymphoma?
- Enlarged, tender, painless, rubbery superficial lymph nodes: cervical, axilla and inguinal
- Node may become matted
- Size fluctuates
- Lymph node pain made worse by alcohol
- Systemic fever, weight loss, night sweats, pruritus
- Pleural effusion due to mediastinal mass effect
- Enlarged liver and spleen
- Anaemia, cachexia
How is Hodgkin’s Lymphoma staged?
- Single node region
- 2 areas on same side of diaphragm
- Nodes on both sides of diaphragm
- Spread beyond nodes
A= no symptoms B = 6 months 10% weight loss, temperature, night sweats
