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Haem Flashcards

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1
Q

What is the epidemiology of iron deficiency anaemia (4)

A
  • Most common cause of anaemia
  • Seen in 14% of menstruating women
  • Develops on inadequate iron for Hb synthesis
  • Microcytic
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2
Q

What are the causes of iron deficiency anaemia (4)

A
  • Bleeding
  • Poor diet
  • Malabsorption
  • Inc. demand eg. growth/pregnancy
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3
Q

How might iron deficiency anaemia present (6)

A
  • Fatigue, Headache, Syncope
  • Palpitations/chest pain
  • Anorexia
  • Shortness of breath
  • Brittle nails/hair
  • Mouth ulcers
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4
Q

How do you diagnose iron deficiency anaemia (6)

A
  • FBC and blood film
    • Decreased MCV
    • Decreased Hb
    • Hypochromic
    • Decreased serum Ferritin/iron (diagnostic)
    • Increased Transferrin receptors
    • Decreased reticulocytes
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5
Q

How do you treat iron deficiency anaemia

A
  • Oral iron (ferrous sulphate)
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6
Q

What is the epidemiology of anaemia of chronic disease (2)

A
  • 2nd most common cause

- Can be normocytic or microcytic (and hypochromic)

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7
Q

What can cause anaemia of chronic disease (3)

A
  • Decreased erythropoetin release
  • Decreased Fe release from bone marrow to erythroblasts
  • Increased RBC death
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8
Q

How might anaemia of chronic disease present (5)

A
  • Headache, fatigue, syncope
  • Chest pain/palpitations
  • Anorexia
  • Breathlessness
  • Chronic disease (fucking obviously)
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9
Q

How would you diagnose anaemia of chronic disease (4)

A
  • FBC and blood film
    • Decreased Hb
    • Decreased or normal MCV
    • Low iron
    • Normal or high transferrin (inflammation)
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10
Q

How do you treat anaemia of chronic disease

A
  • Treat underlying cause

- EPO in kidney or inflammatory disease

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11
Q

What can cause normocytic anaemia (3)

A
  • Pregnancy
  • Acute blood loss
  • Chronic disease
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12
Q

What are the risk factors for B12 deficiency anaemia (4)

A
  • Lack of intrinsic factor (pernicious)
  • Vegan (B12 found in meat, dairy, fish but not plants)
  • Blue eyes, fair hair
  • Thyroid disease
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13
Q

Describe the pathophysiology of pernicious anaemia

A
  • Intrinsic factor binds to B12 to absorb it
  • In pernicious anaemia there is autoimmune attack of parietal cells that secrete intrinsic factor
  • This leads to B12 deficiency
  • B12 is required for thymine hence protein synthesis
  • So due to slowed protein synthesis RBCs mature for longer hence macrocytic and less are produced
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14
Q

How might someone with B12 deficiency present (4)

A
  • Normal anaemia symptoms
  • Lemon coloured skin (mild jaundice due to body breaking down large RBC as they are abnormal and pallor)
  • Big red beefy tongue
  • Mouth ulcers
  • Focal neurology if B12 is very low
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15
Q

How do you diagnose B12 deficiency anaemia (4)

A
  • FBC and blood film
    • Decreased Hb
    • Increased MCV
    • Decreased B12
    • May be raised bilirubin
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16
Q

How do you treat B12 deficiency anaemia (2)

A
  • If dietary dive oral B12 supplements

- If malabsorption eg. pernicious give injections (hydroxocobalamin)

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17
Q

What can cause Folate deficiency anaemia (2)

A
  • Malabsorption (eg. crohns or coeliac)

- Poor diet (folate found in green vegetables)

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18
Q

Describe the pathophysiology of folate deficiency anaemia

A
  • Folate is also required for protein synthesis

- So due to slowed protein synthesis RBCs mature for longer hence macrocytic and less are produced

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19
Q

How might folate deficiency present

A
  • Normal anaemia symptoms
  • Lemon coloured skin (mild jaundice due to body breaking down large RBC as they are abnormal and pallor)
  • Big red beefy tongue
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20
Q

How do you diagnose folate deficiency anaemia

A
  • FBC and blood film
    • Low Hb
    • High MCV
    • Low folate
    • May be high bilirubin
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21
Q

How do you treat folate deficiency anaemia

A
  • Oral folate tablets (be wary of B12 levels)
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22
Q

Describe the pathophysiology of the thalassaemias

A
  • Alpha and Beta
  • Genetic disease causing underproduction of A or B chain
  • This results in RBC precursor death (decreased erythropoesis)
  • Also results in increased haemolysis due to A and B chain imbalance
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23
Q

How might Beta thalassaemia present (6)

A
  • Normal anaemia symptoms
  • Leg ulcers
  • Increased infections
  • Splenomegaly
  • Gallstones
  • Bone deformity
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24
Q

How do you diagnose Beta thalassaemia

A
  • FBC and Blood film
    • Microcytic hypochromic
    • Raised reticulocytes
    • Raised serum iron
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25
How would you treat Alpha/Beta thalassaemia (3)
- Lifelong blood transfusions - Bone marrow transplant - Agents to increased iron excretion
26
What is the epidemiology of sickle cell anaemia (2)
- More common in Africans | - Autosomal recessive
27
Describe the pathophysiology of sickle cell anaemia
- Adenine to thymine substitution mutation - Valine is produced instead of glutamic acid on Beta chain - This causes RBCs to become insoluble and polymerise when deoxygenated - This leads to the characteristic sickle shape - This causes blockage of small vessels leading to infarct and pain and increased haemolysis
28
How might sickle cell anaemia present (6)
- Acute hand and feet pain - Long bone pain - Increased infections - Pulmonary hypertension - Acute chest syndrome - Children have growth/development issues
29
How would you diagnose sickle cell anaemia (2)
- FBC and blood film - Normal Hb - Sicle shaped cell - Gel electrophoresis confirms diagnosis
30
How do you treat sickle cell anaemia (4)
- Acute attacks - Fluids/oxygen - Analgesia - Stem cell transplant - Blood transfusion - Oral hydroxycarbamide (increases HbF)
31
What is polycythaemia
- An increase in Hb, PCV (haematocrit), and red cell count
32
What can cause polycythaemia (4)
- Primary - Polycythaemia Vera - EPO receptor mutation - Secondary - Hypoxia - Inappropriate EPO secretion
33
What is the epidemiology of Polycythaemia vera (2)
- Over 60 | - Genetic association
34
Describe the pathophysiology of polycythaemia vera
- Malignant proliferation of pluripotent stem cell - Causes increased production of RBC, WC and platelets - Causes hyper viscosity and thrombosis
35
How might polycythaemia vera present (6)
- Headache - Tinnitus - Itching (worse on heat) - Dizziness - Burning in fingers and toes - Hepatosplenomegaly
36
How do you diagnose polycythaemia vera (2)
- FBC - Raised Hb, RBC, WCC and platelets - JAK2 mutation on screening
37
How do you treat polycythaemia vera (2)
- Venesection | - Low dose aspirin
38
What is the epidemiology of DVT (3)
- Occurs in 25-50% of surgical patients - 65% are asymptomatic - Commonly occur after periods of immobilisation
39
What can cause DVT (4)
- Immobilisation - Surgery - Plane journey - Leg fracture - Genetic
40
When is DVT a concern
- When it is above the knee (can be fatal) | - Below the knee is not too much of a concern
41
What are the risk factors for DVT (7)
- Increasing age - Surgery - Immobilisation - Cancer - Past DVT - Obesity - Pregnancy
42
How might DVT present (3)
- Pain, warm, red, swollen - Oedema - Cyanosis
43
How would you diagnose DVT (2)
- Plasma D dimer - Clot breakdown product - Raised if not diagnostic but normal rules our - Compression ultrasound
44
How do you treat DVT
- LMW heparin (SC. enoxaparin) - Low dose aspirin - Compression stockings and mobility - IVC filter to decrease risk of PE
45
What can cause thrombocytopenia (2)
- Decreased production | - Increased destruction
46
What is immune thrombocytopenia purpura (ITP)
- Autoimmune destruction of platelets leading to thrombocytopenia
47
Describe primary ITP (3)
- Acute, usually in ages 2-6 - Muco-cutaneous bleeding, rarely haemorrhage - Sudden onset purpura
48
Describe secondary ITP (2)
- Chronic, usually in adults | - Muco-cutaneous bleeding/purpura
49
How might someone with ITP present (5)
- Easy bruising - Heavy nose bleed - Menorrhagia - Purpura - Gum bleeding
50
How do you diagnose ITP (2)
- FBC low platelets | - Bone marrow biopsy
51
How do you treat ITP
- Prednisolone - IV IgG - Splenectomy (2nd line)
52
What are the 4 types of leukaemia
- Acute lymphoblastic - Acute myeloid - Chronic myeloid - Chronic lymphocytic
53
What is the epidemiology of acute lymphoblastic leukaemia (3)
- Most common childhood cancer - B-cell precursors = children, T-cell precursors = adults - Most common between 2-4
54
Describe the pathophysiology of acute lymphoblastic leukaemia
- Malignancy (uncontrolled proliferation) of B/T cell precursors called lymphoblasts - Most commonly the B cell precursors
55
How might acute lymphoblastic leukaemia present (4)
- Marrow failure - Anaemia (standard symptoms) - Infection (low WC) - Bleeding (low platelets) - Metastases (lymphadenopathy etc.)
56
How do you diagnose acute lymphoblastic leukaemia (2)
- FBC - (high lymphocytes, low WC), low RBC/platelets - Bone marrow biopsy
57
How would you treat acute lymphoblastic leukaemia (5)
- Bone marrow transplant - Chemotherapy - Blood and platelet transfusion - Prophylaxis - Allopurinol
58
Describe the epidemiology of acute myeloid leukaemia (4)
- Neoplastic proliferation of myeloid precursor cells - Myeloid precursor cells give rise to eosinophils neutrophils and basophils - Most common acute leukaemia in adults - Associated with radiation and downs
59
How might acute myeloid leukaemia present (4)
- Marrow failure - Anaemia (standard symptoms) - Infection (low WC) - Bleeding (low platelets) - Hepatosplenomegaly
60
How would you diagnose acute myeloid leukaemia
- Bone marrow biopsy
61
How would you treat acute myeloid leukaemia (5)
- Bone marrow transplant - Chemotherapy - Allopurinol - Prophylaxis - Blood and platelet transfusion
62
What is the epidemiology of chronic myeloid leukaemia (4)
- More common in adults - Uncontrolled proliferation of myeloid cells - Associated with Philadelphia chromosome - Males, 40-60
63
How might chronic myeloid leukaemia present (5)
- Anaemia - Weight loss - Malaise - Fever and sweats - Bleeding
64
How do you diagnose chronic myeloid leukaemia (2)
- FBC - Raised WBC, low RBC and platelets - Bone marrow biopsy
65
How do you treat chronic myeloid leukaemia
- Stem cell transplant | - Imatinab
66
What is the epidemiology of chronic lymphoblastic leukaemia (3)
- Most common leukaemia - Mature B-cells escape cell death and proliferate - Later life
67
How might someone with chronic lymphoblastic leukaemia present (4)
- Usually asymptomatic - Anaemia - Sweats, anorexia, weight loss if severe - Hepatosplenomegaly
68
How do you treat chronic lymphoblastic leukaemia (4)
- Stem cell transplant - Chemotherapy - Blood transfusion - IV immunoglobulins
69
What is lymphoma
- A malignant proliferation of lymphocytes that accumulate in the lymph nodes but may be found in the blood or organs
70
What are the two types of lymphoma
- Hodgkins lymphoma - Characteristic cells (Reed-Sternberg) - Non-Hodgkins lymphoma - No characteristic cells - Low, high and very high grades
71
What is the epidemiology of Hodgkins lymphoma (3)
- Teenagers and elderly - EBV association - More common in males
72
What are the risk factors for Hodgkins lymphoma (6)
- Elderly/teenager - EBV - Sibling with it - SLE - Obesity - Immunosupression
73
How might someone with Hodgkins lymphoma present (2)
- Painless rubbery lymphadenopathy | - Malaise, weight loss, sweats
74
How do you diagnose Hodgkins lymphoma (2)
- Lymph node excision | - CT/MRI for staging
75
What staging is used for Hodgkins lymphoma
- Ann-Arbor staging - I one lymph node - II 2+ nodes above diaphragm - III nodes above and below diaphragm - IV systemic spread - A or B where A is no systemic symptoms and B is systemic symptoms
76
How do you treat Hodgkins lymphoma (2)
- ABCD combo chemotherapy | - Radiotherapy
77
What is the epidemiology of non-hodgkins lymphoma (2)
- 80% B-cell, 20% T-cell | - Not all centre of lymph nodes
78
How might someone with non-Hodgkins lymphoma present (3)
- Lymphadenopathy - Fever, weight loss, night sweats - Pancocytopenia
79
How would you diagnose non-Hodgkins lymphoma (2)
- Lymph node excision | - CT/MRI for staging
80
What is the treatment for non-Hodgkins lymphoma (2)
- R-CHOP | - Radiotherapy
81
What is the epidemiology of Myeloma (2)
- >70 | - More common in Afro-Caribbeans
82
Describe the pathophysiology of Myeloma
- Malignant proliferation of plasma cells in the bone marrow - Secrete Immunoglobulins - 55% IgE - 20% IgA - IgD and IgM - Deficiency in non-secreted IG leads to infection
83
How might Myeloma present
``` - OLD-CRAB OLD Calcium high Renal failure (Ig deposits) Anaemia (Pancocytopenia) Bone lesions (back pain) ```
84
How do you diagnose Myeloma (4)
- Bone marrow biopsy - Bloods (raised calcium, Urea and Cr, low Hb) - X-ray shows bone lesions - Proteinurea
85
How do you treat Myeloma (5)
- Analgesia - Biphosphonates to reduce bone fracture - Transfusion for anaemia - Chemotherapy - Stem cell transplant
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