1: Iron Deficiency Anaemia, INR Reversal and Emergencies Flashcards
What is the most common anaemia
Iron-Deficiency
How can aetiology of IDA be divided
- Insufficient intake
- Increase need
- Increase loss
What can lead to insufficient oral intake
Vegan
Eating Disorder
What are 3 causes of insufficient absorption
Whipple’s procedure
Coeliac disease
Hypochlorhydria (H.Pylori induced gastritis)
What are 2 causes of increased need to iron
- Pregnancy
- Puberty
What are the categories of increased loss
Occult and Overt
What can cause overt blood loss
- Menses
- Haematemesis
- Haematuria
- Trauma
What can cause occult blood loss
- GI Bleed
- Peptic Ulcer
- Haemorrhoids
- Hookworm
What are the likely causes of IDA in children
- Meckel’s diverticulum
- Malnutrition
What are the likely causes of IDA in adolscents
Menarche
What can cause IDA in 20-50 year-olds
- Menorrhagia
- Pregnancy
- Peptic ulcer
What is the commonest cause of IDA in over-50’s in developed countries
Colorectal cancer
What is the commonest cause of IDA in over-50’s in developing countries
Hookworm
How does IDA present clinically
- Dyspnoea
- Pallour
- Lethargy
- Dizziness and Syncope
- Cardiac Failure
What are signs of IDA
- Angular stomatitis
- Glossitis
- PICA
- Brittle nails
- Kolonychia
What is plummer-vinson syndrome
- Glossitis
- IDA
- Dysphagia - due to oesophageal webs
How will FBC present in IDA
- Low Hb
- Low MCV
- Low MCHC
- High RDW
How will iron studies present in IDA
- Low Ferritin
- Low transferrin saturation
- High TIBC
Explain TIBC in IDA
Low iron concentration means more free sites on transferrin to bind
What is the problem with using ferritin as a marker for anaemia
Ferritin is an acute phase protein and increases with inflammation
What will be seen on blood-film in microcytic anaemia
- Anisocytosis
- Poikilocytosis
- Target cells
What is anisocytosis
cells unequal in size
What is poikilocytosis
cells unequal in shape
What are target cells
codocytes
What is used to test for coeliac disease
anti-TTG
If IDA in males or non-menstruating females what should be ordered
gastroscopy and colonoscopy
when is stool microscopy for ova ordered
recent foreign travel
what are ova used to detect
hookworm
when should individuals be referred to a gastroenterologist if over 60
IDA
when should individuals be referred to a gastroenterologist if over 50-60
- FH Colorectal cancer
- Marked anaemia
- Rectal bleeding
when should individuals under 50 be referred to gastroenterology
- Symptoms colorectal cancer
- Persistent IDA despite treatment
- FH
How is IDA managed
Oral Ferrous Sulphate
How long should ferrous sulphate be continued
3 months after stores have replenished
What advice is given to individuals with IDA
Increase intake of dark-green leafy vegetables
What are 3 requirements to stop warfarin/ other anti-coagulation
- High INR
- Bleeding
- Surgery
If an individual has an INR >8 what is done
- Stop warfarin
- 1-5mg vitamin K PO
When is warfarin re-started if stopped due to an INR >8
When less than 5
How is INR 5-8 managed
Withhold 1-2 doses of warfarin and re-start at a subsequent lower maintenance dose
what is the risk with stopping warfarin for surgery
Risk VTE
what is the risk of continuing warfarin during surgery
Bleeding
If a major surgery, how many days before should warfarin be stopped
5-days
what anticoagulation is given as a bridging method
LMWH
how long is LMWH continued for
Stop 24-hours before surgery
what are the indications for bridging LMWH
- AF
- Mechanical heart valve
- High risk of VTE
what is measured the day before surgery
INR
if INR is >1.5 the day before surgery what is done
Oral vitamin K
when is warfarin resumed following surgery
Evening or next-day
how long after surgery should heparin be started
24-48h
explain changes in anti-coagulation prior to minor surgery
Advise INR between 1.5-2.
No change in anti-coagulation required unless more than 3
how long before surgery are DOACs stopped
24-48h before
if a person is on warfarin and requires emergency surgery that can be delayed 6-12h, what is done
IV Vitamin K to reverse anti-coagulation
if a person is on warfarin and requires emergency surgery that cannot be delayed, what is done
IV Prothrombin complex and IV Vitamin K
if an individual has a major bleed what is done
- Stop warfarin
- IV Vitamin K
- Prothrombin Complex
what is vitamin K called
phytomenadione
what factors are in prothrombin concentrate
2
7
9
10
if an individual has a INR > 8 and a minor bleed what is done
- Stop warfarin
- IV Vitamin K
when is warfarin re-started if above 8 and minor bleed
- When less-than 5
if INR is 5-8 and minor bleed, what is done
Stop warfarin
IV Vitamin K
what is given for a major bleed
protamine sulphate
