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Year 4 Block 3-Acute medicine > 300. HEAM- Anaemia > Flashcards

300. HEAM- Anaemia Flashcards

1
Q

In the treatment of what two conditions is venesection indicated in

A

Polycythaemia rubra vera

Heamochormatosis

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2
Q

How does anaemia occur?

A

Low heamoglobin

Increased Red cells (e.g. pregnancy)

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3
Q

What are the symptoms of anaemia?

A

Fatigue, dyspnoea, faintness, palpitations, headache, tinnitus, anorexia, angina

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4
Q

What are the signs of anaemia?

A 
Pallor
tachycardia
Flow murmurs- ejection systolic murmur
Cardiac enlargement
retinal hemorrhages (rare)
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5
Q

What are the causes of a microcytic anaemia?

A

Iron deficiency anaemia

Thalaessemia- mcv too low for red count

Sideroblastic anaemia- body cant put iron into heamoglobin

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6
Q

What are the causes of a normocytic anaemia?

A

Acute blood loss

Anaemia of chronic diseases

Bone marrow failure

Renal failure

Hypothyroidism

Heamolysis

Preganacy

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7
Q

What are the causes of a macrocytic anaemia?

A

B12 or folate deficiency

Alchohol excess

Reticulocytosis

Cytotoxics (hydrocarbamide)

Myelodysplastic syndromes (?myeloma)

Marrow infiltration

Hypothyroidism

Anti-folate drugs

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8
Q

What anaemias cause iron accumulation leading to increased iron and ferritin with a low TIBC

A

Thalaseammia and sideroblastic anaemia

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9
Q

How do you transfuse a severe aneamic with heart failure?

A

60-80g/L is the target to reach

give it slowly with 10-40mg furosemide

Check for warning signs of overdose e.g. rising JVP and basal crackles

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10
Q

What are the causes of iron deficiency anaemia?

A

Blood loss

Poor diet

malabsorbtion (coeliac)

Hookworm- most common cause outside UK

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11
Q

Signs of chronic IDA?

A

Koilonychia

Atrophic glossitis

Angular stomatitis

Post cricoid webs- plummer vinson syndrome (treat with iron and oesophageal widening therapy)

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12
Q

How do you treat those with iron deficiency anaemia?

A

Check ceoliac serology

Refer for colonoscopy and upper GI endoscopy. Unless menstruating and ? under 55’s?

Consider stool culture if travel history

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13
Q

How is iron deficiency anaemia treated?

Why might patients fail to respond to treatment?

A

Iron tablets

complaince, continued GI blood loss, anaemia of chronic diseases, thalaseammia

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14
Q

What three disruptions to biochemical processes cause anaemia of chronic diseases?

A

Poor use of iron in eryhthropoiesis

cytokine induced shortening of RBC survival

production of and response to EPO

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15
Q

What are the causes of anemia of chronic diseases?

A

Chronic infection, vasculitis, rhumatoid, malignancy, renal failure

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16
Q

How to treat anaemia of chronic diseases?

A

Treat underlying disease

EPO

IV iron

17
Q

With regards to iron studies (Iron, TIBC and ferritin) what happens to iron in:

Iron deficiency

Anaemia of chronic disease

Chronic heamolysis

Heamochromatosis

Pregnancy

Sideroblastic anaemia

A

Iron deficiency and Anaemia of chronic disease- reduced iron

Chronic heamolysis, heamochromatosis, pregnancy, sideroblastic anaemia- Iron increased

18
Q

What happens to TIBC in those conditions

IDA

CDA

Chronic heamlyosis

Heamochromatosis

Pregnancy

Sideroblastic anaemia

A

Iron deficiecny, pregnancy- TIBC increased

Anaemia of chronic diseases, chronic heamolysis- (reduced)

Heamochromatosis, sideroblastic anaemia- normal

19
Q

How is ferritin affected in the following conditions

Iron deficiency, anaemia of chronic disease, chronic heamolysis, heamochromatosis, pregnancy, sideroblastic anaemia

A

IDA- reduced

Pregnancy- normal

All others- reduced

20
Q

What are the two causes of macrocytic anaemia

A

Megaloblastic-b12, folate or cytotoxic

Non megablastic- alcohol XS, reticulocytosis, liver disease, hypothyroidism, pregnancy

21
Q

How does a bone marrow biopsy help narrow down macrocytic anaemia

A

Will either show:

Megaloblastic marrow-
Normoblastic marrow
abnormal erythropoiesis
increased erythropoisis

22
Q

How do you treat folate deficiency

A

replace with daily 400mcg folate and also give b12 unless b12 status is known.

Unopposed folate replacement causes increased subacute degeneration of the cord

23
Q

What are the causes of vit b12 deficiency

A

Dietary

Malabsorbtion- pernicious anemia/ terminal ileum

24
Q

what are the signs of b12 deficiency

A

Pallor, lemon tinge, glossitis

Irritability, depression, psychosis, dimentia

paraethesia, peripheral neuropathy, subacute degenration of the cord

25
Q

What is subacute degeneration of the cord?

A

combination of peripheral sensory neuropathy with both upper and lower motor neuron signs.

Insidious onset, symmetrical, pain and temperature intact.

26
Q

What is the classic triad of subacute degenration of the spinal cord

A

Absent knee jerks
Absent ankle jerks
Extensor plantars

27
Q

What are the associations with pernicious anaemia?

A

Thyroid disease,

vitiligo,

addison’s,

hypoparathoidism,

carcinoma

A blood group

28
Q

How do you identify a heamolytic jaundice

A

increased unconjugated bilirubin

increased urinary irobilinogen

increased serum LDH

Increased reticulocytes

29
Q

What are the biochemical signs of heamolytic jaundice?

A

Increased free plasma heamoglobin

Methaemalbumineia (increased heam and albumin)

Decreased plasma haptoglobin

30
Q

What examination signs might be seen in those with heamolytic anemia?

A

jaundice

hepatosplenomegaly

gallstones

leg ulcers

31
Q

What tests should be done for heamolytic anemia

A

FBC, reticulocytes, bilirubin, LDH, haptoglobin, urinary urobillogen

Thick and thin blood films (malaria)

BLOOD FILMS

(Further tests)- osmotic fragility, coombs test, electropheresis

32
Q

What are the heamolytic anaemias that are coombs positive?

A

Drug induced

Autoimmune heamolytic anaemia- split into warm and cold. Mostly idiopathic

Warm (extravascular)
Cold (Intravsacular)-

33
Q

What is microangiopathic heamolytic anaemia?

A

Mechanical damage to RBC’s in circulatoin causing intravscular heamolysis and shischotcytes

34
Q

What are the causes of microangiopathic heamolytic anaemia?

A 
HUS, - e coli 0157
TTP, - anaemia, low platelets- ADAMTS13 antibodies
DIC, 
pre-eclampsia and eclampsia, 
prosthetic heart valves
35
Q

What can precipitate and GD6P crisis?

A 
Henna
Broad beans
Aspirin
primaquine
sulfanamides
36
Q

What happens in a gd6P crisis

What is done to relieve it?

A

Jaundice and anemia

Transfuse if severe

Year 4 Block 3-Acute medicine (85 decks)

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