5. Cardiovascular System Pathologies Flashcards
1
Q
Anaemia
A
• A deficiency in haemoglobin given the persons age, sex and geographical location.
2
Q
Anaemia: Signs and Symptoms
A
SIGNS & SYMPTOMS:
• Fatigue, shortness of breath on exertion, palpitations, irritability, fainting.
• Signs: Tachycardia, thin & threadypulse, pallor (skin/conjunctiva).
3
Q
Normal Haemoglobin ranges
A
Males 13 - 18 g/dl
Females 11.5 - 16.5 g/dl
Pregnanct >11 g/dl
4
Q
Iron-Deficiency Anaemia
A
- The most common cause of anaemia worldwide.
- Iron deficiency leads to a reduced concentration of haemoglobin in erythrocytes causing them to appear paler & smaller. Hence iron deficiency anaemia is a ‘hypochromic microcytic anaemia’.
5
Q
Iron-Deficiency Anaemia: Causes
A
- Deficient dietary intake (e.g. low dark leafy vegetables).
- Malabsorption (i.e. low stomach acid, coeliac disease etc).
- Excessive blood loss (i.e. from menses/GIT bleed).
- Excess requirements e.g. Pregnancy, rapid growth.
6
Q
Iron-Deficiency Anaemia: Signs and Symptoms
A
SIGNS & SYMPTOMS:
• General anaemia signs & symptoms.
• Key signs: Spoon shaped nails(koilonychia), angular stomatitis, glossitis, brittle hair, tachycardia.
• Blood tests:Low RBCs & Hb, low ferritin (correlates with total body iron stores).
7
Q
Iron-Deficiency Anaemia: Treatment
A
TREATMENT:
• Treat cause!
• Also: Herbs (Withania), beetroot, dark green leafy vegetables, pumpkin and sunflower seeds. Iron supplementation.
8
Q
Megaloblastic Anaemia
A
- Megaloblastic anaemia is characterised by large, immature and dysfunctional red blood cells.
- Folate (folic acid) & vitamin B12 are required for DNA synthesis in all proliferating cells, hence affecting rapidly dividing cells (erythrocytes).
- DNA replication is slowed down and cell growth continues without division and maturation, resulting in large erythrocytes (may have nucleus and has shorter life span) –macrocytic cells.
- Diagnosis by blood test: ‘MCV’>97 fL.
9
Q
Megaloblastic Anaemia: Causes
A
- Deficient dietary intake of folate (folic acid) &/or vitamin B12 (rare, except in vegans).
- Lack of intrinsic factor due to autoimmune disease (pernicious anaemia), gastrectomy, chronic gastritis, stomach cancer, coeliac disease.
- Malabsorption in crohn’sdisease, surgical excision.
- Drugs–‘methotrexate’is a folate antagonist.
- In order for folate to function in the body, it must be modified by an enzyme that requires Vitamin B12.
- The liver has abundant stores so if absorption is impaired it takes 2-4 years to develop (folate only 4 months).
10
Q
Megaloblastic Anaemia: Signs & Symptoms
A
SIGNS & SYMPTOMS:
• General anaemia signs & symptoms.
• Enlarged red sore shiny tongue.
• Neurological symptoms:Tingling, numbness, weakness, loss of co-ordination, burning sensations, tinnitus, depression (only B12)
11
Q
Megaloblastic Anaemis: Treatment
A
TREATMENT:
• Increase Vitamin B12 status OR
• Folate supplementation
12
Q
Aplastic Anaemias
A
- A rare and potentially life-threatening failure of haematopoiesis (blood cell production).
- ‘Pancytopenia’ (lack of all three blood cell types) and hypocellular bone marrow (few or no cells).
13
Q
Aplastic Anaemias: Causes
A
- Congenital (“fanconi’sanaemia”).
- Idiopathic(unknown cause).
- Can be secondary to drugs (naproxen, diclofenac etc.), chemicals, radiation, cancer, hepatitis/EBV.
14
Q
Aplastic Anaemias: Signs and Symptoms
A
• Anaemia (pallor, headache, dyspnoea, palpitations etc).
• Multiple infections (due to low white blood cell count)
• Easy bleeding(due to low thrombocyte count).
Most common cause of death is sepsis, then haemorrhage
15
Q
Aplastic Anaemias: Treatment
A
- Treat the cause.
- Bone marrow stem cell transplant.
- Platelet transfusion/blood transfusion.
16
Q
Haemolytic Anaemias
A
- Anaemia resulting from excessive breakdown of erythrocytes, when bone marrow activity cannot compensate for the loss of RBC’s.
- Erythrocyte life span can become as low as 5 days.
17
Q
Haemolytic Anaemias: Causes
A
- Genetic (e.g. sickle cell, thalassemia).
* Rhesus factor incompatibility, malaria, some drugs, chemicals, autoimmune, radiation.
18
Q
Haemolytic Anaemias: Signs and Symptoms
A
- Same general signs & symptoms of anaemia.
- Jaundice (excess bilirubin production).
- Splenomegaly (excess haemolysis in the spleen causes it to enlarge, leading to abdominal distention and a feeling of fullness quickly whilst eating.).
- Gallstones and vascular occlusions.
19
Q
Sickle Cell Anaemia
A
- Sickle cell anaemia causes a deficiency of the 2-alpha 2-beta formation of haemoglobin and causes it to sickle up.
- When HbS gives up oxygen to interstitial fluid, it causes the erythrocyte to sickle up.
- These cells rupture easily. Even though erythropoiesis is stimulated, it cannot keep up with the rate of haemolysis.
- The sickle trait protects against malaria because it causes sickle formation and potassium leakage out of erythrocytes.
- Sickle cell is an inherited recessive condition (substitution chromosome 21), affecting African and Caribbean populations.
20
Q
Sickle Cell Anaemia: Signs and Symptoms
A
- Usually begins 3-6 months of age as HbFfalls.
- General signs and symptoms of anaemia.
- Splenomegaly and jaundice.
- Can also occlude vessels and cause ischaemic pain: pain in fingers, placental infarction, strokes, renal colic.
21
Q
Sickle Cell Anaemia: Diagnosis and Treatment
A
BLOOD TEST:
• FBC and blood film. Hb is 6-8g/dL.
TREATMENT:
• Analgesics (pain relief), fluid therapy, blood transfusion, bone marrow transplant.
22
Q
Thalassaemia
A
- Thalassaemia describes a defect in synthesis of either the alpha or beta Hb chains.
- An inherited disease (recessive).
23
Q
Thalassaemia: Signs and Symptoms
A
- B-Thalassaemia -> Starts when HbA production begins/gamma chain ceases (usually later part of first year). Causes ‘failure to thrive’ and anaemia.
- A-Thalassaemia -> Can be lethal in utero in severe cases (‘major’). Signs/symptoms of anaemia, jaundice, splenomegaly, hepatomegaly. To compensate haemolysis, bone marrow proliferation (mostly skull/ribs).
24
Q
Haemolytic Disease of the Newborn
A
- Occurs when the mother produces Anti-Rhesus antibodies that cross the placenta.
- The antibodies bind to the foetal rhesus antigens, causing agglutination & haemolysis.
- Sensitisation occurs with the first baby producing maternal antibodies against rhesus.
- The greatest possibility of sensitisation occurs at delivery, so the first born child is normally unaffected.
- Anti-Rhesus antibodies can be given during pregnancy to bind to Rhesus antigens and block them.
25
Polycythaemia
* Polycythaemia describes an excessive production of erythrocytes resulting in increased blood viscosity, reduced blood flow and an increased risk of thrombosis.
* Also known as ‘erythrocytosis’.
26
Polycythaemia: Causes
* Physiological: occurs at high altitude.
| * Pathological:unknown/genetic
27
Polycythaemia: Signs and Symptoms
* Mild cases may cause no symptoms.
* Arterial thrombosis: Myocardial infarction (heart attack), pulmonary embolism, stroke.
* Venous thrombosis: Deep vein thrombosis (DVT).
* Hypertension, red skin, headaches, dizziness, pruritus.
28
Granulocytopenia
* Marked reduction in the number of granulocyte leukocytes.
| * I.e. ‘neutropenia’ (normal neutrophil count is 2.5 -7.5 x10^9/L. “Severe neutropenia” if <0.5.
29
Granulocytopenia: Causes
* Drug toxicity & radiation.
* Bone marrow diseases.
* Severe infections, HIV & AIDS
30
Granulocytopenia: Signs and Symptoms
* Severe illness.
* Malaise.
* Necrosis of mucous tissues
31
Granulocytopenia: Treatment
* Treat the cause.
* Support immunity i.e. herbs (Echinacea, Andrographis) and nutrients (vitamin C, zinc, vitamin A, vitamin D) as well as life-style (e.g. stress management).
* Acupuncture & homeopathy
32
Leukocytosis
• Leukocytosis describes a marked increase in the number of all leukocytes.
33
Leukocytosis: Causes
* Response to infections (physiological).
| * Leukaemia (uncontrolled production of leukocytes in bone marrow due to cancer).
34
Leukaemia
• ‘Leukaemia’ describes a group of bone marrow cancers, characterised by an abnormal over production of leukocytes.
• This uncontrolled proliferation results in supressed erythrocyte production (= anaemia) and thrombocytes (= thrombocytopenia).
Divided into:
• Acute leukaemia's: Rapid onset, more aggressive course. Immature cells (>20% -blast cells in bone marrow).
• Chronic leukaemia’s:Insidious onset and more differentiated cells.
35
Acute Leukaemia
```
Age: All ages
Onset: Sudden
Leukaemiccells: Immature (-blasts)
Anaemia: Prominent
Thrombocytopenia: Prominent
Leukocyte count: Variable
Lymph node enlargement: Mild
Splenomegaly: Mild
```
36
Chronic Leukaemia
```
Age: Usually Adults
Onset: Insidious
Leukaemiccells: Mature
Anaemia: Mild
Thrombocytopenia: Mild
Leukocyte count: Increased
Lymph node enlargement: Prominent
Splenomegaly: Prominent
```
37
Leukaemia: Types
1. Acute myelogenous leukaemia (AML)
2. Acute lymphocytic leukaemia (ALL)
3. Chronic myeloid leukaemia (CML)
4. Chronic lymphocytic leukaemia (CLL)
38
Leukaemia: Signs and Symptoms
* Malaise, anaemia (fatigue, pallor etc.), frequent infections, easy bleeding/bruising.
* Fever, weight loss.
* Splenomegaly (abdominal swelling/discomfort).
* Lymph node enlargement.
39
Leukaemia: Diagnosis and Treatment
• Full Blood Count: anaemia, low thrombocytes, variable leukocyte count.
• Blood film (viewing sample of blood)
• Bone marrow biopsy.
ALLOPATHIC TREATMENT:
• Chemotherapy, bone marrow transplant, radiotherapy (relapse is common).
40
Thrombocytopenia
• Reduction in the thrombocyte count
41
Thrombocytopenia: Signs and Symptoms
* Excessive bleedingand bruising. Prolonged bleeding times (spontaneous bleeding occurs when count is less than 30).
* Petechiae (micro-haemorrhagesin the skin).
* Haematuria, vomiting blood, bleeding gums.
* Post-partum haemorrhage.
42
Thrombocytopenia: Causes
* Leukaemia.
* Congenital (e.g. Fanconi’s anaemia).
* Radiation, drugs, chemotherapy.
* Viral infections (EBV, hepatitis, HIV, MMR).
* Autoimmune destruction.
43
Haemophilia
• A Deficiency of clotting factors:
Haemophilia A: Deficiency of clotting factor VIII (8).
Haemophilia B:Deficiency of clotting factor IX (9).
44
Haemophilia: Causes
• Genetic: X-Linked recessive disorder (usually affects males. Females normally carriers. 1 in 5000 males).
45
Haemophilia: Signs & Symptoms
* Severe disease:Excessive and easy bleeding, GIT/mucosal haemorrhage, haematuria, haemarthrosis(causing inflammation and pain).
* Moderate disease:Easy bleeding.
* Mild disease:Bleeding after major trauma.
46
Haemophilia: Treatment
• Replacement of clotting factors/blood transfusion. Avoid contact sports. Herbs, Homeopathy, Nutrition.
