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.Year 3 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Anaemia sx

A

Skin + mucosal pallor
Pale conjuctivae
Fatigue
Increased RR + HR if severe

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2
Q

Causes of microcytic anaemia

A

Haem ring dysfunction:
Iron deficiency
Anaemia of chronic disease
Globin chain dysfunction:
Thalassaemia
Sickle cell

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3
Q

Causes of iron deficiency

A

Reduced uptake
- malnutrition, coeliac, IBD, achlorhydria
Increased loss
- GI malignancy, peptic ulcer, IBD, menstruation
Increased requirement
- pregnancy, breastfeeding

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4
Q

ID blood film

A

Aniso-poikilocytosis
Pencil cells
Hypochromic

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5
Q

Compare blood results due to ID and ACD microcytic anaemia

A

ID
- low ferritin, high TIBC
ACD
- high/normal ferritin, low TIBC
- high hepcidin due to increased cytokine activity

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6
Q

How is thalassaemia diagnosed?

A

Bloods show normal iron studies w/ microcytic anaemia
Hb electrophoresis to see problem
- alpha, factor 8 [chr16]
- beta, factor 9 [chr11]

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7
Q

What are sickle cell pts pre-disposed to?

A

Hypoxia, dehydration, acidosis, infection due to chr 11 mutation in beta-globin gene, resulting in the formation of HbS

Sickled RBCs are prone to clumping together into large polymers

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8
Q

Sickle cell blood film

A

Howell-Jolly bodies
Sickled cells
Microcytic anaemia findings

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9
Q

What may a sickle cell crises result in and how is it managed?

A

Acute painful crisis
= saturate (O2), Abx (if needed), pain relief, cannula (IV fluids)
Stroke
= exchange blood transfusion
Sequestrian crisis
= splenectomy
Chronic cholecystitis
= cholecystectomy

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10
Q

How is sickle cell anaemia managed?

A

Conservative
- avoid triggers

Medical
- vaccines
- hydroxyurea; increase HbF production
- prophylactic Abx; if no spleen, reduced immune function

Surgical
- bone marrow transplant; curative

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11
Q

Megaloblastic anaemia blood film

A

Hypersegmented neutrophils
Macrocytic cells

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12
Q

Causes of megaloblastic anaemia

A

Folate deficiency
- alcohol, IBD, coeliac, anti-folate drugs (methotrexate, anti-convulsants like phenytoin), pregnancy

B12 deficiency
- alcohol, IBD, coeliac, bariatric surgery, malnutrition, pernicious anaemia

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13
Q

What is pernicious anaemia?

A

Rare AI mediated B12 deficiency
- anti-parietal cells => produces IF
- anti-intrinsic factor => forms GIT resistant complex with B12

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14
Q

Which deficiency causes what neuro sx?

A

B12 deficiency causes:
- glove and stocking parasthesia
- hyporeflexia
- Romberg’s +ve
- subacute combined degeneration of cord
=> lateral corticospinal tract lesion; myopathy
=> dorsal column tract lesion; pressure, vibration and touch sense diminished

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15
Q

Causes of non-megaloblastic anaemia

A

Low Hb, large MCV:
= Alcoholics: alcohol
= May: myelodysplasia
= Have: hypothyroidism
= Liver failure: liver disease

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16
Q

Haemolytic anaemia presentation

A

Normocytic anaemia
Haptoglobin, unconjugated bilirubin
Increased LDH
Scleral icterus, pallor, pale conjuctivae

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17
Q

Causes of hereditary haemolytic anaemias

A

Membrane
= hereditary spherocytosis

Enzymes
= G-6-PD deficiency

Haemoglobin
= sickle cell
= thalassaemia

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18
Q

Hereditary spherocytosis summary card

A

AD condition, spherocytes on blood film
- defect in protein on wall so no cytoskeleton (beta spectrin/ankyrin deficiency)
- leads to aplastic crisis when infected with parovirus B19
- osmotic fragility test (hypotonic solution leads to lysis of RBCs) + -ve Coomb’s test is diagnostic

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19
Q

What is the Coomb’s test?

A

aka DAT
= direct Coombs test detects antibodies that are stuck to the surface of the red blood cells
= +ve means you have antibodies that attack your RBCs therefore autoimmune haemolytic anaemia

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20
Q

G-6-PD deficiency summary card

A

X-linked recessive disorder
- oxidative stressors trigger this, i.e. naphthalane moth ball, antimalarials (quinine), flava beans
- blood film shows heinz bodies (active haemolysis) or bite cells (previous haemolysis)

21
Q

Causes of acquired haemolytic anaemias

A

Haemolytic uraemic syndrome
= E. Coli shigella toxin in < 5yo

Disseminated intravascular coagulaton
= sepsis, trauma, pancreatitis, cancers, obstetric complications, ABO reactions

Thrombotic purpura
= defective ADAMTS-13 enzyme needed to degrade large vWF multimers

22
Q

HUS features

A

H aemolysis
= jaundice, conjuctive pallor
U rinary problems
= oliguria, increased creatinine
S hits
= abdo pain, bloody diarrhoea

23
Q

DIC features

A

Bleeding
= haematuria, ecchymoses, petechia, increased D-dimer + fibrin degradation products, reduced plts + fibrinogen
Clotting
= prolonged APTT and PT
Haemolytic
= jaudince, conjuctive pallor

24
Q

TP features

A

(rarely complete pentad)
A ntiglobulin -ve
D ecreased plts
A KI
M AHA
T emperature
S winging CNS signs

25
Q

Possible ddx of +ve Coombs test

A

If +ve in warm (>37degrees)
= IgG antibodies
= idiopathic, SLE, CLL

If +ve in cold (<37degrees)
= IgM antibodies
= idiopathic, mycoplasma, mononucleosis

26
Q

Anti-phospholipid syndrome summary card

A

AI-mediated thrombosis, manifesting during pregnancy
= recurrent miscarriages (3+), VTE, strokes/MI, HTN, liverdo reticularis (mottled, purplish disclouration)
= +ve anti-cardolipin, +ve lupus anti-coagulant test

27
Q

Types of polycythaemia

A

Primary
= rubra vera due to philadelphia chromosome -ve myeloproliferative disorder

Secondary
= appropriate; hypoxic response
= inappropriate; EPO-secreting tumour

28
Q

Clinical features of primary polycythaemia

A

Older (>60yo)
Asymptomatic
Aquagenic pruritus
Hyperviscosity syndrome

29
Q

Mutation that results in rubra vera

A

JAK2 V617F +ve (almost all)
= results in excess haematopoiesis
= receptor stays ‘open’ when should ‘close’ when there is no longer any EPO-release from kidneys

30
Q

Myelofibrosis presentation

A

Fibrosis in response to BM malignancy, JAK2 mutation association
= >65 yo, exposure to radiation
= BM aspirate shows ‘dry tap’ fibrosis
= Blood film shows tear drop cells

31
Q

Aplastic anaemia summary card

A

Bone marrow failure causing pancytopaenia
=> Fanconi’c anaemia (AI), infections, radiation
=> BM aspirate shows HYPOcellular
- anaemia; increased EPO
- thrombocytopaenia; bleeding, petechiae
- leucopaenia; sepsis, recurrent infections

32
Q

Krusty is a 54 year old Clown and fast food franchise owner. He reports 6 kg of weight loss over the last 3 months alongside ‘stomach issues’. On examination, he has angular cheilitis, koilonychia and appears pale.

A blood film shows hypochromic red blood cells with evident anisopoikilocytosis and multiple pencil cells.

What is the diagnosis?
A Anaemia of Chronic Disease
B Thalassaemia Major
C Iron Deficiency Anaemia
D Chronic Lymphocytic Leukaemia
E Hyperthyroidism

A

C Iron Deficiency Anaemia

33
Q

Abe Simpson is 83 year old man with enlarged lymph nodes. He has lost 5kg in the last 2 months. He reports episodes of fevers and night sweats. On examination he has hepatosplenomegaly. After follow up from an urgent two week referral, he is diagnosed with Non-Hodgkin’s Lymphoma. Blood testing also identifies an anaemia related to his condition.

Which is increased in Anaemia of Chronic Disease?

A Intrinsic factor
B Hepcidin
C TIBC
D Transferrin
E Ferroportin

A

B Hepcidin

34
Q

Kent Brokodopolis is a news reporter from Greek Cyprus. His son is 6 months old and has stunted growth. On examination the boy is small, docile with pale conjunctivae. He has hepatosplenomegaly and skull abnormalities with ‘chipmunk’ facies.

Which investigation will confirm the likely diagnosis?

A HLA typing
B Haemoglobin Electrophoresis
C Peripheral Blood Smear
D Full Blood Count
E Plain Skull X-ray

A

B Haemoglobin Electrophoresis

35
Q

Carl Carlson is a 36 year old male with Sickle Cell Anaemia. He is admitted to Hospital while undergoing an acute painful crisis.

How should Carl be managed?

A Fluids, Oxygen and Analgesia
B Exchange Blood transfusion
C Emergency Splenectomy
D Urgent Cholecystectomy
E Allogeneic stem cell transplant

A

A Fluids, Oxygen and Analgesia

36
Q

Marge is a 38 year old female who presented with a painless goitre, which she reports covering up for a number of years with her pearl necklace. She was recently diagnosed with Hashimoto’s thyroiditis. Her recent blood results also demonstrated some haematological abnormalities.

Which of the following patterns is most likely to be shown?

A Low Hb, Low MCV, High RDW
B Low Hb, High MCV, megaloblastic on film
C Low Hb, High MCV, non-megaloblastic on film
D Normal Hb, Normal MCV, Normal Haematocrit
E High Hb, Low MCV, High Haematocrit

A

C Low Hb, High MCV, non-megaloblastic on film

37
Q

Lisa is a 12 year old girl presenting to her GP with tiredness and tingling sensations in her hands. Lisa has recently modified her diet, taking part in Veganuary this year and is following this through currently. Her mother has been diagnosed with Hashimoto’s.

On examination she appears pale. The corners of
her lips are notably sore.

Which is the most likely cause of her symptoms?

A Dietary induced B12 deficiency
B Pernicious Anaemia
C Coeliac Disease
D Folate Deficiency
E Iron Deficiency

A

B Pernicious Anaemia

38
Q

Which of these must be avoided in individuals with known
G-6-PD deficiency?

A Gluten products
B Cow’s Milk protein
C Broad beans
D ACE inhibitors
E Smoking

A

C Broad beans

39
Q

Maggie is a 14 month old infant. She has a recent 5 day history of abdominal pain which her parents believe is related to food she ate at their recent trip to the state fair. The paediatric registrar on call believes she has now developed an AKI. Her blood tests reveal a normal PT, normocytic anaemia with leucocytosis and thrombocytopaenia. A section of her blood film shows schistocytes

What is the most likely cause?

A ALL
B DIC
C HUS
D Pyelonephritis
E Sepsis

A

C HUS

40
Q

Which of these statements is incorrect about Antiphospholipid
syndrome?

A APS is screened for after 3 miscarriages
B Patients have an increased risk of thrombosis
C Lupus Pernio is a clinical sign
D Diagnosis includes screening for the Lupus anticoagulant
E Diagnosis includes screening for anti-cardiolipin antibodies

A

C Lupus Pernio is a clinical sign

it’s livedo reticularis actually

41
Q

Which of the following mutations is classically associated with Polycythaemia Rubra Vera?

A EHEC O157N7
B BCR ABL1
C TP53(17q-)
D PML-RARa
E JAK2 V617F

A

E JAK2 V617F

42
Q

Montgomery Burns is an 89 year old owner of a nuclear powerplant. He is hypertensive and managed with Amlodipine. He is referred to his doctor after his dentist notices he appears cachectic and his dentures no longer fit. On examination, Mr Burns has massive splenomegaly. A blood test and subsequent bone marrow biopsy are carried out:
RBC – Low
Hb – Low
WCC – Low
Plts – High
Film: poikilocytosis
Biopsy: ‘dry tap’

Which is the most likely cause of his symptoms?

A Multiple Myeloma
B Acute Myeloid Leukaemia
C Essential Thrombocytosis
D Myelofibrosis
E Myelodysplasia

A

D Myelofibrosis

43
Q

A 60 year old man presents with lethargy to the GP. A full blood count and
smear is requested. The following is found:
Hb: 10 g/dl (135-180)
Platelets: 310 (150-400)
WBC: 14 (4-11)
Film: Leucoerythroblastic picture with tear-drop poikilocytes seen

What is the most likely diagnosis:
1. Iron deficiency anaemia
2. Myelofibrosis
3. Chronic myeloid leukaemia
4. Haemolytic anaemia
5. Myelodysplasia

A
  1. Myelofibrosis
44
Q

A 55 year old lady presents to the GP with long standing pain in her
hands. On examination there are gross deformities of her fingers and
joint swelling.
A FBC reveals
Hb: 7.3 (11.5-186.0)
MCV: 94 (82-100)
WCC: 7 (4-11)

What is the most likely cause of the blood results?
1. Thalassaemia
2. Iron deficiency anaemia
3. Vitamin B12 deficiency
4. Anaemia of chronic disease
5. Sideroblastic anaemia

A
  1. Anaemia of chronic disease
45
Q

A 21 year old female presents with chronic fatigue and tiredness. On
further questioning she reveals a longstanding history of heavy
periods. On examination you notice pale conjunctivae.

What is the most likely cause of her symptoms:
1. Alcohol excess
2. Iron deficiency anaemia
3. Folate deficiency
4. Thalassaemia
5. Vitamin B12 deficiency

A
  1. Iron deficiency anaemia
46
Q

A 35 year old man presents to his GP with worsening fatigue over the past
few months. He mentions that his stools have been darkening recently
and he’s been having recurrent pins and needles in his hands. He has
a history of Crohn’s disease which is managed with azathioprine but
has had several flares this year which required hospital admission. A
full blood count shows the following:
Hb: 10 (13.5-18.0)
MCV: 124 (84-100)
Platelet: 240 (150-400)

What is the most likely diagnosis:
1. Vitamin B12 deficiency
2. Anaemia of chronic disease
3. Alcohol excess
4. Iron deficiency anaemia
5. Haemolytic anaemia

A
  1. Vitamin B12 deficiency
47
Q

A 7 year old male with known sickle cell disease present to A+E with mild
pain in his back for the last 2 days. He has already tried paracetamol
and ibuprofen. On examination he has a blood pressure of 94/62
mmHg, heart rate of 110 bpm, respiratory rate of 30/min and a
temperature of 38.4 degrees. There is no obvious source of infection.

What is the most appropriate next step?
1. Prescribe oramorph and review tomorrow
2. Prescribe daily codeine and ask GP to review in a week
3. Chest x-ray and dipstick urine (give antibiotics if +ve)
4. Admit urgently
5. Full blood count and review tomorrow

A
  1. Admit urgently

?sepsis
= temperature
= low BP
= tachycardic
= tachypnea

48
Q

A 22 year old female presents with lethargy. The following blood results
are obtained:
Hb: 10.6 (11.5-16)
Platelets: 300 (150-400)
WCC: 5.5 (4-11)
MCV: 65 (84-100)
HbA2: 4.5% (<3%)

What is the most likely diagnosis?
1. Beta-thalassaemia major
2. Sickle cell anaemia
3. Hereditary spherocytosis
4. Beta-thalassaemia trait
5. Iron deficiency anaemia

A
  1. Beta-thalassaemia trait

.Year 3 (32 decks)

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