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Meded Flashcards 2020 > anaemia > Flashcards

anaemia Flashcards

1
Q

Fill out the table

A
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2
Q

What are features of anaemia?

A

Skin and mucosal pallor

Pale conjuctivae

fatigue

Increased resp rate and Heart rate

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3
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

Iron Deficiency Anaemia

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4
Q

What is type of anaemia that can be seen here?

What are the features?

What are the causes of it?

A

Iron deficiency anamia

poikilocytosis and anicytosis and pencil cell and microcytic and hypochromic cell

CAUSES:

Reduced uptake

  • Malnutrition
  • Coeliac
  • IBD
  • Achlorhydria

Increased loss

  • GI Malignancy
  • Peptic ulcer
  • IBD
  • Menstruation

Increased requirement

  • Pregnancy
  • Breastfeeding

Reduced prodcution:

  • sideroblastic anaemia
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5
Q

what is the triad of Colon cancer?

A

Iron deficiency anaemia

PR bleeding

Weight loss

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6
Q

What is globally the most common cause of iron deficency anaemia?

A

ascariasis and schistosomiasis

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7
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

Hepcidin

BECAUSE DUE TO ANAEMIA OF CHRONIC DISEASE

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8
Q

How does anaemia of chronic disease work

A
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9
Q

How do you differentiatate between anaemia of chronic disease and iron deficiency

A
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10
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

Haemoglobin Electrophoresis

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11
Q

Why do people with thalassemia and sickle cell get frontal bossing and skull abnormalities?

A

extramedullary haematopoiesis

ALSO GET hepatosplenomegaly

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12
Q

What are the different types of alpha defects?

What is the gene affected?

A

You have 4 genes-

Alpha+ lacking 1 gene

Alpha° lacking 2 genes

Hb H lacking 3 genes - significant anaemia

Hb Barts lacking all 4 - not compatible with life

What is the gene affected? - chr 16

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13
Q

What are the different types of beta thalassemia?

What chromosome is the defect on?

A

Beta minor

Beta intermedia

Beta major

Chr 11

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14
Q

What disease does thalassemia give resistance to

A

falciparum - malaria

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15
Q

How do you investigate thalassemia?

A

Investigations:

  • Microcytic anaemia
  • Normal Iron studies
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16
Q

Label the haemoglobin curve

Explain at what ages beta thalassemia presents

A

Typically presents between first 3 & 6 months

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17
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

Allogeneic stem cell transplant

A

a)Fluids, Oxygen and Analgesia

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18
Q

FIll out the table

A
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19
Q

What are the complication/ crisis (emergency) you can get in sickle cell and how do you treat them?

A
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20
Q

What are the symptoms of sickle cell?

A
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21
Q

What is the treatment of sickle cell

A

Conservative

  • Trigger avoidance

Medical:

  • Vaccinations
  • Hydroxyurea
  • Prophylactic ABx

Surgical:

  • Bone Marrow Transplant (curative)
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22
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A
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23
Q

Someone with a low MCV without thalassemia or sickle cell thought to have iron deficiency anaemia was given iron but his anaemia is not getting any better.

What could he have

A

20% of older people have sideroblastic anaemia

condition is characterized by ineffective erythropoiesis, leading to increased iron absorption, iron loading in marrow ± haemosiderosis (endocrine, liver, and heart damage due to iron deposition)

24
Q

Fill in the table

A
25
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

26
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

27
Q

What is type of anaemia that can be seen here?

What are the features?

What are the causes of it?

A

CAUSE

Macrocytic anaemia and hypersegmented neutrophils

B12-

  • Alcohol
  • IBD& celiac
  • Bariatric surgery
  • Malnutrition
  • Pernicious anaemia

Folate

  • Alcohol
  • IBD and Celiac
  • anti folate drugs
  • pregancy
28
Q

How long do your B12 researves last for?

A

3-4 years

29
Q

What is a cause of macrcytic anaemia with neuro signs?

What neuro signs could you get

A

B12 deficiency

  • Glove & stocking parasthesiae
  • Hyporeflexia
  • Romberg’s +ve
  • Subacute combined degeneration of the cord
    • Lateral corticospinal tract lesioned: myopathy
    • Dorsal column tract lesioned: pressure, vibration and touch sense diminished
30
Q

B12 deficiency and folate deficiency usually go hand in hand

Which do you treat first?

A

B12 because of neuro signs

31
Q

What is an autoimmune cause of B12 deficiency?

What are the antibodies present?

What are risk factors?

What are diagnostic factors?

A

What is an autoimmune cause of B12 deficiency?

  • Pernicious Anaemia

What are the antibodies present?

  • Anti-Parietal cells - produce intrinsic factor
  • Anti-Intrinsic factor - forms GIT resistant complex with B12

What are risk factors?

  • older(average onset is 60 yrs older
  • Auto-immune PMHx

What are diagnostic factors?

  • Macrocytosis
  • Megaloblastic film
  • Neuro signs
  • Low B12
32
Q

How long do folate storage last?

A

6 months

33
Q

What are diagnostic factors for classic megaloblastic anaemia?

A
  • Macrocytosis
  • Megaloblastic film
  • Low Folate
34
Q

What are non megaloblastic causes of macrocytic anaemia

A

Alcoholic May have liver failure

Alcohol

Myelodysplasia

Hypothyrodism

Liver disease

35
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

36
Q

What are the feature of haemolytic anaemia?

What are the blood results

A

pale conjunctiva

pallor

sclera icterus

BLOOD resutls:

  1. low Hb
  2. Haptoglobin low
  3. high unconjugated bilirubin
  4. LDH raised
37
Q

What are heredetary causes of haemolytic anaemia

A
38
Q

How do you test for autoimmune haemolytic anaemia?

A

Direct antiglobulin test (DAT)- COOMBS test

39
Q

What is this condition?

What can be seen on this image?

Why does this happen and in reaction to what?

What si the pattern of transmition

A

Haemolytic anaemia due to G6 PD deficiency

Heinz bodies and bite cell

x linked recessive

Aggrevated by beans, moth ball and antimalarias

40
Q

What is this condition?

What can be seen on this image?

What is the pattern of transmition?

What is the pathophysiology

What is the investigation of it and complication?

A

Hereditary spherocytosis

autosomal dominant

Pathophysiology: Spectrin and Ankyrin deficiency

investigation: Coombs - see if autoimmune spherocytosis (- ) + Osmotic fragility test - (hypotonic solution get lysis)

Complication: Parvirus B19 - aplastic crisis

41
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 is shown:

What is the most likely cause?

a) ALL
b) DIC
c) HUS
d) Pyelonephritis
e) Sepsis

A

c)HUS

42
Q

What is MAHA?

What does it stand for

A
43
Q

What is microangiopathic haemolytic anaemia?

A

anaemia caused by the destruction of erythrocytes due to physical shearing as a result of passage through small vessels occluded by systemic microthrombi

IT is characteristically thrombocytopenia in the absence of defects in coagulation

44
Q

What is it most likely due to?

What is the pathophysiology haemolytic uraemic syndrome?

In what demographic does it occur in?

What are the syptoms

A

Ecoli infection

E. coli produces shiga like toxin - binds to endothelial cells in the kidney and damages them -> damaged endothelium attracts platelets -> widespread platelet aggregation -> microthrombi shear blood vessel -> AKI with haemolytic anaemia

Haemolytic Urinary problems Shits (HUS)

SYMPTOMS:

Renal:

  • oliguria
  • creatine raised

Haemolytic:

  • pallor
  • jaundice

GI

  • abdominal pain
  • bloody diarrhoea
45
Q

What is Disseminated intravasclar coagulation?

What are the causes?

What are symptoms?

A

sytemic activation of the clotting cascade-> depostition of firbin and resutls in mocrovascular thrombi -> multi organ dysfunciton syndrome

+ all the clotting factor used up -> life threatening haemorrhage

CAUSES
pacreatitis

sepsis

obstetric complications

Cancers

Trauma

ABO reaction

SYMPTOMS

Bleeding features:

  • Pettechia
  • Ecchymoses
  • Haematuria
  • Low platelets
  • low fibrinogen
  • High Fibrin degradation products
  • high d dimer

CLotting features

  • prolonged APPT/ PT

Haemolytic feature:

  • pallor
  • jaundice
46
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

47
Q

What is the pathophysiology of thrombotic thrombocytopaenia purpura?

What is the pentad?

What enzyme is dysfunctional?

A

What is the pathophysiology of thrombotic thrombocytopaenia purpura?

ADAMTS-13 breaks down Von Willebrand factor into monomere to prevent spontaneous clotting but antibodies block it in TTP-spontaneous clotting

What is the pentad? antibody negative, decreased plateltets, AKI, MAHA, Temperature, Swiniging CNS signs

What enzyme is dysfunctional? ADAMTS -13

48
Q

When is auto imune thrombosis manifested ?

What are the clinincal features?

What are the antibodies?

A

When is auto imune thrombosis manifested ? - during pregnancy

What are the clinincal features?

  • Recurrent miscarriages (3+)
  • VTE
  • Stroke/MIs, HTN (arterial problems)
  • Livedo reticularis (mottled)

What are the antibodies?

  • Anti-cardolipin +ve
  • Lupus anti-coagulant test +ve
49
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

50
Q

Fill out the table

A
51
Q

What are clinical feature of polycythemia vera?

What is the definition of it?

What would you see in the blood?

What mutation is it associated with?

A

What are clinical feature of polycythemia vera?

  • Older (~60)
  • Asymptomatic
  • Aquagenic pruritis
  • Hyperviscosity syndrome

What is the definition of it?

  • Philadelphia chromosome negative myeloproliferative disorder.

What would you see in the blood?

  • Elevated Hb & haematocrit
  • +/- Thrombocytosis

What mutation is it associated with?

  • Almost all PCV is JAK2 V617F +ve
52
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

53
Q

What is this condition?

What can be seen?

In what demographic is it?

What mutation is it associated with?

A
54
Q

What is an aplastic anaemia?

What happens?

What can be seen in bloods and patients

What causes it ?

What would a Bone marrow aspirate show

A

What is an aplastic anaemia?

Bone marrow failure causing pancytopaenia

What happens?

autoantibodies attack the Bone marrow

What can be seen in bloods and patients?

Anamia - high EPO

Thrombocytopaenia - bleeding & pettechia

Leucopoenia- frequent infections & sepsis

What causes it? rafiation and infection

What would a Bone marrow aspirate show - hypocellular

55
Q
A

Meded Flashcards 2020 (36 decks)

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