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Med Year 3 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

what is the definition of anaemia

A

low level of Hb in blood

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2
Q

what does MCV, MCH mean

A

mean corpuscular volume, indicates SIZE of RBC,

MCH = ave amount of Hb in each RBC

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3
Q

what is ferritin and folate and b12?

A

ferritin - intracellular protein that stores iron
folate - many forms of vitamin b9, including folic acid

b12 and folate work to make erythrocytes. makes up Hb

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4
Q

what are the general symptoms of anaemia

A 
tiredness
SOB
headaches
dizziness
palpitations
worsening of other conditions such as angina
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5
Q

generic signs of anaemia

A

pale skin
conjuctival pallor
tachycardia
raised resp rate

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6
Q

other specific signs of anaemia

A

koilonychia
angular chelitis
smooth tongue
jaundice - haemolytic

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7
Q

what lab tests can you do for anaemia

A

haematocrit= what % of blood is taken up by red cells
normal - 40%

Hb concentration

MCV - macrocytic or microcytic

reticulocyte count: low = cause of anaemia is due to reduced production
high = being made ok but destroyed prematurely

red cell morphology: hypochromic, spherocytic etc

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8
Q

what further investigations should you do for anaemia?

A

oesphago-gastroduodenoscopy and colonoscopy for GI bleed

bone marrow biopsy

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9
Q

what are the microcytic anaemias, and what are the features?

A

low MCV, low MCH
causes:
TAILS

thalassameias
anaemia of chronic disease
iron deficiency anaemia
lead poisoning
sideroblastic anaemia
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10
Q

what is IDA

A

inadequate iron containing foods in diet, or malabsorption, or blood loss

causes:

  • physiological eg menarche, pregnancy
  • neonatal: prematurity, LBW
  • diet
  • GIT: bleeding/NSAID’s/cancers
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11
Q

how do you diagnose IDA

A

low hb, low MCV, low MCH

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12
Q

specific symptoms to IDA

A 
headache, esp with activity 
craving for non-food items 
smooth tongue
brittle nails or hair loss
koilonychia
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13
Q

how do you manage IDA

A

100-200mg elemental iron dialy eg

ferrous fumarate 210mg 2-3 times a day: raises Hb by 0.1 a day
treat till it is normal then 3 months after and maybe maintenance dose

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14
Q

what are side effects and contraindications of IDA

A

gi: nausea, black stools

may change to ferrous sulfate

  • thyroxine tablets and antibiotics: take few hours apart

take with orange juice or on an amepty stomach

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15
Q

what is thalassaemia

A

absence of alpha globin or beta globin chains which are used for erythropoesis to form hb

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16
Q

what is beta thalassaemia

A

beta thalassaemia minor: 1 abnormal, and has raised HbA2 = mild microcytic
BT major has 2 abnormal genes = only HbF

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17
Q

what is alpha thalassaemia

A 
4 genes:
1 deletd = clinically silent 
2- AT trait 
3- haemoglobin H disease
4 - bart's hydrops fetalis
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18
Q

what is the pathophys of thalassaemia

A

RBCs are more fragile and break down more easily
- spleen acts as a sieve to filter the blood and remove older blood cells but in thalassaemia spleen collects all the destroyed RBCs = splenomegaly

-bone marrow expands to produce extra RBCs to compensate for ammonia = susceptibility to fractures and bony features

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19
Q

what are the signs and symptoms of thalassaemia

A 
low MCV 
fatigue 
pallor 
jaundice 
gallstones 
splenomegaly 
poor growth and development
20
Q

how do you diagnose thalassaemia

A

FBC to show microcytic
Hb electrophoresis = globin abnormalities
DNA testing for genetic components

21
Q

what is iron overload and what are the symptoms? (same symptoms as haemochromatosis)

A

result of faulty creation of RBCs, recurrent transfusions and increased absorption of iron in response to anaemia

fatigue, liver cirrhosis, infertility, heart failure, arthritis, diabetes and osteoporosis and joint pain

22
Q

how do you manage thalassaemia?

A

long term blood transfusions, iron chelation (removal of iron excess by increasing excretion in urine or faeces)

  • desferrioxamine, deferipone, deferasirox infusion over 8-12 hours, 5 nights per week

deferasirox is the first line for treatment > age 6

23
Q

what are the side effects of DFP, DFX

A

painful, local inflammation, poor compliance, potential neuro and skeletal toxicity

24
Q

what is macrocytic anaemia

A

high MCV - large RBCs
megaloblastic or normoblastic

megaloblastic = impaired DNA synthesis, preventing cell from dividing normally

rather than dividing = grows into larger or abnormal cell and is caused by b12 or folate def

25
Q

pathophys of vitamin b12 deficiency

A

haptocorrin etc LOOK AT NOTES

26
Q

what causes acquired b12 deficiency

A 
nutritional - vegan, poor diet, pregnancy 
malabsorption:
-gastric: surgery, pernicious anaemia 
-intestine
-crohn's, coeliac etc
27
Q

what is acquired folate deficiency syndrome

A 
nutritional - poor diet, goat's milk
intestinal - coeliac, jejunal resection
excessive requirement eg pregnancy
increased turnover like chronic haemolysis 
excess loss like dialysis
28
Q

how do you manage folate deficiency anaemia

A

folic acid 5mg daily for 4 months

  • for undiagnosed anaemia: never give folic acid alone, give with vit b12 concurrently
29
Q

what are the signs and symptoms of b12 or folate deficiency

A 
insidious onset
mild jaundice and anaemia 
glossitis
angular chelitis
neuropathy
30
Q

how do you treat vit b12 deficiency

A

hydroxocobalamin: every couple of days until stores replenished then every 2-3 months

cyanacocabalamin

31
Q

other than megaloblastic anaemia, what are the other causes of macrocytosis?

A
  • alcohol
  • pregnancy
  • drugs like chemotherapy (anti-folates etc)
  • liver disease
  • reticuloycytosis
  • hypothyroidism
32
Q

what is normocytic anaemia and what causes it?

A

normochromic and normal MCV but low Hb. central pallor <33%

3 A’s 2 H’s

-acute blood loss (bc blood cells left are normal but hb conc takes time to lower so may not be immediate)

  • anaemia of chronic disease
    -aplastic anaemia
    h-haemolytic
    h-hypothyroidism
33
Q

hepcidin and ferroportin pathophysiology

A

??? notes

34
Q

what is haemolytic anaemia and what are the different types?

A

anaemia due to destruction, rather than underproduction, of RBC

  • hereditary spherocytosis
  • elliptocytosis
  • stomatocytosis
  • G6PD and PK deficiency
  • auto-immune haemolysis (Acquired)
35
Q

how do you diagnose the haemolytic anaemias?

A

blood films
bilirubin
specific: coomb’s test, ema-bonding, G6PD level, Hb identification

36
Q

what is spherocytosis

A

autosomal dominannt inherited abnormalities of red cell membrane proteins

= RBCs are sphere and fragile and broken down when passing through the spleen

37
Q

what are the symptoms and signs of hereditary. spherocytosis and how do you treat it

A

jaundice
chronic haemolysis
gall stones

  • give folic acid regularly
  • may need splenectomy
38
Q

how do you diagnose HS?

A
  • family history
  • reticulocyte count
  • MCHC raised on blood film

if all that negative, use EMA-binding: binds to eryhtrocyte membrane proteins and if they have it the fluorescence is weaker cos missing proteins

39
Q

what is G6PD?

A

x linked recessive disease, usually healthy between attacks. often FH of jaundice

  • sudden onset of feeling unwell, lack of energy, jaundice, back ache, dark coloured urine
40
Q

what is PK defieciency

A

autosomal recissive
-protruding spikes on RBCs
-chronic haemolysis
may need splenectomy

41
Q

what is AIHA

A

auto-immune haemolysis

  • warm and cold (what temp the antibody is active)
  • need a blood fillm and a positive DAT or coomb’s
42
Q

what causes AIHA

A

warm: idiopathic, or rheumatoid disease, CLL
cold: idiopathic, or EBV, ulcerative colitis

43
Q

how do you manage AIHA

A

steroids: prednisolone

dont transfuse patients unless severely visibly unwell

44
Q

what is SCA

A

beta globin variant, co-dominant

carriers HbAs normal, usually HbSS = patient has no normal Hb

45
Q

what is a sickle cell crisis, how are the different types managed?

A

for example, painful crisis: blood supply to bone is blocked and hence bone infarction and painful
- NSAID’s at home or ICU opiates if severe

chest crises: sickling in alveoli

abdomen: sickling in ometum
- blood supply to brain gets cut off = stroke, so preventions like reg blood transfusions

46
Q

what is the pathophys of SCA

A

most RBCs are disc shaped, and agglomerate with platelets and neutrophils to form clots that block off RBCs to rest of the body

  • scd does not affect fetuses because the fetal hb have gamma chains not beta
47
Q

how do you manage long term SCA

A
  • penicillin and folic acid
  • pneumovax to maintain immunity to pneumonia
  • hydroxyurea (demethylating and switching ON their fetal Hb gene)
  • stem cell transplant

Med Year 3 (25 decks)

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