Anaemias

Question 1

What would you use to treat sickle cell disease?

Answer 1

Folate supplementation helps make new RBCs = folic acid 5mg OD

Question 2

What would you use to treat sickle cell crises?

Answer 2

Hydroxycarbamide to reduce frequency of crises

Question 3

What is gluclose-6-phosphate dehydrogenase deficiency?

Answer 3

It is an inborn error of carbohydrate metabolism.

• It predisposes to haemolytic anaemia (spontaneous destruction of RBCs)
• In response to certain drugs or food.

Question 4

What drugs have a definite risk to gluclose-6-phosphate dehydrogenase deficiency (G6DP)?

Answer 4

• Dapsone and other sulphones
• Sulphonamides - e.g. co-trimox
• Nitrofurantoin
• Quinolones
• Rasbirucase

Question 5

What are symptoms of iron deficiency anaemia?

Answer 5

Tiredness
Pallor
SoB
Palpitations

Question 6

Which conditions does a prophylaxis of Fe is required for iron deficiency?

Answer 6

Malabsorption, e.g. Crohn's
Gastrectomy
Menorrhagia
Chronic renal failure; haemodialysis
Pregnancy
Low birth weight infants

Question 7

What are some pt counselling points for Fe?

Answer 7

• Take w or after food (reduces GI SEs)
• Take with a glass of orange juice - Vit C aids absorption of Fe
• Cont for 3 months after blood levels return to normal

Question 8

Who can you give compound preparations fo Fe for?

Answer 8

Pregnant women.

Folic acid & Fe as they are at a high risk of both!

Question 9

What are parenteral Fe preps for?

Answer 9

• Chronic renal failure with haemodialysis
• Malabsorption syndromes
• Chemotherapy-induced anaemia

Question 10

What MHRA/CHM advice is there for intravenous Fe?

Answer 10

Serious hypersensitivity reactions with IV Fe.

• take caution with every IV dose - test doses aren’t recommended
• Monitor for 30mins after each injection - use trained staff and resuscitation is immediately available
• High risk of allergies - immune, inflammatory conditions, severe atopic allergies, asthma, eczema. Give if benefit outweighs the risk
• AVOID IN PREGNANCY; esp in 1st trimester.

Question 11

What are symptoms of megaloblastic anaemia?

Answer 11

Vit B12 OR folic acid deficiency

• Numbness
• tingling hands/feet
• muscle weakness
• depression

Question 12

What are the causes of vit B12 deficiency?

Answer 12

• Dietary deficiency - can treat with PO HYROXOCOBALAMIN
• Or Mmalabsorption: gastrectomy, Crohn’s disease, pernicious anemia (lack of GI intrinsic factor) - can treat with IM HYDROXOCOBALAMIN

Question 13

What happens if you just give folic acid for megaloblastic anaemia?

Answer 13

Folic acid given alone can cause neuropathy.

Hence, in emergencies, give both folic acid and vit B12

Question 14

In megaloblastic anaemia, what is the cause of folate deficiency?

Answer 14

Poor diet
Coeliac’s disease; malabsorption
Pregnancy
AEDs, methotrexate etc.

Question 15

What is the treatment for folate deficiency in megaloblastic anaemia?

Answer 15

Folic acid OD for 4 months
Don’t give folic acid alone for undiagnosed megaloblastic anaemia or vit B12 deficiency megaloblastic anaemia = neuropathy of the spinal cord!

Question 16

Treatment for Fe poisoning?

Answer 16

DESFERRIOXAMINE MESILATE

Fe poisoning is fatal in kids

Question 17

What would you use to treat neutropoenia?

Answer 17

FILGRASTIM - recombinant human granulocyte colony-stimulating factor - this can reduce the duration of chemo-induced neutropenia.

Question 18

What do you use to treat immune thrombocytopenic pupura?

Answer 18

Initial treatment is with prednisolone (corticosteroid) - 1mg/Kg OD and reduce gradually over time

Question 19

What are the treatment options for PERSISTENT or CHRONIC immune thrombocytopenic purpura?

Answer 19

Thrombopoietin receptor agonists (avatrombopag, eltrombopag); rituximab (unlicenced) or fostamatinib

Question 20

What would you treat in refractory immune thrombocytopenic purpura?

Answer 20

Azathioprine, ciclosporin, cyclophosphamide, dapsone, mycophenolate mofetil, vincristine.