Blood Flashcards
Daily requirement and causes of iron deficiency anemia
Daily requirement: 10mg/day
Causes
- Inadequate supply of iron
- premature, twin pregnancy
- fetal blood loss at delivery
- prolonged BF without iron supplement
- food poor with iron
- chronic diarrhea,
- malabsorption syndrome - Excessive demand of iron
- acute, chronic hemorrhage
- parasitic infection - Failure to meet increase demand of growth
- premature
Clinical picture of iron deficiency anemia
- common 9-24 month
- screening at 12 month by laboratory
- anorexia, fatigue
- pallor
- pica
- impair intellectual activities
- cardio: tachycardia, murmur
- spleen enlarge
Investigate of iron deficiency anemia
- decrease serum ferratin
- decrease serum iron
- decrease MCV, MCH, MCHC
- variation size of RBC
- increase reticulocyte
Treatment of iron therapy
- Iron therapy
a) oral
- ferrous sulphate
- ferrous gluconate
- 6mg/kg/ day for 4-6 weeks
b) parenteral
- if GIT irritation
- iron dextran mixture , IM
- 50mg ( infant), 100mg (child) for 3-5 days
- Blood transfusion
- if severe anemia
- 10ml/kg
Type of aplastic anemia
- Acquired aplastic anemia
- Congenital
- fanconi anemia
Definition and clinical picture of fanconi test
Definition
- inherited as autosomal recessive character
Clinical picture - 3- 14 years - abscence radii and thumb - pallor, fatigue - bleeding mucous membrane - short stature - pigment of skin - FA facies: > micrpencephaly > small eyes > epicantus fold
- horseshoe kidney
Investigation and treatment of Fanconi Anemia.
Investigation (lab)
- thrombocytopenia, granulocytopenia
- macrocytic anemia
- scanty reticulocyte
- test of skin fibroblast
- test amnion fluid cell for abnormal chromosome breakage.
Treatment
- hemopoitic stem cell transplant
- granulocyte colony stimulating factor (for increas platelet)
- GCSF + erytropoietin ( increase neotrophill)
- oral oxymetholone
- low dose prednisone
- supportive: blood transfusion + Ab
Cause and clinical picture of acquired aplastic anemia
Causes
- chemotheraphy
- drug: chloramphenicol, antiepileptic
- virus: cytomegalovirus, HIV, Hep. B, C
- leukemia
- pregnancy
CP
- fatigue
- heart failure
- infection: throat, skin
- bleeding, purpura
Investigation and treatment of acuired aplastic anemia
Investigate as FA
Treatment
1. Bone marrow transplant
- Immunosuppression
- antithymocyte globulin
- cyclosporine - High dose cyclophosphamide
DD of acquired aplastic anemia
- acute leukemia ( pancytopenia without leukemic cell)
- hypersplenism ( has splenomegally)
- bone marrow replacement
- autoimmune pancytopenia
Type of chronic hemolytic anemia
- B-thalessemia
- sickle cell anemia
- hereditary spherocytosis
Definition and clinical picture of B- thalessemia
Definition
Hereditery chronic hemolytic anemia due to impair production of B- chain
CP - mangoloid face > big head > depress nasal bridge > frontal bosing > protusion of maxilla
- jaundice
- pallor
- cardiomegaly
- hepatosplenomegally
- short stature
- delay puberty
Complication of B-thalessemia
- infection
- iron overload
- anemic HF
- hepatitis C
- hypersplenism
Investigation of B-thalessemia
- microcytic hypochromic anemia
- increase reticulocytic count
- increase serum iron
- BM exam
- xray bone skull ( hair appearance)
- PCR : detact mutation
Treatment of B-thalessemia
- packed RBC transfusion ( 10-15ml/kg/dose every 4-6 weeks)
- irom chelation: desferroxamime
- folate 1mg/ day
- decrease iron diet
- splenectomy
- BM transplant
- gene therapy
Definition and clinical picture of hereditary spherocytosis
Definition
Chronic hemolytic anemia due dysfunction of cell membrane protein ( spectrin)
CP
- anemia
- aplastic crisis
- splenomegally
- jaundice
- gall stone formation
Investigate of hereditary spherocytosis
- anemia: normocytic normochromic
- increas reticulocyte
- unconjugated bilirubinemia
- spherocyte
- increase osmotic fragility
Treatment of hereditary spherocytosis
- blood transfusion
- folic acid supplement
- splenectomy
- vaccines: pneumococci, h. Influenza
- penicillin
Etiology and clinical picture of idiopathic thrombocytopenic purpura
Etiology
- virus particle attach to platelet to provoke immunologic response
CP
- history of viral infection 1-4 weeks before
- hemorrhagic rash: petechial, ecchymosis
- bleeding
> oozing gums
> epistaxis
> hematuria, melena
- anemia ( if blood loss)
- Spleen and liver NOT ENLARGE
Management of idiopathic thrombocytopenic purpura
- whole fresh blood transfusion
- IV immunoglobulin 0.8-1g/kg/day
- prednisone 1-4mg/kg
- IV anti-D
- splenectomy
What is hemophilias A and its Clinical picture
Deficiency of factor VIII
CP
- Predisposing factor
- male
- +ve family history - Present
- recurrent hge after minor trauma
- prolonged bleeding after circumcision - Frequency and severity of bleeding
- Site of bleeding
- large intramuscular hematoma
- ecchymosis
- mucous membrane
Investigation and ttt of hemophilis A
Investigate
- prolonge clotting time and PTT
- factor VIII assay: reduce
- normal prothrombin level
Ttt
- Prevent of bleeding
- avoid trauma & surgery
- dental hygiene
- pad on knee - Replacement therapy
- fresh frozen plasma
- cryoprecipitate
- factor VIII Concentration 25-75unit/ kg
Type of leukemia
Malignant neoplasm
- Acute Lymphoblastic leukemia
- acute myeloid leukemia
- chronic lymphoblastic leukemia
- Chronic myeloid leukemia
Definition of ALL
Group of malignant disease,
genetic abnormalities in hematopoietic cell rise
unregulated clonal proliferation of cell
