Blood and infection Flashcards
what is used to correct B12 deficiency
IV hydroxycobalamin
normal lifespan of RBC
120 days - can be as short as 5 days in haemolytic anaemia
3 types of acquired immune haemolytic anaemias
- autoimmune (warm/cold antibody type)
- alloimmune (transfusion reaction, haemolytic disease of newborn)
- drugs (methyldopa, penicillin)
types of acquired non-immune haemolytic anaemias
- microangiopathic (TTP/HUS, DIC, malignancy, pre-eclampsia)
- prosthetic heart valves
- infections (malaria)
- dapsone
- paroxysmal nocturnal haemoglobinuria
treatment of autoimmune haemolytic anaemia
- corticosteroids
- rituximab/ azathioprine/ cyclophosphamide
what virus is found in 50% of cases of Hodgkin’s lymphoma
EBV
HIV and immunosuppression and smoking are also risk factors
B symptoms found in 25% of patients with Hodgkin’s lymphoma
- night sweats
- unexplained fever >38
- weight loss >10% over 6 months
what blood test finding shows a poor prognosis in Hodgkin’s lymphoma
ESR >70
vaccines given in lymphoma
pneumococcal and flu
risk of giving chemotherapy in Hodgkin’s lymphoma
can cause leukaemia, especially AML
poor prognostic factors for Hodgkin’s lymphoma
- older
- male
- low albumin
- stage IV disease
- anaemia, leukocytosis, lymphopenia, monocytosis
type of non-hodgkin’s lymphoma associated with EBV
Burkitt’s
how does Burkitt’s lymphoma present
large abdo mass and symptoms of bowel obstruction
appearance of biopsy in Burkitt’s lymphoma
starry sky
what is MGUS
monoclonal gammopathy of undetermined significance
can progress to smouldering myeloma which leads to multiple myeloma
presentation of myeloma - CRABBI
- Calcium - hypercalcaemia due to increased osteoclast activity within bones
- Renal damage (elevated creatinine)
- Anaemia (BM crowding suppresses erythropoiesis)
- Bleeding (thrombocytopenia)
- Bones - lytic bone lesions
- Infection (reduced production of normal immunoglobulins)
investigation to do for myeloma
serum/urine protein electrophoresis
raised concentration of monoclonal immunoglobulins
Bence Jones proteins in urine
common MRI finding in myeloma
rain drop skull due to bone lysis
BM biopsy in myeloma
monoclonal plasma cells in BM >10%
management of myeloma in younger healthier patients
autologous stem cell transplantation
given with bortezomib (proteasome inhibitor) and dexamethasone
management of myeloma in older patients
thalidomide, dexamethasone and an alkylating agent
complications of myeloma
- hypercalcaemia
- renal impairment
- anaemia
- infection
- hyper viscosity (stroke?)
- SCC
- pathological fractures
- bleeding
- amyloidosis
- peripheral neuropathy
most common causes of DIC
sepsis
also malignancy - especially leukaemia
then trauma, pregnancy complications etc.
typical presentation of DIC
bleeding from at least 3 unrelated sites
confusion and disorientation
fever
bruising, purpura
features of sickle cell disease in infancy
- dactylics
- splenic sequestration
- pneumococcal sepsis
features of sickle cell disease in young children
- infections, parvovirus
- vaso-occlusive crises in long bones
- upper airway obstruction
- stroke
features of sickle cell disease in older children
- vaso-occlusive crises
- avascular necrosis
- stroke
management of acute sickle cell crisis
- analgesia
- antihistamine
- hydration 150% of normal maintenance oral or IV
- abx if needed
- blood transfusion in aplastic crisis, sequestration or anaemia
maintenance management of sickle cell disease
- avoid precipitating factors
- hydroxycarbamide
- L-glutamine
- repeated blood transfusions
- vaccinations
- lifetime oral penicillin V prophylaxis
- daily oral folic acid
what can be curative for sickle cell disease
BM transplantation
commonest cause of mortality in sickle cell disease
acute chest syndrome - vast-occlusion and collapse in the lungs
trigger for aplastic crisis in sickle cell
parvovirus B19
what is splenic sequestration in sickle cell
life threatening sudden enlargement of the spleen leading to hypovolaemia
what can sickle cell do to the penis
cause priapism - risk of long term impotence
when does someone with haemophilia require prophylactic factor VIII concentrate
if <1% activity = severe disease
what can IM bleeds in haemophilia lead to
compartment syndrome
nerve compression
ischaemic contracture
clotting results in haemophilia
increased APTT
normal PT
prophylactic treatment in haemophilia A
regular injections of octocog alfa (FVIII)
prophylactic treatment of haemophilia B
regular injections of nonacog alfa (FIX)
what is indicated if bleeding in haemophilia doesn’t respond to treatment
FVIII inhibitor development
most common type of thalassaemia
beta - heterozygous
how is diagnosis of thalassaemia made
haemoglobin electrophoresis
- beta = high levels of HbA2 and HbF
- alpha = normal levels
features of homozygous beta-thalassaemia
- severe haemolytic anaemia
- compensatory bone marrow hyperplasia
- protruding characteristic bossing of facial and skull bones and dental abnormalities
- hepatosplenomegaly
why is desferrioxamine given when doing blood transfusions for thalassaemia
blood transfusions cause haemosiderosis due to iron overload therefore give a chelating agent with it
drugs which can cause neutropenia
- chemotherapy/ radiotherapy
- alcohol
- phenytoin
- chloramphenicol
infections which can cause neutropenia
malaria hep B/C HIV CMV infectious mononucleosis
definition of febrile neutropenia
temp >38.5 or 2 temps >38 for 2 hours
and absolute neutrophil count <0.5
autologous vs allogenic bone marrow replacement
autologous = stem cells for transplant from own body (sourced when in remission)
allogenic = stem cells from a donor
cells on blood film in AML
blast cells
Auer rods
what is diagnostic of AML
bone marrow aspiration
first line treatment for CML
imatinib (tyrosine kinase inhibitor)
what is Richter’s syndrome
transformation of CLL to terminal lymphoma in 10%
when to give antibiotic prophylaxis during surgery with anaesthesia
- prosthesis or valve
- clean-contaminated surgery
- contaminated surgery
- surgery on dirty/infected wound
- tourniquet is used
type of cancer associated with infectious mononucleosis
- Burkitt’s lymphoma
- B cell lymphomas
difference in symptoms between tonsillitis and infectious mononucleosis
EBV = generalised tender lymphadenopathy
tonsilitis = only enlarges upper anterior cervical chain
when can there be a false positive with a mono spot test
lymphomas
leukaemia
RA/SLE
some viral illnesses
diagnostic test for infectious mononucleosis in the immunosuppressed
quantitative PCR
CNS complications of infectious mononucleosis
- aseptic meningitis
- encephalitis
- Guillain-Barre syndrome
suppression if MRSA positive
- mupirocin for nose TDS 5 days
- chlorhexidine gluconate for skin, OD for 5 days
typical antibiotic which can cause C. diff
clindamycin
severe complication of C. diff
toxic megacolon
test to do if symptomatic (C. diff)
C. diff toxin in stool
management of C. diff
- supportive
- AVOID loperamide/codeine (retention of toxins?)
- cease causative antibiotic
- oral METRONIDAZOLE 10-14 days
- if not responding - VANCOMYCIN
antibiotics to give in life-threatening C. diff
oral vancomycin + IV metronidazole
is C. diff a reportable disease
yes
3 types of influenza
A B C
A and B cause most disease (A causes most flu outbreaks)
when to use antivirals in influenza (oseltamivir, zanamivir)
significant comorbidities, immunosuppression, pregnancy
most common complication of influenza
acute bronchitis
blood film - measles
leucopenia
lymphopenia
LFTs - measles
raised transaminases
complications of measles
- acute OM
- pneumonitis
- febrile convulsions
- keratoconjunctivitis, corneal ulceration
- encephalitis
- subcutaneous sclerosing pan encephalitis (about 7 years after measles infection)
complications of mumps
- orchitis
- hearing loss
- meningoencephalitis
- pancreatitis
- oophoritis
school exclusion for mumps
for 5 days following parotid swelling
school exclusion for chicken pox
5 days from start of skin eruption
when to use acyclovir in chicken pox
- severe varicella
- encephalitis
- pneumonia
- babies
- immunosuppressed
complications of chicken pox
bacterial infection may occur with invasive group A strep - leading to cellulitis, necrotising fasciitis or TSS
NSAIDs may increase this risk
antibiotics given for whooping cough
azithromycin (5 days)
clarithromycin (7 days0
erythromycin if pregnant
when to do stool culture in infective gastro-enteritis
- suspected sepsis
- blood/mucus in stool
- immunocompromised
- recently been abroad
- diarrhoea not improving
complications of infective-gastroenteritis
- dehydration and electrolyte disturbance
- HUS
- reactive arthritis
- erythema nodosum
- GBS
- malnutrition
what virus commonly causes Guillain-Barre
campylobacter
protective factors for malaria
- sickle cell trait
- G6PD deficiency
- HLA-B53
what to check before giving primaquine
G6PD deficiency
management of non-falciparum malaria
outpatient
chloroquine
primaquine used for prevention of relapse
management of falciparum malaria
quinine plus doxycycline orally if uncomplicated
IV quinine if severe with ECG monitoring
antimicrobial therapy given for traveller’s diarrhoea
fluoroquinolone
