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Medium Weighted Topics > Blood And Nutrition > Flashcards

Blood And Nutrition Flashcards

1
Q

Blood

A

Made up of cells and plasma
Cells = RBC, platelets and WBCs
Blood transports; gas, nutrients, waste and hormones
Regulates pH, temperature, water and electrolytes
Protects against disease (via immune cells) and blood loss (via clotting)

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2
Q

White blood cells

A

Split into; monocytes, lymphocytes and granulocytes
Lymphocytes split into T and B cells
Granulocytes split into; eosinophils, neutrophils and basophils

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3
Q

Haematology

A

Study of blood

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4
Q

Different types of anaemia

A

Iron deficiency anaemia
Sickle cell anaemia
Megaloblastic anaemia
Haemolytic anaemia
Renal anemia
Must determine the type before beginning treatment as iron stalls can be harmful can lead to iron overload in those who dont need them

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5
Q

Iron deficient anemia

A

Caused by lack of iron
Iron is needed to make haemoglobin
Only give iron when justified - in this case lack of iron = need iron
Can be used as prophylaxis only; malabsorption diseases (chrons), menorrhagia, pregnancy, total gastrrectomy, haemodyalsis (chronic renal failure), management of low birth weight infant

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6
Q

Characteristics of iron deficiency anaemia

A

Small (microcytic) and pale (hypochromic) Red blood cells

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7
Q

Symptoms of iron deficiency anaemia?

A

Tiredness
Struggling to concentrate at work or colleague
Memory problems
Reduced ability to exercise
Hair loss
Dyspnoea
Brittle nails or change shape (ridigid, concave, break easily, spoon shaped)
Cuts and grazes take longer to heal
Sore tongue
Sores at the corner of the mouth

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8
Q

What causes iron deficiency anaemia?

A

Causes; dietary deficiency, malabsorption, increased blood loss, increased requirements
Drug induced antiplatelet, anticoagulants, NSAIDs, SSRIs and corticosteroid

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9
Q

Oral iron

A

Little differences between iron salt in efficiency and absorption of iron
Choice determined by cost and side effects
Oral dose of elemental iron for iron deficiency anaemia should be 100 - 200 mg daily
Ferrous sulphate (normal and dried), ferrous fumorate, ferrous gluconate
Ferrous sulphate and fumeroate are populate as small amount contains high contents of iron

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10
Q

Iron important facts and figures

A

He concentration should rise by about 100-200 mg / 100 mL per day daily
20g/L over 3-4 weeks
When haemoglobin has reached normal ranges, continue for 3 months or replenish iron stores
Ascorbic acid (vitamin C) aids absorbtion

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11
Q

How to treat iron overload

A

Desferrioxamine

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12
Q

Side effects of iron

A

Constipation or diarrhoea
MR iron can exacerbate diarrhoea in certain patients e.g IBS
GI discomfort, nausea
Care with patients with intestinal strictures and diverticular disease

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13
Q

Counselling on iron

A

Best absorbed on an empty stomach
Vitamin C (ascorbic acid) aids absorption
Can be taken after food to reduced S/E of GI if needed
May discolour stool

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14
Q

Parenteral iron

A

MHRA; hypersensitivity reaction; including life threatening and fatal anaphylactic reaction
Avoid I.V iron in 1st trimester of pregnancy, only is in second or third if benefits outweighs risk
Only use when oral is ineffective
Compound preparations; folic acid + iron only for pregnant women at high risk of iron and folic deficiency

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15
Q

G6PD deficiency

A

Predisposed to haemolytic anaemia
Genetic condition in which RBCs break down when the body is exposed to certain drugs or stress/infection (hereditary) or fava beans (broad beans)
Prevalent in Africans, Asians, Oceania and south Europe
More common in men than women
Drugs found safe in one G6PD deficient patient may not be safe in another
Manufactures don’t routinely test their drugs on this sets of patients
Risk and severity of haemolytic is dose related

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16
Q

Definite risk of haemolysis in G6PD.

A

Nitrofurantoin
Quinolones
Dapsone
Methylthioninium chloride
Sulfone
Sulfonamides

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17
Q

Possible risk of haemolysis in G6PD deficienct

A

Aspirin
Chloroquine
Menadione
Quinine
Sulfonylureas

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18
Q

Megaloblastic anaemia

A

Vitamin B12 and folate is common cause
Caused by; poor diet, pregnancy, methotrexate and antiepileptics
Characteristics; larger than normal RBCs (macrocytosis)
Pernicious anaemia (malabsorptions and vitamin B12; due to lack intrinsic factor) common cause
Hydroxocoblamin, diet related, cynocobalamin
Treat folic acid for 4 months as well to replenish stores; don’t give only folic as it will mask B12 deficiency symptoms

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19
Q

Folic acid

A

Given alone or in Megaloblastic anaemia (for neuropathy)
Given in folate deficiency Megaloblastic anaemia as well as prophylaxis
Taken before and during pregnancy to prevent neural tube defects
High risk; 5 mg
Low risk 400 mcg

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20
Q

Folinic acid

A

Given as calcium folate
Effective in treatment of folate deficiency Megaloblastic anaemia but generally used with cytotoxic

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21
Q

Hydroxocabalamin

A

Vitamin B12
Replaced by cyanocobalamin in form of vitamin B12 of choice
Retained in the body for longer therefore is better

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22
Q

Sickle cell disease

A

Structurally abnormality of Haemoglobin leading to deformed, less flexible RBCs
Causes reduced oxygen to organs and severe pain
Sickle cell crisis requires hospitalisation, IV fluids, analgesia and treatment of concurrent infections
Increases susceptibility to infection and various vaccines required and prophylactic penicillin
Chronic complications include skin ulcerations, renal failure and increased infection risk
Take folic acid throughout pregnancy 5 mg

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23
Q

Acute porphyria

A

Hereditary disorder of haem biosynthesis
Prevalence abour 1 in 75000 of the population
Certain drugs can induce acute prophetic crises
Screen relatives and advice dangers of certain drugs
TREATMENT; Haem arginate IV infusion
Signs and symptoms; severe abdominal pain, pain chest, legs, back, N/V, red/brown urine, muscle pain, numbness, tingling
Unsafe to use; MAOIs, TCA, anabolic steroids, contraceptions, antifungals, HRT, barbiturates, seek specialist advice

24
Q

Haemolytic anaemia

A

E.g Sickle cell and thalassaemia
RBCs die or are destroyed early in their life and are unable to replace RBC that have been destroyed quickly enough
Aim to treat underlying cause to decrease RBC destruction

25
Q

How to treat erythropoietin deficiency in CKD

A

Epoetins treat anemia

26
Q

Hypoplastic and haemolytic anaemia treatment

A

Anabolic steroids
Corticosteoids
Puridoxiine
Anti lymphocytes immunoglobulin
Rituximab

27
Q

Phenylketonuria

A

Inability to metabolise phenylalanine
Managed by restricting dietary intake of phenylalanine
Aspartame contributes to phenylalanine intake (inform patients of aspartame contains products)
Symptoms; moldy musty smell to breath and skin, tremors, Brian damage, eczema, behavioural difficulties, repeated being sick

28
Q

Total parenteral nutrition

A

TPN
Sole source of nutrition
Glucose is given via central vein to avoid thrombosis (add enough phosphate to allow phosphorylation)
Fructose and sorbitol added to avoid hyper o solar hyperglycaemia non ketoacidosis acidosis
Used; chemotherapy, radiation therapy, major surgery, prolonged GI disorders, coma, refusal to eat, under malnourished
Contains amino acids, glucose, fat, electrolytes, trace elements, vitamins
E.g nutriflex

29
Q

Special diet

A

Preparations which have been modified to eliminate a particular constituent from a food
E.g gluten free

30
Q

Neural tube defects

A

Congenital defects caused by incomplete closure of neural tube within 28 days of conception
E.g spina birdies, encephalocole and anencephaly
Main risk factors; maternal folate deficiency or B12, previous Hx of baby with neural tube defect, smoking, obesity, diabetes, use of anti-epileptics, older patients at higher risk
Supplement with folic acid before and 12 weeks into pregnancy unless high risk

31
Q

High risk patients with neural tube defect babies

A

Sick cell
Thalassemia
Previous history
Diabetic
Anatiepileptic drugs
Obsess >30 kg/m2

32
Q

Folic acid and neural tube defect

A

Low risk; 400 mcg before and 12 weeks of pregnancy
High risk; 5 mg before and up to 12 weeks
Sickle cell and thalassaemia take throughout pregnancy

33
Q

Magnesium

A

PPIs can decrease magnesium concentration = HYPOmagnesium
Involved energy generation
Higher doses cause diarrhoea e.g antacids high concentration
Can cause lead to imbalances with calcium, proassium and sodium
Treat magnesium sulphate
Normal range 0.7 to 1.05

34
Q

Zinc deficiency

A

Only give supplements if deficient and evidence seen
Deficient in; diet, malabsorption, trauma, burns
Treat Wilson’s disease (rare condition that reduces zinc absorption)

35
Q

Oral rehydration therapy

A

Enhances absorption of water and sodium
Replaces electrolytes safely
Prevents possible induction of osmotic diarrhoea
Palatable (different flavours available), child friendly and readily available
E.g dioralyte

36
Q

HYPERkalaemia

A

> 5.5 mmol/Mol
Signs and symptoms; ventricular tachycardia/fibrillation, peak T waves, cardiac arrest
Cause/factors; Addisons disease, CKD, ketoacidosis, ACEi/ARBs, NSAID, heparin, Ciclosporin, spironolactone, epelorone, digoxin
Treatment; calcium gluconate 10% IV, soluble insulin, salbutamol
Review and stop drugs which exacerbate
Monitoring; serum potassium, blood glucose, ECG
Any ECG change is regarded as severe hyperkalaemia

37
Q

HYPOkalaemia

A

<3.5 mmol/Mol
Signs; mild can be asymptomatic, moderate; lack energy, constipation/muscle pain, severe muscle weakness, respiratory failure, paralysis and paraesthesia
Causes; diarrhoea, vomiting, alcohol cirrhosis, diuretics (K sparing)
Treatment; check if drug induced and withhold, depending on severity; supplement K (banana etc), oral supplements or IV pottasium
Exacerbates digoxin toxicity

38
Q

Phosphorus

A

Oral phosphate supplements and vitamin D required in small numbers with hypophosphataemic vitamin D resistant rickets
Phosphate infusions used alcohol dependence
Phosphate depletion occurs in severe ketoacidosis
Sevelamar and lanthanum liecensed for treatment of hyperphosphataemia (patients on haemodyalsis and pernotreal dialysis)

39
Q

HYPERnatraemia

A

High sodium 146 +
Symptoms; convulsions, dehydration, thirst, hypokalaemia, tachycardia
Causes oral contraception, corticosteroids, lithium, sodium bicarbonate, high sodium content
Caused by volume depletion e.g diabeties
Replace water (IV sodium chloride and glucose)

40
Q

HYPOnatraemia

A

Symptoms; drowsiness, confusion, convulsions, N/V, cramps
Drug causes thiazide/ loops, desmopressin, antidepressants
Mild to moderate; treat oral NaCl, sodium bicarbonate (+ glucose if water depletion)
Several IV saline slowly due to risk osmotic demylenation

41
Q

HYPERcalcaemia and HYPERcalciuria

A

Hypercalcaemia; biphosphonates or corticosteroids
HYPERcalciuria; bendroflumethiazides

42
Q

HYPOcalcaemia

A

Caused by osteoporosis
Mild to moderate treat with Vitamin D and calcium supplements
Severe acute; slow IV calcium gluconate (too rapid = arrhythmias)

43
Q

Vitamin A

A

Retinol
Associated with ocular defects (dry eyes)
Teratogenic
Associated with increased susceptibility to infections
Rare deficiency in the UK
Found in; liver, pates, fish, liver and raw eggs

44
Q

Vitamin C

A

Ascorbic acid
Essential in scurvy, gingival bleeding and petechiae
Helps aid iron absorption and protect cells, wound healing, collagen formation
Found in oranges, peppers, tomatoes and blackcurrant

45
Q

Vitamin E

A

Tocopherol
Powerful antioxidant; protects free radicals, healthy skin, eyes
Little evidence for value
Nuts seeds and plants

46
Q

Vitamin D

A

Colecalciferol
Prevention and treatment of rickets and osteomalacia
Occurs with limited exposure to sunlight or diet deficiency
Alfacalcidol (active form); used in severe renal impairment patients who need vitamin D

47
Q

Vitamin B

A

B1; thiamine used wenickes encephalopathy e.g fortified cereal, whole grains
B2; riboflavin; healthy skin , nerves, eyes e.g mild, egg fortified cereals, rice
B3; Niacin; nicotrinamide or nicotine acid; healthy eyes and skin e.g meat, fish, egg, milk
B6; pyridoxine; prevents peripheral neuropathy, helps make neurotransmitters
B7; biotin; strengthen hair and nails, essential for fat metabolism
B12; hydroxocbalamin / cobalamin; treats Megaloblastic anaemia, B12 deficiency; healthy nervous system, makes RBC, processed folate e.g meat, salmon fortified cereals

48
Q

Fat soluble vitamins

A

A
D
E
K

49
Q

Diagnosing anaemia

A

Shape (sickle cell)
Size (big = megabblastic or small = microlyric iron )
colour
Counting (low count is haemolytic)
Measure their Hb
Pact cell volume

50
Q

Red flags anaemia

A

Over 60
Rectal bleeding
All men and post menopausal women
Treatment failure
Patient unable to tolerate treatment

51
Q

Denosumab

A

Used for osteoporosis
MHRA alert for hypocalcaemia

52
Q

Lansoprazole and magnesium levels

A

Causes HYPOmagnesium
Common after 1 year of use
Increase falls and c.diff

53
Q

Hypophosphataemia

A

Caused by decreased intestinal absorption, increased urinary excretionn re-distribution into cells
Hyper is treated by sevelamar

54
Q

Bleeding or high INR > 8 warfarin

A

Give Vitamin K

55
Q

Hyperparathyroidism

A

Give vitamin D
Active formal calcitol and alfacalcidol

Medium Weighted Topics (5 decks)

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