Blood disorders Flashcards
Symptoms of anaemia
Fatigue
Pale skin
Tachycardia
Palpitations
Insomnia
Leg cramps
Difficulty concentrating
Dyspnoea or headache
Depression
Koilonychia (thin and flat or concave nails)
Causes of anaemia
Increased haemoglobin loss
Reduced haemoglobin synthesis
Pregnancy- increase of plasma volume leads to dilutional anaemia
Causes of iron deficiency anaemia
Developing world- multiple pregnancies, parasitic infections and dietary intake
Developed world- blood loss (pregnancy, menstruation and gastrointestinal bleeding)
Symptoms of iron deficiency anaemia
Koilonychia
Tinnitus
Pale skin
Mouth ulcers
Sore tongue
Hair loss
Food tasting strange
Itchy feeling
Pale skin
Cravings for paper or ice
Sources of iron
Red meat
Poultry
Fish
Beans
Nuts
Dried fruit
Wholegrains (brown rice)
Fortified cereals
Dark green leafy veg
When is IV iron given?
With severe blood loss or malabsorption
Severe renal failure (can be given with
erythropoietin)
Patients intolerant of oral or non-compliant
Side effects of iron supplements
Constipation
Nausea and abdominal pain
IV iron- anaphylactoid reactions
Managing side effects of iron supplements
Take iron with food
Reduce daily dose (alternative iron salt)
Gradual dose titration
Treat side effects (laxative)
Monitoring iron treatment
Monitor full blood count after 2-4 weeks to assess response
Hb levels should increase by 1g/L per day
What drugs do iron salts reduce the absorption of
By chelation:
- Levothyroxine
- Bisphosphonates
- Tetracycline antibiotics
What drugs/supplements impact the absorption of iron
- Vitamin C (ascorbic acid) improves absorption
- Calcium inhibits absorption
- PPIs inhibit absorption
What counselling would you give a patient that is taking levothyroxine and iron
Take your iron supplement 4 hours after having the levothyroxine
List two megaloblastic anaemias
Folic acid deficiency
B12 deficiency
What is the role of B12 and folic acid
Folic acid is demethylated by a B12 reaction to be absorbed for DNA synthesis
What are the signs of megaloblastic anaemia
Raised mean cell volume (macrocytic)
Decreased levels of white cells and platelets
Unexplained neurological symptoms
Hyper-segmented neutrophils
Symptoms of megaloblastic anaemia
Sore, pale tongue
Altered bowel habit
Anorexia
Mild jaundice
Peripheral neuropathy or dementia (B12)
Fever (B12)
Treatment for folic acid deficiency
Oral folic acid
4 months for poor dietary intake or lifelong for other causes
Rule out B12 deficiency before starting folate
What are the monitoring requirements for folate?
Monitor FBC and reticulocytes after 10 days and after 8 weeks
Why is folic acid given in pregnancy?
Used as prophylaxis to prevent neural tube defects
Causes of folate deficiency
Poor dietary intake
Malabsorption
Pregnancy
Causes of B12 deficiency
Inflammatory bowel disease
Resection of the ileum
H. pylori infection
Gastrectomy (stomach)
Treatment for B12 deficiency
IM hydroxycobalamin 1mg
Cyanocobalamin between meals for poor dietary intake
What monitoring is required for B12 treatment
Monitor FBC and reticulocytes after 10 days and 8 weeks
