Blood Disorders Flashcards
What is the dose for iron for anaemia?
One daily or on alternate days and continue for three months after reach normal levels
What is the MHRA warning for IV iron?
Hypersensitivity
At higher risk: those with severe atopic reactions e.g. asthma and eczema, immune or inflammatory conditions
Can iron supplements be given to pregnant women?
Avoid during 1st trimester
Can be given in 2nd-3rd trimester if benefit outweighs risks
What are the side effects of iron and how should a patient take it?
SE: constipation or diarrhoea
- counsel to take with or after food if GI effects otherwise take on empty stomach to allow better absorption
- can take with glass of orange juice as vitamin C enhances absorption of iron
What drugs interact with iron?
Antacids - leave 2 hr gap
Bisphosphonates - leave 2 hr gap
Levothyroxine - leave 4 hr gap
Quinolones - leave 2 hr gap
Tetracyclines - leave 2 hr gap
What is megaloblastic anaemia?
Enlarged RBC caused by low B12 or folate
What are the symptoms of megaloblastic anaemia?
Fatigue
Dyspnoea
Tingling hands and feet
Muscle weakness
Who are at higher risk of megaloblastic anaemia?
Pregnant women
Patients taking antifolate drugs e.g. methotrexate
Patients taking antiepileptic drugs
How do you treat patients with megaloblastic anaemia with a B12 deficiency?
IM Hydroxocobalamin
What is the MHRA warning for hydroxocobalamin?
Those with cobalt allergy - look out for hypersensitivity reaction
Counsel patients to report any skin reactions and seek medical help:
- extensive ir blistering rash
- wheeze
- difficulty breathing
- feeling faint
How do you treat patients with megaloblastic anaemia with a folate deficiency?
Folic acid daily for 4 months
- never give alone unless B12 also tested
If both low - treat B12 first as otherwise it can cause spinal cord neuropathy
What are the symptoms of neutropenia?
Fever
Sore throat
Mouth ulcers
Influenza
How do you treat neutropenia?
Recombinant human granulocyte colony-stimulating factor
- filgratism
stimulate more bone marrow to make more granulocytes including neutrophils
How do you treat sickle cell anaemia?
Folic acid
How do you treat sickle cell crises?
Hydroxycarbamide
Which increases the risk of haemolytic anaemia from G6PD anaemia?
Fava beans (broad-beans) = favism
Infections
Who are more at risk of G6PD deficiency?
Those from Africa, Asia and Mediterranean region and the Middle east
Males
Which drugs have a definite risk of haemolysis in most G6PD-deficient individuals?
Nitrofurantoin
Fluoroquinolones
Quinolones
Sulfonamides
Which drugs have a possible risk of haemolysis in most G6PD-deficient individuals?
Aspirin
Chloroquine
Quinine
Sulfonylureas
What is used as immunosuppressive treatment for aplastic anaemia?
IV horse antitymocyte globulin in combination with ciclosporin
What is used to prevent adverse effects associated with antithymocyte globulin treatment?
Prednisolone
Early reactions include:
- fever
- rash
- fluid retention
- rigors
- acute respiratory distress syndrome
- anaphylaxis
- serum sickness may occur 7-14 days later
How is idiopathic sideroblastic anaemia treated?
Pyridoxine
What is used to treat erythropoietins deficiency in chronic renal failure?
Epoetins (recombinant human erythropoietins
- also used to shorten period of symptomatic anaemia in patients receiving cytotoxic chemotherapy
Which eythropoietin is licensed for preventing anaemia in pre-term neonates of low birth-weight
Epoetin beta
What are the MHRA warnings associated with epoetins?
Recombinant human erythropoietins - very rare risk of severe cutaneous adverse reactions
Erythropoietins - overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase risk of death and serious cardiovascular events
- haemoglobin concentrations between 10-12g/ 100ml should be maintained
Erythropoietins - tumour progression and survival in patients with cancer
What are the side effects of epoetins?
Arthralgia
Embolism and thrombosis
Headache
Hypertension
Influenza like illness
Skin reactions
Stroke
What colour does hydroxocobalamin turn urine?
Reddish
How is immune thrombocytopenic purpura treated?
Corticosteroids - prednisolone
What are the symptoms of dehydration?
Thirst and reduced urine output
Light-headed and fatigue
Sunken eyes
Dry skin
Rapid breathing
Low BP
How is severe dehydration treated?
IV sodium chloride, potassium and glucose
What enhances absorption of oral rehydration therapy?
Glucose and rice starch
How do you rehydrate in diabetes insipidus?
Slowly over 12 hours because you lose water without losing sodium which causes hypernatremic dehydration
What are the symptoms of hyponatraemia?
Drowsiness
Muscle cramps
Headache
Confusion
N/V
Severe cases: coma/ seizure
What drugs can cause hyponatraemia?
Carbamazepine
Antidepressants
Desmopressin
Diuretics
How do you treat mild to moderate hyponatraemia?
Oral sodium salts
Chloride - if blood pH too alkaline
Bicarbonate - if blood pH too acidic
How do you treat severe hyponatraemia?
IV saline
If injection in peripheral vein - it has to be isotonic and have the same salt concentration as blood
If higher saline concentration is required - use central vein
Use glucose and sodium when theres a combined water and sodium depletion
What happens if you try to correct sodium imbalance too quickly?
risk of osmotic demyelination syndrome
When is Hartmann’s solution used for hyponatraemia?
During or after surgery or in the initial management of the injured or wounded - reduces risk of hyperchloraemic acidosis
What are the symptoms of hypernatraemia?
Low urine output
Thirst
Muscle spasms
Lethargy
N/V
Confusion
Seizure and coma in severe cases
How is severe hypernatraemia treated?
IV glucose
Which drugs are known to cause hypernatraemia?
Oral contraceptives
IV antibiotics
Corticosteroids
Lithium
What two electrolytes go hand in hand?
Potassium and sodium
When sodium goes up, potassium goes down
What are the signs and symptoms of hyperkalaemia?
Muscle cramps
Constipation
Fatigue
Arrhythmias
Polyuria
Polydipsia
What drugs are associated with hypokalaemia?
Loop and thiazide diuretics
Insulin
Theophylline
Laxatives (overuse)
B2 agonists
Corticosteroids
What is the treatment for mild-moderate hypokalaemia?
Oral potassium salts
- smaller doses required in renal insufficiency to reduce risk of hyperkalaemia
What is the treatment for severe hypokalaemia?
IV potassium chlroide
- CAREFUL in overdose can be fatal
What is potassium depletion commonly associated with?
Chloride depletion and metabolic acidosis
What are the signs and symptoms of hyperkalaemia?
Muscle weakness
Numbness
Tingling
Arrhythmias
Cardiac arrest
Which drugs are associated with hyperkalaemia?
ACE/ARB
BB
Digoxin
Potassium-sparing diuretics
Heparins
NSAIDs
Drug causes- HAD BEANS:
➢ Heparin
➢ ACE-inhibitors/ARBs
➢ Digoxin
➢ Beta blockers
➢ Eplerenone
➢ Amiloride
➢ NSAIDs
➢ Spironolactone
How is acute severe hyperkalaemia treated in presence of ECG changes?
Potassium 6.5mmol/L or > or in the presence of ECG changes
- IV calcium chloride OR
- Calcium gluconate 10%
These temporarily protect against myocardial excitability
IV soluble insulin with 50ml of glucose 50% given over 5-10 minutes reduces serum-potassium concentration: can be repeated or infusion set-up
Salbutamol by nebulisation or slow IV may be given to reduce plasma-potassium concentration –> caution in patients with CVD
How do you treat mild-moderate hyperkalaemia when there is no ECG changes?
Calcium resonium
How do you treat hypomagnesiaemia?
IV/IM magnesium sulfate
How do you treat hyperchloremia?
hyperchloremia can result in metabolic acidosis
Treat using IV sodium bicarbonate
If potassium levels low too - potassium bicarbonate
How do you treat hypercalcaemia?
Bisphosphonates or corticosteroids
How is hypercalciuria treated?
Increasing fluid and
Bendroflumethiazide
What does Hyperparathyroidism result in?
Hypercalcaemia, hypophosphataemia and hypercalcuria
What are the symptoms of hypercalcaemia?
Thirst
Increased urine output
Constipation
Fatigue
Memory impairment
Long-term effects
- CVD
- kidney stones
- osteoporosis
- fractures
What is the treatment for hyperparathyroidism?
1st line surgery
2nd line: cinacalcet
increased risk of fractures - consider bisphosphonate BUT do not offer for chronic hypercalcaemia of primary hyperparathyroidism
What is used to treat magnesium toxicity?
Calcium gluconate injection
What is the MHRA warning for magnesium sulfate?
Risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy (administered for longer than 5-7 days)
Which vitamin is teratogenic?
Vitamin A
What is a sign of severe vitamin C deficiency?
Gingival bleeding
What is the contraindication or vitamin E?
Warfarin
What are the signs of vitamin A deficiency?
Ocular effects e.g. dry eyes, poor night vision, risk of infection
What are good sources of vitamin A?
Lives pates
Fish liver oil
Raw eggs
Soft cheese
What are the signs of vitamin C deficiency?
Scurvy
Gingival bleeding
petechiae
When would you give an hydroxylated (activated) version of vitamin D?
In severe renal and hepatic impairment e.g. alfacalcidol, calcitriol
What are the signs of iron poisoning?
N/V
Abdominal pain
Diarrhoea
Haematemesis
Rectal bleeding
Hypotension and hepatocellular necrosis can occur later
What is used to treat iron poisoning?
IV desferrioxamine mesilate
How do you treat hypercalcaemia of malignancy?
Calcitonin
What vitamins does orlistat impair?
Vitamins (fat-soluble vitamins);
- A
- D
- K
- E
What is used in Wernicke’s encephalopathy?
Vitamin B1 (thiamine)
Which vein should glucose be given via?
Central vein to avoid thrombosis
Why are Fructose and sorbitol given in parenteral nutrition?
avoid hyperosmolar hyperglycaemic acidosis
Why is phosphate given in parenteral nutrition?
allow phosphorylation of glucose
What ferritin level usually confirms a diagnosis of anaemia?
30 micrograms per litre
What levels of haemoglobin in men, women, children and pregnant women would be considered as anaemia?
In men aged over 15 years - Hb below 130 g/L
In non-pregnant women aged over 15 years - Hb below 120 g/L
In children aged 12–14 years of age - Hb below 120 g/L.
Pregnant women:
1st trimester: 110g/L
2-3 trimester: 105g/L
What liver function test is raised when there is a liver blockage (blocked bile dutcs)?
ALP
What binds to acidic drugs?
Albumin
What electrolyte is found in dark chocolate, seeds and avocado?
Magnesium
What is the by-product of muscle breakdown?
Creatinine
Which vitamin, if given long-term, can cause peripheral neuropathy?
B6
What is a low neutrophil count?
Less than 1.5x10^9/L
How is severe acute hypocalcaemia treated?
IV calcium gluconate injection 10%
- ECG monitoring (risk of arrythmias if given too rapidly)
Calcium chloride injection is also available but it is more irritant - care should be taken to avoid extravasion
Concurrent hypomagnesaemia should be corrected with magnesium sulfate
How is severe hypercalcaemia treated?
Rehydration using sodium chloride
If persists - bisphosphonates and pamidronate disodium
Corticosteroids sometimes given
Calcitonin (Salmon) if associated with malignancy
How should hyperphosphataemia be treated?
Calcium acetate - phosphate binder
2nd line: sevelamer
3rd line: calcium carbonate
What vitamin is used to treat Wilson’s disease?
Vitamin B6 - Pyridoxine
