Blood disorders

Question 1

Types of anaemias: not enough RBC made

Answer 1

• Nutritional deficiency (iron, folic acid, B12)
• Problem w bone marrow (aplastic, hypoplastic anaemia)
• CKD (renal anaemias (erythpoietin deficiency))
• Chemo

Question 2

Types of anaemias: RBC destroyed (haemolytic)

Answer 2

• Sick cell disease, G6PD deficiency, autoimmune conditions
• Cancers (leukaemia), infections

Question 3

Iron deficiency: symptoms

Answer 3

• Fatigue
• Dyspnoea
• Pallor
• Palpitations

Question 4

Ferrous salts: MOA

Answer 4

• Replenish depleted iron stores in body
• MR prep not recommended
• Folic acid prep in pregnant women w high risk of deficiency

Question 5

Ferrous salts: Drugs

Answer 5

• Ferrous sulfate
• Ferrous fumarate
• Ferrous gluconate

Question 6

Ferrous salts: Dose

Answer 6

OD or alt days
- Continue 3M after normal

Question 7

Ferrous salts: IV

Answer 7

MHRA: IV iron: hypersensitivity

• High risk: severe atopic allergies (asthma, eczema, inflammatory conditions, give if benefit > risk)
• Pregnancy: 1st trimester - avoid, 2nd/3rd if benefit > risk

Chemo
Haemodialysis
Malabsorption
Blood loss
Oral intolerance

Question 8

Ferrous salts: iron overload

Answer 8

• Fatal in children
• Antidote: deferoxamine

Question 9

Ferrous salts: side effect

Answer 9

Constipation or diarrhoea
- Counsel: take w or after food, take with glass of orange juice

Question 10

Ferrous salts: interaction

Answer 10

RED drug absorption
- Label: do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
- Label: do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

Antacids
Bisphosphonates
Levothyroxine
Quinolones
Tetracyclines

Question 11

Megaloblastic anaemia

Answer 11

enlarged RBC caused by low B12 or folic acid

Question 12

Megaloblastic anaemia: symptoms

Answer 12

• Fatigue
• Dyspnoea
• Tingling hands + feet
• Muscle weakness

Question 13

Megaloblastic anaemia: treatment

Answer 13

IM hydroxocobalamin
- MHRA: cobalt allergy
- Counsel: report allergic skin reactions
- Seek urgent help: extensive or blistering rash, wheeze, difficulty breathing or feeling faint

Folic acid daily 4M
- Never give alone if undiagnosed or in B12 deficiency = spinal cord neuropathy

Question 14

Neutropenia: symptoms

Answer 14

• Fever
• Sore throat
• Mouth ulcers
• Influenza

Question 15

Neutropenia: treatment

Answer 15

Filgrastim (recombinant human granulocyte colony stimulating factor)

Question 16

Sickle cell anaemia

Answer 16

structural abnormality of haemoglobin that causes moon shaped RBC

Question 17

Sickle cell anaemia: treatment

Answer 17

• Sickle cell anaemia: Folic acid
• Sickle cell crisis: hydroxycarbamide

Question 18

G6PD deficiency: inc risk

Answer 18

glucose 6 phosphate dehydrogenase deficiency causes haemolytic anaemia

• Fava beans
• Nitrofurantoin
• Quinolones
• Sulphonamides
• Methylthioninium