Blood disorders and pharmacological management Flashcards

Question

What are fibrinolytic prescribed for? Give examples

Answer 1

Arterial and venous thrombosis Streptokinase Alteplase

Answer 2

Anaemia due to inflammation of chronic disease or acute blood loss

Answer 3

Microcytic anaemia - may be caused by iron deficiency

Answer 4

Macrocytic anaemia - may be due to B12 or folate deficiency, liver disease or toxicity

Answer 5

% of blood made up by RBC

Answer 6

Number of red blood cells present per unit of volume of blood

Answer 7

A measure of newly formed, immature RBC. Indicates recent bone marrow function

Answer 8

The average mass of Hb per RBC

Answer 9

- Nutritional deficiencies (especially iron deficiency, folate and B12 and A - involved in RBC production) - Infectious diseases e.g. malaria, tuberculosis, HIV and parasitic infections - Haemoglobinpathies - Heavy blood loss - Excessive RBC destruction - Lack of new RBC being formed (e.g. from a bone marrow tumour) - Sickle cells anaemia - Bone marrow tumour or infection

Answer 10

- Fatigue - Lack of energy - Breathlessness - Headaches - Fainting/ lightheadedness - Palpitations - Pale skin Iron deficiency anaemia - Koilonychia -> spoon-shaped tongue - Smooth tongue, Angular Chelitis - Dysphagia - Cricoid web, an abnormal extension of oesophageal tissue

Answer 11

Microcytic - e.g. iron deficiency Macrocytic - e.g. vitamin B12 deficiency Depleted - e.g. aplastic anaemia Deformed - e.g sickle cell anaemia

Answer 12

Ferrous iron --> in meat, readily absorbed Ferric iron 00> in vegetables, inefficiently absorbed. Ascorbic acid helps convert to ferrous iron for absorption Tea can prevent iron absorption

Answer 13

Look at diet, cells under a microscope, blood loss. FInd cause and treat cause. Advise adequate iron intake Consider dietetic referral Supplementation for 3 months, side effects such as constipation may occur. Taken with food

Answer 14

Anaemia prevalent in patients with diseases that cause prolonged immune activation, including infection, autoimmune diseases, cancer, CKD, congestive heart failure, CPD and obesity. Inflammation inducible cytokines and the master regulator of iron homeostasis, hepcidin, block intestinal iron absorption and cause iron retention in reticuloendothelial cells, resulting in iron-restricted eryhtopoesis

Answer 15

Treatment of the disease underlying the anaemia Combination of iron therapy and eryhtropoiesis-stimulating agents - iron supplementation (oral/IV) - blood transfusion Use of anti-inflammatory food supplements: fatty acids and vitamin D Future treatment targeting at the genes coding inflammatory cytokines The clinician needs to consider the contribution of anaemia to patient morbidity and the impact of anaemia treatment on the patient's prognosis.

Answer 16

B12 and folic acid deficiency Otherwise known as Megaloblastic anaemia Anaemia characterised by - Megaloblasts in bone marrow - Lave oval macrocytic erythrocytes B12 and folic acid essential for normal bone marrow function. B12 essential for normal function of cells in nervous system 1. Malabsorption Pernicious anaemia - an autoimmune disorder - strong familial tendency Gastrectomy --> cells removed that produce intrinsic factor Ileum diseases - not absorbing B12 2. Inadequate intake of food containing B12 - Animal products - Marmite - Fortified foods

Answer 17

Commonly found in middle aged-elderly, usually women Slow onset over several years Lemon complexion - excess bilirubin as fragile erythrocyte disintegrate - Sore mouth Neurological problems - Demyelination of neural axons - Sensations altered (peripheral neuropathy) - Memory problems - Leg pains - Ataxia and weakness

Answer 18

Diagnosis - FBC - macrocytic cells, low serum B12, folate deficiency Treatment (without nerve problems) - Vitamin B12 supplements, usually injection - Initial treatment with hydroxocobalamin 1mg intramuscularly three times a week for 2 weeks - Maintenance treatment with hydroxocobalamin 1mg intramuscularly every 3 months for life - when B12 deficiency is not thought to be diet related - Maintenance treatment with oral cyanocobalamin tablets or twice yearly 1mg injection - where vitamin B12 is thought to be diet related. Treatment (with nerve problems) Seek urgent specialist hematologist advice - Initial treatment - Hydroxocobalamin 1mg intramuscularly on alternate days until there is not further improvement, then every 2 months Treatments may be needed throughout life Cautions: - Some medicines such as metformin can affect B12 absorption - Long-term use of medicines that effect stomach acid production e.g. PPI can worsen B12 deficiency

Answer 19

Fortified... - Milk alternatives - Soya yoghurt alternatives - Yeast extract e.g. marmite - Breakfast cereals

Answer 20

When foods are eaten with B12, its needs to be protected until where its absorbed in the ileum, the stomach coats it with intrinsic factor - produced by parietal cells of gastric muscosa. B12 binds with IF as protection from digestion by in the ileum it is bind to mucosal receptors and transported across the musocsa into bloodstream and freed of IF and bound to plasma globulins, transcobalamin I, II and II. Then goes to bone marrow or stored in liver.