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PR - BLOOD + NUTRITION > BLOOD + NUTRITION > Flashcards

BLOOD + NUTRITION Flashcards

1
Q

Types of anaemias

A
  • sick cell anaemia
  • G6PD Deficiency
  • hypoplastic, haemolytic
  • iron deficiency
  • megoblastic anaemia
  • aplastic
  • eryhtropoeitic def
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2
Q

Haemolysis

A

red blood cell destruction

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3
Q

Sickle-cell anaemia

A

Deformed, less flexible red blood cells

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4
Q

Severe complications of sickle-cell anaemia

A
  • Acute complications: sickle-cell crisis → restricted blood supply to organs
  • Hospitalisation → fluid replacement, analgesia, treat any infections
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5
Q

Sickle cell anaemia - complications

A

anaemia, leg ulcers, renal failure, susceptibility to infections

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6
Q

Sickle-cell anaemia - treatment

A
  1. Vaccines
    - E.g. PCV, HiB, Influenza and possibly Hep B
  2. Penicillins
    - E.g. phenoxymethylpenicillin
  3. Folate supplementation- E.g. folic acid
    - Due to associated haemolytic anaemia and increased erythropoiesis
  4. Hydroxycarbamide
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7
Q

Hydroxycarbamide

A
  • An antineoplastic
  • Reduces the frequency of sickle-cell crisis
  • The beneficial effect may not be evident for months
  • SE: myelosuppression and skin reactions
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8
Q

G6PD Deficiency

A

Glucose-6-phosphate dehydrogenase
* Susceptible to developing acute haemolytic anaemia

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9
Q

Who is G6PD Deficiency more common in?

A
  • Africa, Asia, Oceania, S Europe
  • Males
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10
Q

Drugs with definite risk of haemolysis in most G6PD-deficient individuals

A
  1. Nitrofurantoin
  2. Quinolones
    - e.g. ciprofloxacin
  3. Sulfonamides
    - Co-Trimoxazole
    - Sulfadiazine
  4. Dapsone and other sulfones
  5. Methylthioninium
  6. Niridazole
  7. Pamaquin
  8. Primaquin
  9. Rasburicase
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11
Q

Drugs with possible risk of haemolysis in some G6PD-deficient individuals

A
  1. Aspirin
    - Acceptable up to 1g daily dose in MOST G6DP deficient individuals
  2. Chloroquine
    - Acceptable in acute malaria and malaria chemoprophylaxis
  3. Sulfonylureas
    - E.g. Gliclazide, Glimepiride
  4. Quinine
    - Acceptable in acute malaria
  5. Quinidine
    - Acceptable in acute malaria
  6. Menadione
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12
Q

What are three key points to bear in mind with G6DP deficiency?

A
  1. A drug found to be safe in some G6DP deficient
    individuals may NOT be safe in other G6DP deficient individuals.
  2. Manufacturers do NOT routinely test drugs for their effects in G6DP-deficient individuals.
  3. The risk and severity of haemolysis is almost always dose-related.
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13
Q

How do you treat Hypoplastic and haemolytic anaemias?

A
  1. Anabolic steroids
  2. Pyridoxine
  3. Various corticosteroids
  4. Rituximab (unlicensed)
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14
Q

How do you treat aplastic anaemias?

A
  1. Antilymphocyte immunoglobins
    - IV via central line.
    - Given for 12-18 hours each day for 5 days.
    - Severe reactions can occur in the first 2 days.
    - Profound immunosuppression can occur.
    - Rate response may increase if Ciclosporin is given as well.
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15
Q

How do you treat erythropoietic deficiency?

A
  1. Epoetin-beta
    - Babies
    - Low birth weight
    - DONT give any preparation containing benzyl alcohol
  2. Darbepoetin alfa
    - Has a long half-life, so less frequent administration.
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16
Q

Symptoms of iron deficiency

A

tiredness
sob
palpitations
pale skin

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17
Q

What must you do before treating iron deficiency?

A

Must be able to show iron-deficiency to treat with iron preparation

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18
Q

Before treating iron deficiency exclude serious underlying causes

A
  • Gastric erosion
  • GI cancer
19
Q

Prophylaxis with an iron appropriate in:

A

Malabsorption
Menorrhagia
Pregnancy
After subtotal or total gastrectomy
In haemodialysis patients
In the management of low birth-weight infants such as preterm neonates

20
Q

What is iron available as?

A
  1. PO
    - IR or MR
  2. Parenteral

Ferrous fumarate, gluconate, sulfate, sulfate (dried)

21
Q

Daily elemental iron dose

A

100 to 200 mg
* Usually as ferrous sulfate (dried) - can be MR preps too (reduces absorption)

22
Q

What oral iron is available and what is the equivalent elemental iron?

A
  1. Ferrous Fumarate 200mg
    - 65mg
  2. Ferrous Gluconate 300mg
    - 35mg
  3. Ferrous Sulphate 300mg
    - 60mg
  4. Ferrous Sulphate, dried
    200 mg
    - 65mg
23
Q

Which oral preparation of iron has the lowest elemental iron?

A

Ferrous Gluconate 300mg

24
Q

Side effects

A
  • Constipation
  • Diarrhoea (with MR)
  • Black tarry stools
25
Q

When haemoglobin is in normal range

A

continued for 3 more months

26
Q

Iron - toxicity

A

treated with desferrioxamine

27
Q

Iron - c.diff

A

if pt has c.diff
stop any iron preps
can cause diarrhoea

28
Q

Iron - counselling points

A

Take after food to reduce side-effects
Take before food for best absorption
Best taken with orange juice, VIT C aids absorption

29
Q

Parenteral iron preparations

A

Iron dextran, iron sucrose, ferric carboxymaltose, or ferric derisomaltose.

30
Q

When is parenteral iron used?

A
  • Oral therapy is not tolerated / doesn’t work
  • Chemotherapy-induced anaemia
  • Chronic renal failure who are receiving haemodialysis
31
Q

MHRA Warning: Serious hypersensitivity reactions with intravenous iron

A
  • Serious hypersensitivity reaction
  • Pt with allergies, Hx of severe asthma or eczema
  • Appropriately trained staff and resuscitation must be available
  • Monitor for hypersensitivity for at least 30 minutes after every administration
32
Q

Megoblastic anaemia can be caused by either:

A

Can be either malabsorption of vitamin B12 or Folate deficiency (first step = establish cause)

33
Q

Which pt should receive B12 prophylactically

A

After
- total gastrectomy
or
- total ileal resection

34
Q

Which drug can cause vit B12 deficiency?

A

Metformin

35
Q

B12 deficiency treatment

A
  1. Cyanocobalamin
    - Given orally
  2. Hydroxocobalamin
    - 1mg given every 3 months by
    IM injection
36
Q

Which of the two types of treatment for Vitamin B12 is largely used now and why?

A
  • Hydroxocobalamin has replaced Cyanocobalamin
  • Hydroxocobalamin is retained in the body longer and administered MUCH less frequently than Cyanocobalamin
37
Q

Folate deficiency

A
  • Poor nutrition
  • Pregnancy
  • AEDs
38
Q

Folic deficiency treatment

A

Daily folic acid supplementation for 4 months

39
Q

Megoblastic anaemia - emergency

A

Administer both while plasma assay results are awaited
Don’t give folic acid alone if undiagnosed → may cause neuropathy

40
Q

Folic acid - doses in pregnancy

A
  • Regular pregnancy: 400mcg daily from before conception till week 12 of pregnancy
  • Risk of NTDs: 5mg daily from before conception till week 12 of pregnancy
41
Q

Folic acid doses in prevention of methotrexate induced SE

A

5mg once a week
on diff day to metho

42
Q

Folic acid SE

A
  • Vit B12 def
  • GI SE
43
Q

Risk factors of Neural Tube Defects:

A
  • Smoking
  • Sickle cell anaemia
  • Diabetes
  • Obesity
  • Use of anti-epileptic drugs
  • Use of anti-malarial drugs

PR - BLOOD + NUTRITION (13 decks)

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