Cardiovascular 1 Pathologies Flashcards
What is General Anaemia
Low Hb concentration
What are the normal Hb ranges in
Men
Women
Pregnancy
Men = 13 -18g/ dL
Women = 11.5 - 16.5g /dL
Pregnancy = above 11g/dL
d/L = deciliter
What are the main signs of general anaemia
Fatigue, shortness of breath on exertion, palpitations, irritability fainting
What are the main symptoms of general anaemia
Tachycardia, thin, thready pulse, pallor skin/conjunctiva
What happens to a woman’s blood volume in pregnancy
Goes up by 50% but mostly plasma not cells
What is the difference between tiredness and fatigue
Fatigue generally isn’t relieved with sleep
How many beats per minute indicates Tachycardia
over 100 beats per minute
What part of the body is Stomato
Mouth
Which anaemia is the most common
Iron deficient anaemia
What does Iron deficiency lead to
leads to reduced concentration of Hb in Erytrocytes, which causes them to appear pale and small.
What is the name given to Iron deficiency anaemia
Hypochromic Microcytic Anaemia
Low colour small cell decreased blood
What are the 4 main causes of Iron deficiency anaemia
Deficient dietary intake e.g green leafy veg
Malabsorption ( low stomach acid, coeliac etc)
Excessive blood loss (menses, pregnancy GIT Bleed)
Excess requirements (pregnancy, rapid growth)
Explain the difference in Iron from Plant food and animal food
Iron from animals - we absorb quickly this is because the animal has already stored the Iron and done the conversion.
Iron from plant foods isn’t in its final state so we have to this through absorption. If we don’t have enough vitamin C we can’t absorb the iron. A squeeze of lemon over your green veg will do the trick.
How is Megaloblasic Anaema characterised
Large, immature dysfunctional red blood cells
Describe what happens in Megaloblastic Anaemia
Folate and B12 are required for DNA Synthesis. Without one or either of these it will cause issues in cell maturation and division.
DNA replication is slowed down and cells continue to grow without maturation or division (may have nucleus and organelles still) Macrocytic cells. They will have a shorter life cycle
How do we diagnose Megaloblastic Anaemia
By blood test with a reading MCV 97fl
Explain Dysfunctional red blood cells in Megaloblastic Anaemia
Dysfunctional red blood cells don’t get rid of nucleus and organelles, so they are unable to carry as much oxygen around the body
What is the autoimmune disease that creates antibodies that attack the lining of the stomach and why does it happen.
Pernicious Anaemia - we don’t create enough intrinsic factor
What is Intrinsic factor and why do we need it?
Intrinsic factor is a glycoprotein produced by the stomach. Intrinsic factor is required to absorb vitamin B12 in the small intestine where most vitamins are absorbed.
What do we need for folate to work
B12
What is the difference between folate and folic acid
Folate - natural form
Folic Acid - Synthetic version of folate
What commonly used drug is an antagonist for folate?
Methotrexate - commonly used for autoimmune diseases and chemotherapy
What is B12 synthesised by?
B12 is Synthesised by bacteria in our gut.
What are the 4 main causes of Megaloblastic Anaemia?
Deficient dietary intake
Lack of Intrinsic factor
Malabsorption
Drugs
Lack of folate and vit B12 is rare but where could we find it?
Vegans
What could lack on intrinsic factor be due to?
Autoimmune disease (pernicious anaemia) gastrectomy, chronic gastritis stomach cancer
What could cause malabsorption in Megaloblastic Anaemia
Coeliac, Crohn’s disease low HCL and pancreatic enzymes
What is a Gastrectomy
where part or all of the stomach is removed
Low HCL and pancreatic enzymes is common in xxxx
chronic stress
In order for folate to function in the body it must be ……
modified by an enzyme that requires vitamin B12
Do we store vitamin B12 explain
We store B12 in our liver so if we were to say go vegan it would take 2 - 4 years to develop
How long do we store folate
4 months
What is vitamin B12 essential for?
DNA Synthesis
Production and maintenance of the myelin sheath
Explain the myelin sheath
In the nervous system B12 coats the nerve cells, the coating is called Myelin helps to speed up nerve transmission.
What happens Neurologically when we don’t have enough B12
Less B12 = Less Myelin - nerves will travel at a slower speed meaning information can’t get round the system as fast resulting in various symptoms
What are the Neurological symptoms of lack of B12
Tingling, numbness, weakness, lack of coordination, burning sensations tinnitus depression
What are the signs and symptoms of Megaloblastic anaemia
General anaemia signs and symptoms
Enlarged red sore shiny tongue
Neurological symptoms
What does the myelin sheath surround
Nerve fibres
What are the signs and symptoms of folate deficiency
Same as general and Megaloblastic anaemia but no neurological symptoms
Red, sore swollen tongue
Define Aplastic Anaemia
A rare and potentially life threatening failure of Haematopoiesis
What is haematopoiesis
Production of all blood cells
What does an before a word generally mean in medicine
without/absent
What does plastic indicate in medicine
formation
What is the name given to when we have a lack of all 3 blood cell types
Pancytopenia
In Aplastic Anaemia we have xxxxxx (lack of all 3 blood cells and xxxxxxx bone marrow (few or no cells)
Pancytopenia
Hypo cellular
What are the causes for Aplastic Anaemia
Congenital (Fanconi’s anaemia)
Idiopathic (no cause)
Can be secondary to drugs (naproxen, diclofenic NSAID’s chemicals radiation cancer hepatitis EBV
What is the most common cause of death in Aplastic anaemia?
Sepsis then Haemorrhage
Signs and Symptoms of Aplastic Anaemia
Anaemia - Headaches, pallor, dyspnoea palpitations etc
Multiple infections (due to low wbc count)
Easy bleeding due to low thrombocyte count.
What is the treatment for Aplastic Anaemia
Treat the cause
Platelet transfusion or blood transfusion
Bone marrow stem cell transplant
Define Haemolytic Anaemia
Anaemia resulting in excessive breakdown of erythrocytes where bone marrow activity cannot compensate for the loss of RBC’s
What is the lifecycle of a cell in Haemolytic anaemia’s
As low as 5 days
List 6 causes of Haemolytic Anaemia
Genetic - Sickle Cell Anaemia or Thalassaemia
Rhesus factor incompatibility, antibiotics, radiation
Infections e.g Malaria or viral infections
What happens in malaria to cause Haemolytic anaemia
The parasites enter and mature within human erythrocytes and cause them to rupture. (they create a colony in your blood cells and then when they are done they stab them causing them to rupture) causing Haemolysis
What are the signs and symptoms of Haemolytic Anaemia
Same as general Anaemia
Jaundice due to the excess production of Bilirubin
Splenomegaly - excess Haemolysis in the spleen causes the spleen to enlarge leading to abdominal distention = feeling full quicker
Gallstones - excessive breakdown of waste products and Bilirubin causes the gallbladder to get clogged up resulting in stones
Vascular Occlusions - Blockages in blood vessels
What part of the body is the Sclara
Whites of the eyes
What causes Jaundice
Excess Bilirubin production.
Define Sickle Cell Anaemia
Is associated with abnormal Beta Chain in Hb which distorts the shape of the cell.
What is sickle cell with genes from both parents referred as
HbS known as Sickle Cell Anaema or Disease
Describe what it means to have a Sickle Cell Trait
HbS - inherited from one parent and HbA from the other. This gives the trait so would be a carrier of the disease
Where in the world are there more cases of Sickle Cell
African and Caribbean regions. 1 in 10 Western Africans carry the trait and 1 -10 African Caribbean. We also find it in Central and Southern America, parts of Eastern Europe and Middle East
Describe the Pathophysiology of Sickle Cell
It is an inherited recessive disease (substitution chromosome 11)
When HbS gives Oxygen over to interstitial fluid is sickles up
The cells rupture easily. Even though Erythrocytes are stimulated it cannot keep up with the rate of Haemolysis.
The defomed cells form clusters that block blood vessels
They offer protection against malaria in both Sickle Cell Disease and Trait
Signs and Symptoms of Sickle Cell
Same as general Anaemia
Jaundice and Spleomegaly
Vascular Occlusion, pain swelling in hands and feet
Usually begins age 3-6 months when HbF falls
How do we diagnose Sickle Cell
Full blood count low Hb levels 6-8fl - D/L
Blood film
What is a blood film
It is a diagnostic test where blood is put on a plate and viewed under a microscope where the cell structure can be clearly seen.
What is the treatment for Sickle Cell
Analgesics (pain killers), Antibiotics (prevention as pneumonia risk is higher), fluid therapy, blood transfusion and bone marrow transplant
What does Thalassaemia descrsibe
A defect in synthesis of either the alpha or Beta chains due to a genetic fault.
What are the signs and symptoms of A Thalassaemia
Same as general anaemia, jaundice, splenomegaly, hepatomegaly.
What happens in A Thalassaemia
To compensate Haemolysis bone marrow proliferation (mostly skull and ribs)
What happens in B Thalassaemia
Starts when HbA production begins gamma chain ceases by the end of the first year of life. Causes failure to thrive and anaemia
When does Haemoloytic disease of the newborn occur and
What is Polycythaemia also known as
Erythrocytosis
What are the causes of Polycythaemia
High Altitude - Hypoxia stimulates the release of Erythropoietin which stimulates Erythropoiesis
Unknown/Genetic
How do we diagnose Polycythaemia
Haematocrit levels - above 56% women 60% men
Haematocrit % volume of blood made up of Erythrocytes
What are the signs and symptoms of Polycythaemia
Often none to start with
Symptoms - Headaches, red skin , red conjunctiva, hypertensison puritus
Signs - Arterial Thrombosis - Arteries blocked with a clot
Myocardial Infarction
Pulmonary embolism
Venous Thrombosis - DVT
What is Leukopenia
Reduction in White Blood Cells
What is the common subgroup of Leukopenia called.
Neutropenia
What are normal Neutrophil readings? What would the condition be called if they were reduced and what ranges would the readings be.
Normal = 2.5 - 7.5
Neutropenia < 1.5
What are the causes for Leukopenia
Viral infections e.g EPV virus (Glandular fever, HIV, Hepatitis)
Drug Toxicity - Chemotherapy/Radation
Folate & B12 Deficiencies
Bone Marrow Diseases
What are the signs and symptoms for Leukopenia
Often none until the person gets an infection.
Severe illness - Cough, nausea, malaise fatigue difficulty breathing, fever.
Severe infection - Sepsis can be fatal
What is Leukocytosis
Over production of Leukocytes
What are the causes of Leukocytosis
Response to infections
Leukaemia (Over production of Leukocytes in the bone marrow due to cancer)
Injury or stress
Describe Leukaemia
A group of bone marrow cancers, characterised by an over production of Leukocytes
What happens in Leukaemia
Uncontrolled proliferation of leukocytes results in suppressed Erythrocyte production. Anaemia and thrombocytes = Thrombocytopenia
What is leukaemia divided into
Acute Leukaemias = Rapid onset, more aggressive immature cells,
Chronic Leukaemia - gradual onset, more differentiated cells
Acute Anaemias:
Age
Onset
Leukaemic Cells
Anaemia
Thrombocytopenia
Leukocyte count
Lympnode enlargement
Splenomegaly -
All ages
Sudden
Immature (blasts)
Prominent
Prominent
Variable
Mild
Mild
Chronic Leukaemia
Age
Onset
Leukaemic Cells
Anaemia
Thrombocytopenia
Leukocyte count
Lympnode enlargement
Splenomegaly -
Adults
Insidious
Mature
Mild
Mild
Increased
Prominent
Prominent
How do we diagnose Leukaemia
Full blood count = Anaemia, low thrombocytes, variable leukocyte count
Blood Film- under microscope
Bone marrow biopsy
