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pre reg > Chapter 9: Blood and nutrition > Flashcards

Chapter 9: Blood and nutrition Flashcards

1
Q

What is sickle cell disease?

A
  • Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia.
  • most common in those with african or caribbean background
  • People with sickle cell disease produce unusually shaped red blood cells that can cause problems because they do not live as long as healthy blood cells and can block blood vessels.
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2
Q

What helps make new red blood cells in sickle cell disease?

A
  • folate supplementation
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3
Q

What reduces the frequency of sickle cell crises?

A

Hydroxycarbamide

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4
Q

What is glucose-6-phosphate dehydrogenase deficiency?

A
  • inborn error of carbohydrate metabolism
  • genetic disorder that affects red blood cells, which carry oxygen from the lungs to tissues throughout the body. In affected individuals, a defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely.
  • predisposes to haemolytic anaemia (spontaneous destruction of rbcs)
  • in response to certain drugs/food
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5
Q

Drugs with definite risk of glucose-6-phosphate dehydrogenase deficiency?

A
  • dapsone and other sulphones
  • sulphonamides
  • nitrofurantoin
  • quinolones
  • rasbirucase
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6
Q

Symptoms of iron deficiency anaemia?

A
  • tiredness
  • pallor (unhealthy pale appearance)
  • shortness of breath
  • palpitations
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7
Q

When is Prophylaxis required for iron deficiency anaemia?

A
  • malabsorption e.g. crohns
  • gastrectomy
  • menorrhagia
  • chronic renal failure; haemodialysis
  • pregnancy
  • low birth weight infants
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8
Q

Iron supplements counselling?

A
  • take with or after food (reduce gi side effects: constipation, diarrhoea)
  • take with a glass of orange juice (vitamin C aids absorption of iron)
  • continue for 3 months after blood levels return to normal
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9
Q

Compound iron preparations?

A
  • folic acid and iron - for pregnant women only (at high risk of iron AND folic acid deficiency)
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10
Q

Parenteral iron preparations, when are they used?

A
  • chronic renal failure with haemodialysis
  • malabsorption syndromes
  • chemotherapy-induced anaemia
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11
Q

MHRA advice for iron IV hypersensitivity?

A

MHRA: serious hypersensitivity reactions with IV iron

  • take caution with every IV dose (test doses not recommended)
  • monitor for 30 mins after each injection (used trained staff and resuscitation immediately available
  • high risk in allergies, immune, inflammatory conditions, severe atopic allergies; asthma, eczema. Give if benefit outweighs risk
  • avoid in pregnancy, especially 1st trimester
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12
Q

What is megaloblastic anaemia?

A
  • vitamin b12 or folic acid deficiency
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13
Q

Symtpoms of megaloblastic anaemia?

A
  • numbness, tingling of hands/feet, muscle weakness, depression
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14
Q

Vitamin b12 deficiency causes?

A
  • dietary deficiency: –> oral hydroxocobalamin (b12)

- OR malabsorption: gastrectomy, crohns, pernicious anaemia (lack of GI instrinsic factor) –> IM hydroxocobalamin

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15
Q

In megaloblastic anaemia emergencies?

A
  • give both folic acid and vitamin b12, if folic acid is given alone, neuropathy can occur
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16
Q

Folate deficiency causes?

A
  • poor diet
  • coeliacs disease: malabsorption
  • pregnancy
  • anti-epileptics, methotrexate etc
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17
Q

Folate deficiency treatment?

A
  • folic acid daily for 4 months
  • never give folic acid alone for megaloblastic anaemia or vitamin b12 deficiency as can lead to neuropathy of the spinal cord
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18
Q

Why should you take caution to avoid iron overload?

A

can be fatal in children

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19
Q

Treatment for iron poisoning?

A

DESFERRIOXAMINE

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20
Q

What is neutropenia?

A

Lower than normal neutrophils (type of white blood cell)

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21
Q

Neutropenia treatment?

A

FILGASTIM

- recombinant human granulocyte colony-stimulating factor (can reduce the duration of chemotherapy-induced neutropenia)

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22
Q

What are used in hypoplastic and haemolytic anaemia?

A
  • anabolic syteroids, pyridoxine hydrochloride, antilymphocyte immunoglobulin, rituximab (unlicensed) and various corticosteroids
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23
Q

What is used to Mobilise haematopoietic stem cells to peripheral blood for collection and subsequent autologous transplantation in patients with lymphoma or multiple myeloma (specialist use only)?

A

PLERIXAFOR

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24
Q

What is Immune thrombocytopenic purpura?

A

Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a decrease in the number of platelets in the blood. Platelets are cells in the blood that help stop bleeding. A decrease in platelets can cause easy bruising, bleeding gums, and internal bleeding.

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25
Q

How is Immune thrombocytopenic purpura (ITP) treated?

A
  • In adults, initial treatment is usually with a corticosteroid, such as prednisolone.
  • Intravenous normal immunoglobulin, or intravenous anti-D (Rh0) immunoglobulin [unlicensed use] may be appropriate in patients with immune thrombocytopenic purpura who are bleeding or at high-risk of bleeding, who require a surgical procedure, or who are unresponsive to corticosteroids. Immunoglobulin preparations may also be considered where a temporary rapid rise in platelets is needed, for example in pregnancy.
  • Treatment options for persistent or chronic immune thrombocytopenic purpura include thrombopoietin receptor agonists (avatrombopag, eltrombopag, and romiplostim), rituximab [unlicensed use], or fostamatinib.

Other therapies that have been tried in refractory immune thrombocytopenic purpura include: azathioprine, ciclosporin, cyclophosphamide, danazol, dapsone, mycophenolate mofetil, and vincristine sulfate.

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26
Q

What is the normal range value for Na+?

A

Normal value: 133-146mmol/L

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27
Q

Symptoms of hypernatraemia?

A
  • convulsions
  • hypovolaemia ( a state of low extracellular fluid volume)
  • thirst
  • dehydration
  • oliguria (a urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL daily in adults)
  • postural hypotension
  • tachycardia
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28
Q

Drug causes of hypernatraemia?

A
  • oral contraceptives
  • corticosteroids
  • sodium bicarbonate
  • sodium content in IV antibiotics
  • lithium
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29
Q

Other causes of hypernatraemia?

A
  • hypernatraemia caused by volume depletion e.g. diabetes insipidus IV GLUCOSE
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30
Q

Symptoms of hypOnatraemia?

A
  • drowsiness
  • confusion
  • convulsions
  • nausea
  • vomiting
  • headaches
  • cramps
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31
Q

Drug causes of hyponatraemia?

A
  • antidepressants
  • loop and thiazide diuretics
  • carbamazepine
  • desmopressin
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32
Q

Treatment of hyponatraemia?

A

MILD-MODERATE HYPONATRAEMIA
- oral sodium chloride/sodium bicarbonate (add glucose if there is water depletion)

SEVERE HYPONATRAEMIA

  • IV saline (isotonic: via peripheral vein OR concetrated: via central vein
  • give slowly: risk of osmotic demyelination syndrome
33
Q

What is given for electrolyte imbalance?

A

ORAL REHYDRATION THERAPY (K+, Na+, Glucose)

  • given over 3-4 hours in diarrhoea
  • over 12 hours in hypernatraemic dehydration e.g. diabetes insipidus
34
Q

What is given to replace water deficit?

A

IV GLUCOSE
- should not be given alone unless there is no significant loss of electrolytes e.g, hypercalcaemia or diabetes insipidus

35
Q

Normal level for Cl-?

A

Normal value: 103mmol/L

*high levels = metabolic acidosis

36
Q

What is the normal calcium level?

A

2.10-2.58mmol/L

37
Q

Hypercalcaemia vs hypercalciuria ?

A

Hypercalcaemia (too much calcium in the blood) and Hypercalciuria (too much calcium in urine)

38
Q

What is given to treat hypercalaemia?

A
  • biphosphonates or corticosteroids
39
Q

What is used to treat hypercalcaemia of malignancy?

A

calcitonin

40
Q

What is used to treat hypercalcaemia caused by hyperparathyroidism?

A
  • cinacalcet reduces parathyroid hormone therefore calcium

- paracalcitol - in chronic renal failure

41
Q

What is used to treat hypercalciruria?

A

BENDROFLUMETHIAZIDE

- increase fluid intake and reduce dietary calcium

42
Q

What does hypocalcaemia cause?

A

Osteoporosis

43
Q

Treatment of hypocalcaemia?

A

MILD-MODERATE
- vitamin D and calcium supplements

SEVERE ACUTE OR HYPOCALCAEMIC TETANY
- slow IV calcium gluconate (too rapid = arrhythmias)

44
Q

Normal magnesium levels?

A
  • normal range: 0.7-1.05mmol/L
45
Q

When is hypomagnesaemia common?

A
  • common in alcoholics
  • hypomagnesaemia also leads to hypo ca2+, K+ and Na+
  • IV/IM magnesium sulphate
46
Q

Normal phosphate range?

A

0.85 - 1.45mmol/L

47
Q

Hyperphosphataemia treatment?

A

Calcium-containing preparations (phosphate-binding agent)

48
Q

Hypophosphataemia treatment?

A

Phosphate - given IV if mod-severe

49
Q

Normal potassium level?

A

3.5 - 5.3mmol/L

50
Q

Symptoms of hyperkalaemia?

A
  • ventricular fibrillation

- cardiac arrest

51
Q

Hyperkalaemia drug causes?

HADBEANS

A
  • Heparin
  • Ace inhibs/ARB
  • Digoxin
  • Beta blockers
  • Eplerenone
  • Amiloride
  • NSAIDs
  • Sprionolactone
52
Q

Hyperkalaemia treatmemt of mild to moderate with no ecg changes?

A
  • calcium resonium
53
Q

Hyperkalaemia treatment for acute severe hyperkalaemia >6.5mmol/L?

A

Slow IV calcium gluconate

  • IV insulin, glucose and salbutamol can be given in addition
  • add sodium bicarbonate to correct compounding acidosis
  • do not give via the same line; precipitation = thrombosis
54
Q

Symptoms of hypokalaemia?

A
  • muscle hypotonia

- arrhythmias

55
Q

Hypokalaemia drug causes ? (Dare Insult Betty’s Tough Carpet)

A
  • Diuretics
  • Insulin
  • B2 agonist
  • Theophylline
  • Corticosteroid
56
Q

Mild hypokalaemia treatment?

A

ORAL SLOW POTASSIUM CHLORIDE

  • nausea and vomiting causes poor compliance
  • smaller doses in renal impairment
  • if caused buy diuretic = potassium-sparing diuretic preferred
57
Q

Severe hypokalaemia treatment?

A

IV POTASSIUM CHLORIDE

  • do not add glucose for initial potassium replacement as glucose causes hypokalaemia
  • KCl injection overdose is fatal = use ready-mixed solution or thoroughly mix concentrate
58
Q

What is Acute Porphyrias?

A

Genetic defect in haem biosynthesis

  • if certain drugs are taken haemolytic anaemia and acute porphyric crises can occur
59
Q

Treatment of acute porphyric crises?

A

(Moderate, severe or unremitting crises)

- haem arginate

60
Q

What is parenteral nutrition?

A

Parenteral nutrition contains amino acids, glucose, electrolytes and trace elements and vitamins via central or peripheral vein

61
Q

What is SPN?

A

Supplementary parenteral nutrition:

- given in addition to oral/enteral feeds

62
Q

What is TPN?

A

Total parenteral nutrition: sole source of nutrition

  • glucose is given via a central vein to avoid thrombosis
  • give enough phosphate to allow the phosphorylation of glucose
  • fructose and sorbitol are added to avoid hyperosmolar hyperglycaemic nonketotic acidosis
  • do not add additives to fat emulsions unless compatibilty known
63
Q

When are special diets used ?

A
  • unable to metabolise phenylalanine: restrict dietary proteins, coeliac disease (gluten intolerance): avoidance
64
Q

Which vitamins are fat soluble?

A

ADEK

65
Q

Which vitamins are water soluble?

A

B and C

66
Q

What is vitamin A and what does deficiency in it cause/lead to?

A

RETINOL

  • teratogenic
  • deficiency = ocular effects; dry eyes and risk of infection
  • benefits = night vision, immune system, healthy skin
  • sources = liver pates, fish liver oil, raw eggs
67
Q

What is vitamin C and what do deficiencies lead to?

A

ASCORBIC ACID

  • deficiency = scurvy, gingival bleeding and petechiae
  • aids absorption of iron
  • claimed to improve the common cold
  • benefits = protects cells, wound healing, collagen formation
  • sources = oranges, peppers, tomatoes, blackcurrants
68
Q

What is calciferol and what can deficiency lead to?

A
  • VITAMIN D
  • deficiency = rickets and osteomalacia
  • d2 = ergocalciferol
  • d3 = cholecalciferol
  • give hydroxylated versions in severe renal impairment = alfacalcidol, calcitrol
  • if nausea and vomiting occurs - check plasma concentration
  • benefits = vitamin D is needed for dietary absorption of calcium. Maintain Ca and PO4 levels. Healthy bones and teeth
69
Q

What is tocopherol and deficiencies?

A
  • VITAMIN E
  • inhibits platelet aggregation; increased risk of bleeding with warfarin
  • benefits = powerful antioxidant which protects free radicals, healthy skin, eyes
  • sources = plant oils e.g. olive oil, nuts and seeds, wheat germ
70
Q

What is phytomenadione ?

A
  • VITAMIN K = blood clotting
  • phytomenadione = lipid soluble
  • menadiol = water soluble used in liver impairment
  • vitamin K given to all new born babies to prevent neonatal haemorrhage
  • do not give vitamin K with warfarin; antagonising effect
  • sources = green leafy vegetables
71
Q

What is thiamine and when is it used?

A
  • VITAMIN B1
  • used in wernickes encaphalopathy.
  • anaphylaxis with vitamin b1 injections
  • benefits = b vitamins release energy from food, healthy CNS
  • sources = fortified cereals, wholegrain
72
Q

What is riboflavin?

A
  • VITAMIN B2
  • benefits = healthy skin, nerves and eyes
  • sources = milk, eggs, fortified cereals, rice
73
Q

What is Niacin?

A
  • VITAMIN B3
  • available as nicotinamide (preferred) and nicotinic acid (vasodilation side effect)
  • benefits = healthy skin and eyes
  • sources = meat, fish, wheat flour, eggs, milk
74
Q

What is pyridoxine?

A
  • VITAMIN B6
  • prevents peripheral neuropathy; given with isoniazid/penicillamine
  • risk of sensory neuropathy with prolonged use of high doses >200mg. Treats premenstrual syndrome
  • benefits = helps make several neurotransmitters, haemoglobin
  • sources = fortified cereals, chicken, veg
75
Q

What is biotin?

A
  • VITAMIN B7
  • used to strengthen hair and nails
  • benefits = essential for fat metabolism
  • sources = range of foods; vegetables, whole cereals
76
Q

What is cobalamin/hydroxocobalamin?

A
  • VITAMIN B12
  • treats megaloblastic anaemia.
  • b12 deficiency is common in vegans
  • benefits = healthy nervous system, makes RBCs, processing folic acid
  • sources = meat, salmon, fortified cereals
77
Q

What is taken by pregnant women to reduce the risk of neural tube defects e.g. spina bifida?

A
  • folic acid 400mcg daily

- before conception and until week 12 of pregnancy

78
Q

What is the dose of folic acid for women in high risk pregnancy groups?

A
  • folic acid 5mg daily
  • before conception and until week 12

High risk groups:

  • anti-epileptic medication
  • diabetes
  • previous infant witj neural tube defect
  • sickle cell disease: give throughout whole pregnancy
79
Q

How long should pregnant women take folic acid?

A
  • before conception and until week 12 of pregnancy

- *apart from sickle cell disease = take throughout whole pregnancy

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