Conditions summary Flashcards by Jay Slater

tired
low Hb
low MCV
pencil cells on blood film

what investigation do you want to do
for what

serum ferritin - for iron deficiency anaemia

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young girl
tired
low Hb
low MCV

microcytic anaemia caused by iron deficiency (probs dietary)

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rheumatoid arthritis
tired
low Hb
low MCV

microcytic anaemia caused by anaemia of chronic disease (chronic inflammation in RA)

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management of iron deficiency anaemia

ferrous fumarate

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tired 
low Hb 
high MCV 
hypothyroidism 
Fx autoimmune

macrocytic anaemia caused by pernicious anaemia

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macrocytic anaemia management

folic acid 5mg 
IM hydroxycobulamin (B12)

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tired
low Hb
spherocytes and reticulocytes on blood film 
coombs test positive 
IgG mediated (more common)

warm autoimmune haemolytic anaemia

coombs +ve = immune problem

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mechanical heart valve
dark urine
tired
low Hb

microangiopathic haemolytic anaeamia

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Fx
child
jaundice, splenomegaly, tired
spherocytes and reticulocytes on blood film

hereditary spherocytosis

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transferrin stores >50%

hereditary haemochromatosis (iron overload)

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hereditary haemochromatosis (iron overload) management

weekly venesection for life

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management of iron overload from repeated FBC transfusion (eg thalassaemia)

iron chelating drugs

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pancytopenia in child - infections, fatigue, bleeding

MSK problems

fanconis anaemia

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infections fatigue, bleeding

autoimmune PMH

idiopathic aplastic anaemia

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management of panyctopaenia

blood transfusion - if symptomatic anaemia <70
platelet transfusion - if bleeding
antibiotics - for everyone (bc risk of infection)

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<5mins of transfusion
fever
flush
feeling of impending doom

acute haemolytic transfusion reaction - ABO incompatibility or bacterial contamination

IgM (bc immediate), intravascular

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management of acute haemolytic transfusion reaction (3)

STOP transfusion
ABCDE
blood cultures for sepsis (bacterial contamination)

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30 mins into transfusion 
elderly 
raised JVP
SOB 
pitting oedema

transfusion associated circulatory overload (TACO)

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management of transfusion associated circulatory overload (TACO) (2)

diuretics (furosemide)

transfuse slower

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current transfusion
fever
rash

febrile non haemolytic transfusion reaction (mild, acute)

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management of febrile non hemolytic transfusion reaction (2)

paracetamol for fever

transfuse slower

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PMH allergy
current transfusion
mild urticarial rash
SOB

allergic transfusion reaction

can also present as severe anaphylaxis

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FFP transfusion

SOB but normal JVP

transfusion associated lung injury

no fluid overload like TACO
anti-leukocyte reaction to FFP

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management of allergic transfusion reaction (4)

adrenaline
anti histamine (chlorampheniramine)
salbutamol (for SOB bronchoconstriction)
steroids

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5-10 days after transfusion | jaundice

delayed haemolytic transfusion reaction IgG, extravascular haemolysis

splenomegaly jaundice HbH haemoglobin present

HbH disease (type of alpha thalassaemia)

electrophoresis with increased HbA2

beta thalassaemia

management of beta thalassaemia

transfusion dependent lifelong if beta thalassaemia major (with iron chelating drugs)

6 months old thrive pallor bony deformities - cortical thinning, hair on end bone appearance blood film - target cells, nucleated RBCs

beta thalassemia major up until 6 months HbF will compensate for missing HbA

dactylitis - v v painful priapism electrophoresis with HbS

sickle cell anaemia

management of acute sickle cell crisis

hydration opiate analgesia transfusion

chronic treatment of sickle cell disease

folic acid and hydroxocobalamin

young boy haemarthrosis in knee factor VIII deficiency prolonged APTT normal PT

haemophilia A

young boy haemarthrosis in knee factor IX deficiency prolonged APTT normal PT

haemophilia B

'bleeding form everywhere' - venflon sites etc bruising purpura prolonged APTT and PT

DIC

haemophilia management

IV factor VIII/IX

DIC management

``` platelets FFB fibrinogen blood transfusion cryoprecipitate ```

arterial thrombosis management

aspirin - anti platelet

venous thrombosis management

warfarin/NOAC/heparin - anti coagulant

puerperium | unilateral red hot swollen leg

DVT

recurrent DVTs | Fx thrombosis

thrombophilia

autoimmune condition | arterial and venous thrombosis

anti phospholipid syndrome

anti phospholipid syndrome management

aspirin (anti platelet) and warfarin (anti coag)

``` young female CD30+ reed Sternberg cells night sweats lymphadenopathy fatigue alcohol induced pain (sip of wine) ```

hodgkins lymphoma

``` night sweats lymphadenopathy fatigue African kid with EBV PMH tumour in jaw translocation 8;14 ```

burkitts lymphoma

``` night sweats lymphadenopathy fatigue slow onset incurable CD20+ ```

low grade B cell non hodgkins lymphoma

``` night sweats lymphadenopathy fatigue fast onset - aggressive curable CD20+ ```

high grade B cell non hodgkins lymphoma

management of all non hodgkins lymphoma

rituximab

management of hodgkins lymphoma

chemo (not rituximab bc not CD20+)

``` 60yo anaemia - fatigue bleeding from gums infections auer rod cells myeloblasts ```

AML (granda)

``` child anaemia - tired bleeding infections lymphoblasts ```

ALL

``` anaemia - tired bleeding infections philidelphia chromosome 9;22 translocation BCR-ABL gene increased granulocytes, abnormal ```

CML

CML treatment | what type of drug is it

imatinib (tyrosine kinase inhibitor)

AML and ALL treatment

chemo

``` anaemia - tired bleeding infections increase lymphoma risk abnormal B cells = smudge cells on blood film ```

CLL

``` monoclonal rise in IgG abdo pain renal impairment thirsty bone pain - 'punched out lytic lesions' pathological fracture ``` what electrolyte imbalance causes symptoms

myeloma hypercalcemia causes symptoms note monoclonal rise in Ig = paraprotein

management of myeloma (4)

analgesia (not NSAIDs bc renal impairment) chemo steroids bisphosphonates

increased para protein (monoclonal rise in Ig) but asymptomatic

monoclonal gammopathy of undetermined significance (MGUS)

paraprotein formation = organ damage | congo red stain with 'apple green bifringence'

AL amyloidosis

``` type of non hodgkins lymphoma - night sweats, fatigue, weight loss hyperviscosity IgM paraprotein (seen on electrophoresis) ```

waldenstroms macroglobinaemia

waldenstroms macroglobinaemia management

plasmaphoresis (remove IgM paraprotein plasma with donor plasma) chemo

itch after bath thrombosis gout JAK2 mutation

polycythaemia rubra vera (PRV) (type of MPD)

arterial thrombosis gout fatigue digital ishcaemia JAK2 mutation

essential thrombocytopaenia (type of MPD)

polycythaemia rubra vera (PRV) management

venesection and aspirin

essential thrombocytopaenia management

anti platelets (aspirin)

increased RBC platelets and granulocytes after surgery

normal reactive changes (not MPD!)

leukoerythroblasts - immature RBCs and neutrophils blood film - tear drop RBCs bone marrow biopsy - dense collagen JAK2 mutation positive

idiopathic myelofibrosis (caused by PRV or essential thrombocytopaenia)

investigation for isolated high RBC

JAK2 mutation for polycythaemia rubra vera