Conditions summary Flashcards
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
young girl
tired
low Hb
low MCV
microcytic anaemia caused by iron deficiency (probs dietary)
rheumatoid arthritis
tired
low Hb
low MCV
microcytic anaemia caused by anaemia of chronic disease (chronic inflammation in RA)
management of iron deficiency anaemia
ferrous fumarate
tired low Hb high MCV hypothyroidism Fx autoimmune
macrocytic anaemia caused by pernicious anaemia
macrocytic anaemia management
folic acid 5mg IM hydroxycobulamin (B12)
tired low Hb spherocytes and reticulocytes on blood film coombs test positive IgG mediated (more common)
warm autoimmune haemolytic anaemia
coombs +ve = immune problem
mechanical heart valve
dark urine
tired
low Hb
microangiopathic haemolytic anaeamia
Fx
child
jaundice, splenomegaly, tired
spherocytes and reticulocytes on blood film
hereditary spherocytosis
transferrin stores >50%
Fx
hereditary haemochromatosis (iron overload)
hereditary haemochromatosis (iron overload) management
weekly venesection for life
management of iron overload from repeated FBC transfusion (eg thalassaemia)
iron chelating drugs
pancytopenia in child - infections, fatigue, bleeding
MSK problems
fanconis anaemia
infections fatigue, bleeding
autoimmune PMH
idiopathic aplastic anaemia
management of panyctopaenia
blood transfusion - if symptomatic anaemia <70
platelet transfusion - if bleeding
antibiotics - for everyone (bc risk of infection)
<5mins of transfusion
fever
flush
feeling of impending doom
acute haemolytic transfusion reaction - ABO incompatibility or bacterial contamination
IgM (bc immediate), intravascular
management of acute haemolytic transfusion reaction (3)
STOP transfusion
ABCDE
blood cultures for sepsis (bacterial contamination)
30 mins into transfusion elderly raised JVP SOB pitting oedema
transfusion associated circulatory overload (TACO)
management of transfusion associated circulatory overload (TACO) (2)
diuretics (furosemide)
transfuse slower
current transfusion
fever
rash
febrile non haemolytic transfusion reaction (mild, acute)
management of febrile non hemolytic transfusion reaction (2)
paracetamol for fever
transfuse slower
PMH allergy
current transfusion
mild urticarial rash
SOB
allergic transfusion reaction
can also present as severe anaphylaxis
FFP transfusion
SOB but normal JVP
transfusion associated lung injury
no fluid overload like TACO
anti-leukocyte reaction to FFP
management of allergic transfusion reaction (4)
adrenaline
anti histamine (chlorampheniramine)
salbutamol (for SOB bronchoconstriction)
steroids
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
