Deck 13 Flashcards
Low Hb
Anaemia
High Hb
Polycythaemia rubra vera, chronic hypoxia, increased EPO, relative increase (decrease in plasma volume)
Microcytic anaemia
Thalassaemia, IDA (pregnancy, poor intake), anaemia of chronic disease
Normocytic anaemia
acute blood loss, sickle cell, haemolytic anaemia, anaemia of chronic disease, bone marrow failure
Macrocytic anaemia
B12/folate deficiency, alcohol excess
Reticulocytes
immature cells, raised during excessive production
WCC raised
Infection, inflammation, leukaemia, tissue necrosis (surgery/MI/burns), drugs (prednisalone)
Reduced WCC
Bone marrow disorder, SLE, autoimmune, HIV
Neutrophilia
Bacterial infection, inflammation, steroids, myeloproliferative disoders, stress (surgery)
neutropoenia
Post chemo, viral infection, severe sepsis, hypersplenism, bone marrow failure
Lymphocytosis
Viral infection, chronic infection (TB), lymphoma/leukaemia
lymphocytopoenia
Steroids, HIV, post chemo
Bone marrow failure
monocytosis
chronic infection, AML/lymphoma, EBV
Eosinophilcytosis
Allergy, drug reaction, parasite, skin disease (eczema)
Basophilocytosis
Myeloproliferative disorder, viral infection, IgE, hypersensitivity reaction
Isolated raised basophils suggests malignancy
Thrombocytosis
reactive (post bleed, infection, chronic inflammation, malignancy, surgery) or essential (myeloproliferative disorder)
Thrombocytopoenia
bone marrow failure, autoimmune (e.g. ITP), viral infection
Hyponatraemia
- lost in urine (need to check urine sodium) - can be Addison’s, renal failure, diuretic excess, diarrhoea/vomiting, burns, SBO
- Due to fluid retention (nephrotic, cardiac failure, liver cirrhosis, SIADH - need to rule out other causes first)
Hyponatraemia gives headache, irritability, confusion, weakness and seizures
- Due to fluid retention (nephrotic, cardiac failure, liver cirrhosis, SIADH - need to rule out other causes first)
hypernatraemia
- Diarrhoea/vomiting, diabetes insipidus, incorrect IV replacement
Hypernatraemia causes lethargy, thirst, weakness, confusion, fits/coma
Hypokalaemia
Hypokalaemia can be due to diuretics, V&D, cushing’s, steroids, conn’s.
Causes muscle weakness, hypotonia, hyporeflexia, cramps, palpitations, light headedness
Hyperkalaemia
Hyperkalaemia can be due to renal failure, K sparing diuretics, metabolic acidosis, addison’s disease, burns, excess potassium therapy but can also be damaged blood.
Can see Tall, tented T waves, small p waves and wide QRS on ECG
Chest pain
Fast irregular pulse, weakness, palpitations
Isolated ALP rise
bone mets, primary bone tumour, vitamin D deficiency, fracture
HbA1c impacted in
haemolytic anaemia, IDA, B12/folate deficiency, recent blood transfusion/donation, venesection, haemoglobinopthy, CKD4/5, liver disease, drugs (EPO, anti HIV), alcoholism, severe hperlipidaemia, chronic malaria
HbA1C CI in
Not appropriate in children, to diagnose T1DM, acute illness, steroids, pregnancy, recent acute pancreatitis/pancreatic surgery
Hypothyroidism presentation
Lethargy, coarsening features, dry hair, cold intolerance, angina, constpiation, fatigue, exertional dyspnoea, muscle weakness, carpal tunnel syndrome, depression, infertility.
Weight gain, malar flush, loss of eyebrow, bradycardia, hypercholesterolaemia, abdominal distension (constipation), anaemia, myopathy, hyporeflexia, menorrhagia
Main diagnostic for hypothyroidism
TSH level (raised) is strong indicator, along with low T4 (T3 unreliable)
Secondary hypothyroidism
Pituitary damage due to autoimmune disorder/tumour. Can get hyponatraemia (cortisol deficiency), hypogonadotrophic hypogonadism (low testosterone with low LH/FSH)
Risks of levothyroxine
Go low and slow in elderly and IHD due to risk of AF and osteoporosis
Symptomatic hyperthyroidism with normal T4 and suppressed TSH
T3 toxicosis
Symptoms of hyperthyroidism
Fatigue, increased appetite, heat intolerance, goitre, weight loss, hair loss, palpitations, tachicardia, myopathy, agitation, psychosis, diarrhoea, vomiting, infertility, amenorrhoea, oligomenorrhoea, pruritis, pretibial myxoedema, exopthalmos, lid retraction, lid lag
Type 1 hypersensitivity
IgE and mast cell mediated (e.g. asthma, anaphylaxis, excema, allergic rhinitis)
Type 2 Hypersensitivity
IgG against surface antigens leading to NK cells and complement mediated destruction (Goodpastures, MGs)
Type 3 hypersensitivity
Immune complex deposition and complement activation (SLE, extrinsic allergic alveolitis)
Type 4 Hypersensitivty
T cells, delayed
Mnemonic for hypersensitivity
Eczema (atopy, anaphylaxis - IgE)
Gives (IgG, goodpastures, MGs)
Complex (SLE, extrinsic allergic alveolitis)
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