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tcd haematology > Fatigue (I Feel Tired) > Flashcards

Fatigue (I Feel Tired) Flashcards

1
Q

What is the role of the hormone erythropoietin?

A

It stimulates red blood cell production in the red bone marrow.

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2
Q

Where and when is erythropoietin produced?

A

In the kidneys, in response to hypoxaemia.

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3
Q

Where does haematopoiesis take place in an adult?

A

The bone marrow and thymus.

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4
Q

Where in the body is iron primarily absorbed?

A

Duodenum

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5
Q

Where in the body is B12 primarily absorbed?

A

Terminal ileum

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6
Q

Where in the body is folate primarily absorbed?

A

Jejunum

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7
Q

Where is iron stored?

A

In the liver or bone marrow macrophages.

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8
Q

What molecule is iron bound to whilst in storage?

A

Ferritin

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9
Q

What does ‘total iron binding capacity (TIBC)’ tell us about a patient?

A

How many transferrin molecules are in the blood.

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10
Q

What does ‘transferrin saturation (%)’ tell us about a patient?

A

How many transferrin molecules are bound to iron.

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11
Q

What do ferritin levels tell us about a patient?

A

How much iron is in storage.

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12
Q

What is a loss of corticomedullary differentiation on kidney ultrasound a sign of?

A

Chronic fibrous scarring

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13
Q

What is the normal length of the kidneys?

A

Around 11-14cm

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14
Q

How should the cortex of a healthy kidney look on ultrasound compared to the liver?

A

The cortex of a healthy kidney on ultrasound should look less echo dense (blacker) than the liver.

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15
Q

What are the target transferrin saturation and serum ferritin in a patient with Chronic Kidney Disease (CKD)?

A

Transferrin saturation > 20%
Serum ferritin > 100ug/L

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16
Q

What is the major cause of anaemia in Chronic Kidney Disease (CKD) patients?

A

Erythropoietin deficiency

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17
Q

What are the two primary factors that cause renal bone disease?

A

High phosphate levels (due to impaired excretion) and failure of renal tubular cells to activate vitamin D

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18
Q

How can vitamin D deficiency present? (4)

A

Fatigue, bone pain, muscle aches and low mood.

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19
Q

How can acute myeloid leukaemia (AML) present? (5)

A

-Tiredness
-Breathlessness
-Recurrent infections
-Abnormal bleeding (such as from gums or nosebleeds)
-Weight loss

20
Q

Which type of anaemia does B12 deficiency result in?

A

Macrocytic anaemia

21
Q

Which type of anaemia would folate deficiency result in?

A

Macrocytic anaemia

22
Q

Which type of anaemia does liver disease classically cause?

A

Macrocytic anaemia

23
Q

What are reticulocytes?

A

A type of immature red blood cell.

24
Q

What does an increased reticulocyte count indicate?

A

The bone marrow is producing more red blood cells; this is suggestive of haemolysis.

25
Q

What is poikilocytosis?

A

Variation in the shapes of red blood cells.

26
Q

What presentations should prompt a 2 week wait referral if seen alongside iron deficiency anaemia? (4)

A

-age 40 and over with unexplained weight loss and abdominal pain
-age 50 and over with unexplained rectal bleeding
-age 60 and over with either iron deficiency anaemia alone OR altered bowel habit
-patient tested positive for occult blood in faeces

27
Q

What is haematocrit?

A

The proportion of RBCs in the blood.

28
Q

What type of anaemia does thalassaemia result in?

A

Hypochromic, microcytic anaemia

29
Q

What is thalassaemia?

A

A group of inherited disorders resulting in reduced production of one or more globin chains; this results in an imbalance of globin chains, with the excess chain producing the pathological effects.

30
Q

What is hepcidin?

A

A hormone produced by liver cells when the body has enough iron, that binds to ferroportin 1 and inhibits this step of iron absorption.

31
Q

When is a blood transfusion indicated? (3)

A

In patients who are actively bleeding, symptomatic and have an Hb<7.0

32
Q

What is Pernicious Anaemia?

A

An autoimmune condition in which autoantibodies target either parietal cells of the stomach or intrinsic factor, resulting in a lack of intrinsic factor and a lack of absorption of vitamin B12, and subsequent B12 deficiency.

33
Q

How is Pernicious Anaemia diagnosed?

A

Checking levels of intrinsic factor antibodies.

34
Q

What must be tested for in every patient presenting with peripheral neuropathy, particularly with pins and needles?

A

Vitamin B12 deficiency and pernicious anaemia.

35
Q

What is megaloblastic anaemia?

A

A form of macrocytic anaemia that occurs due to vitamin B12/B9 (folate) deficiency.

36
Q

What are haemoglobinopathies?

A

A group of recessively inherited genetic conditions affecting the haemoglobin component of blood, caused by a mutation in haemoglobin.

37
Q

Where is Sickle Cell Disease most common? (2)

A

West Africa and India

38
Q

Where is Thalassaemia major more common? (2)

A

Asia and Mediterranean countries.

39
Q

What is meant by a ‘de novo’ haemoglobin mutation?

A

A genetic haemoglobin mutation that is not directly inherited from parents but is present only in that individual.

40
Q

What is Sickle Cell Disease?

A

Genetic variation in β globin chain of Hb molecules produces HbS (instead of normal HbA). This causes the Hb molecule to become unstable in low oxygen conditions, leading to the formation of insoluble rigid chains - this causes vaso-occlusion (‘sickling’) and destruction of red cells (haemolysis).

41
Q

What causes a sickle cell crisis?

A

Small blood vessels becoming occluded by a number of sickle shaped red cells which cause infarction of the tissues.

42
Q

What are the 4 main thalassaemia conditions that have clinical significance?

A

-Alpha thalassaemia major
-Haemoglobin H disease (alpha thalassaemia 3 gene deletion)
-Beta thalassaemia major
-Beta thalassaemia intermedia

43
Q

What three signs are indicative of increased haemolysis?

A

-Anaemia (usually macrocytic)
-Elevated reticulocytes count (>2%)
-Jaundice with unconjugated hyperbilirubinaemia

44
Q

What is the Coomb’s Test?

A

An antiglobulin test, used to look for antibodies to red blood cells in the patient’s blood.

45
Q

What are the two types of Coomb’s Test?

A

Indirect antiglobulin test –> tests antibody in patient’s serum; used to cross match blood for suitability for transfusion. (Positive test = tested donor’s RBCs are incompatible and should not be given as a transfusion.
Direct antiglobulin test (DAT) –> detects antibodies to a patient’s own serum causing an autoimmune haemolytic anaemia.

tcd haematology (2 decks)

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