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Phase 3a > GP - Haem > Flashcards

GP - Haem Flashcards

1
Q

What are the main causes of iron deficiency anaemia?

A
  • Excessive blood loss (menorrhagia)
  • Inadequate dietary intake (meat/dark green leafy vegetables)
  • Poor intestinal absorption (coeliac)
  • Increased iron requirements (children/pregnancy)
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2
Q

What are more specific features of iron deficiency anaemia?

A
  • Koilonychia
  • Atrophic glossitis
  • Post-cricoid webs
  • Angular stomatitis
  • Pica
  • Hair loss
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3
Q

What are the investigations for iron deficiency anaemia?

A
  • FBC (hypochromic microcytic anaemia)
  • Serum ferritin (low)
  • Total iron-binding capacity/transferrin (high)
  • Blood film (anisopoikilocytosis)
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4
Q

What is the management for iron deficiency anaemia?

A
  • Oral ferrous sulphate (should continue taking for 3 months after it has corrected in order to replenish iron stores)
  • Iron-rich diet e.g. dark green leafy vegetables/meat/iron-fortified bread
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5
Q

What are the main causes of vitamin B12 deficiency anaemia?

A
  • Pernicious anaemia
  • Post gastrectomy
  • Vegan/poor diet
  • Disorders/surgery of terminal ileum
  • Metform
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6
Q

What are more specific features of vitamin B12 deficiency anaemia?

A
  • Sore tongue/mouth
  • Neurological symptoms (dorsal column affected first)
  • Mood disturbances
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7
Q

What are the investigations for vitamin B12/folate deficiency anaemia?

A
  • FBC (macrocytic megaloblastic anaemia)
  • B12/folate
  • Intrinsic factor antibodies
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8
Q

What is the management for vitamin B12 deficiency anaemia?

A
  • 1mg of IM hydroxocobalamin 3 times/week for 2 weeks –> 1 time/3 months
  • Treat B12 deficiency before folate deficiency
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9
Q

What are the main causes of folic acid deficiency?

A
  • Phenytoin
  • Methotrexate
  • Pregnancy
  • Alcohol excess
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10
Q

What type of anaemia does anaemia of chronic disease cause?

A

Microcytic or normocytic (more common)

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11
Q

Describe the pathophysiology of anaemia of chronic disease?

A

Inflammation-mediated reduction in RBC production/survival

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12
Q

What are the differences in results between iron deficiency anaemia and anaemia of chronic disease?

A
  • Serum iron = both low (IDA - lower)
  • Total iron binding capacity = high (IDA)/low (AOCD)
  • Transferrin saturation = both low
  • Ferritin = low (IDA)/high (AOCD)
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13
Q

How does chronic kidney disease cause anaemia?

A
  • Reduced erythropoietin (EPO) levels - normochromic normocytic anaemia
  • Reduced absorption of iron
  • Reduced red cell survival
  • Blood loss due to poor platelet function/capillary fragility
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14
Q

What is the target haemoglobin levels for anaemia due to chronic kidney disease?

A

10-12g/dl

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15
Q

Describe the pathophysiology of chronic lymphocytic leukaemia

A

Monoclonal proliferation of well-differentiated lymphocytes - almost always B cells

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16
Q

What are the investigations for CLL?

A
  • FBC = lymphocytosis/anaemia/thrombocytopenia
  • Blood film = smudge/smear cells
  • Immunophenotyping
17
Q

What is a complication of CLL?

A

Richter’s transformation = leukaemia cells enter lymph nodes and change into high-grade, fast-growing non-Hodgkin’s lymphoma

  • Lymph node swelling
  • Fever without infection
  • Weight loss
  • Night sweats
  • Nausea
  • Abdominal pain
18
Q

Describe the pathophysiology of chronic myeloid leukaemia

A

Proliferation of myeloid blood cells (neutrophils/basophils/eosinophils)

19
Q

What is strongly associated with CML?

A

Philadelphia chromosome

20
Q

What is the management for CLL?

A
  • Imatinib (first-line)
  • Hydroxyurea
  • Interferon-alpha
  • Bone marrow transplant
21
Q

What are poor prognostic factors for ALL?

A
  • Age <2 years or >10 years
  • WBC >20*10^9/l at diagnosis
  • T or B cell surface markers
  • Non-Caucasian
  • Male sex
22
Q

What are poor prognostic factors for AML?

A
  • > 60 years
  • > 20% blasts after first course of chemo
  • Cytogenetics = deletions of chromosome 5 or 7
23
Q

What is seen on a blood film in Hodgkin’s lymphoma?

A

Reed-Sternberg cells

24
Q

What is seen on a blood film in ALL?

A

Blast cells

25
Q

What are B symptoms?

A

Symptoms commonly associated with lymphoma (or HIV)

  • Unexplained fever
  • Unexplained weight loss
  • Drenching sweats
26
Q

What is used for monitoring treatment response in lymphoma?

A

PET scan

27
Q

What is the management for sickle cell disease?

A
  • Prophylactic abx (if had splenectomy)
  • Blood transfusion
  • Hydroxycarbamide
  • Stem cell transplant (curative)

Phase 3a (21 decks)

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