haem Flashcards
symptomatici anemia
s.o.b
chest pain
syncope - esp standing up
pale
lethargic
pica
koilinhcyia
cold extrmeities !
restless leg syndrome
at what level would we usually transfuse
less than 70
and if not then patient is symptomatic +
what is Glasgow Blatchford score
it is used in upper gi bleed and if more than zero it means high risk of GI bleed, and some medical intervention is necessary like endoscopy or transfuison its a sense of urgency thats the whole point of the score, how urgent do they need the intervention
score for lower gi bleed
oakland
a patient comes in with really low levels of hb really low what will you do
- want to see if he is bleeding from anywhere, any hemoptysis or melaena, hematochezia
- physical exam PR, any fresh blood coming out? even if patient says they dont see blood in their poo you should never take the word for it
- ask about cancer symptoms
- you would think about blood transfusion to replace the blood
- DO GBS score?
- do a group and save incase its a surgical issue?
causes of panctyopenia
- drugs - chloramphenicol , TMP
- chemo + radio
- infections- viral, EBV, CMV, parovirus
- b12/b9 deficieny (because essential for dna synthesis which all cell lines need, so if none, then you cant produce the cells, also on top of that you get dodgey cells which are immatures and crowd the bone marrows as they are non functional )
- cancers like leukemia
an example of inherited panctyopenia
fanconis anemia - recessive
how do CS affect blood cells
increase neutrophil counts but makes them less functional hence infection risk
decrease lymphocytes
increase plt and rbc
feltys syndrome
isorder that includes rheumatoid arthritis, a swollen spleen, decreased white blood cell count, and repeated infections.
agranuloctyosis
cause
Agranulocytosis is a severe reduction in granulocytes, especially neutrophils, leading to a high risk of infections. It is a life-threatening condition where the absolute neutrophil count
drugs
inherited - kostmann
feltys syndrome
lymphocytosis
Acute viral infection (especially EBV and CMV)
Chronic atypical infection (tuberculosis, brucella, toxoplasmosis)
Lymphoproliferative disorders (chronic lymphocytic leukaemia and lymphoma).
itp vs ttp
- both low plt counts
- itp has anitbodies against plt (immune response)
- itp not as clinically unwell but ttp clinically unwell
- itp usually a dignosi of exclusion, no abnormal cells on a smear
- cause of itp usually recent infection
- TTP - not just ptl affcted rbc too hence you get shistocytes as they are getting detsroyed, pt looks unwell, fever, neurologic signs
- ttp deificency in adams 13
- ttp - the terible pentad 1. fever, 2. neuoloigc symptoms 3. kidney 4. anemia 5. plt
HUS FINDINGS AND HISTORY
rcent bbq or eaten something
e. coli 157, h7
anemia
plt
kindey failure (increased creatine )
bloody diarrhea
shistiocytes
neutrohilia
steroids
infection
stress
inflammtion
smoking
causes of thrmobocytopenia
- ITP
- TTP
- Heparin induced (typically 1- 2 weeks after startinh )
what steps to take if you pt has very low plt and you need to see if they are actively bleeing or not
HISTORY
1. signs of upper gi bleed, cofee ground vomit, black tarry stools
2. any nose bleeds
3. any bruises on your skin
4. any fresh blood from back passage
5. any feeling dizzy, dificulty breathing (signs of shock ) feeling clammy
physical exam
- look for purpra, petechiae
- pulse (fast if shock and bleeding )
- look at nose and gums signs of bleeing
- resp exam - standard
- abdo - if tender could mean inernal bleeding
- PR exam
cut off for heparin induced thrombocytopneia
a drop by more than 30 %
how does temporal arteritis affect bloods?
the esr (most important indicator)
commonly also raises the plateletf
