Haem Flashcards
mnemonic for remembering the causes of microcytic anaemia
T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia
causes of normocytic anaemia
3 As and 2 Hs for normocytic anaemia:
A – Acute blood loss
A – Anaemia of chronic disease
A – Aplastic anaemia
H – Haemolytic anaemia
H – Hypothyroidism
caused of macrocytic anaemia
Megaloblastic anaemia is caused by:
- B12 deficiency
- Folate deficiency
Normoblastic macrocytic anaemia is caused by:
- Alcohol
- Reticulocytosis (usually from haemolytic anaemia or blood loss)
- Hypothyroidism
- Liver disease
- Drugs, such as azathioprine
Mx of pernicious anaemia
IM hydroxocobalamin alternate days is initially given to all patients with B12 deficiency
Do you treat b12 or folate deficiency first
B12
to prevent subacute degeneration of the spinal cord
Inherited haemolytic anaemic conditions
- Hereditary spherocytosis
- Hereditary elliptocytosis
- Thalassaemia
- Sickle cell anaemia
- G6PD deficiency
acquired haemolytic anaemic conditions
- Autoimmune haemolytic anaemia
- Alloimmune haemolytic anaemia (e.g., transfusions reactions and haemolytic disease of newborn)
- Paroxysmal nocturnal haemoglobinuria
- Microangiopathic haemolytic anaemia
- Prosthetic valve-related haemolysis
different thalassemias
alpha: defect in alpha globin chain
beta: defect in beta globin chains
alpha thalassaemia featuer
- chr16
Mx - Monitoring
- Blood transfusions
- Splenectomy may be performed
- Bone marrow transplant can be curative
beta thalassaemia features
- chr11
- minor, intermedia, major
Mx - intermedia and major: blood transfusion, iron chelation
what is a sickle cell crisis
- an occur spontaneously or triggered by dehydration, infection, stress or cold weather
- Mx supportively, keep warm, good hydration, analgesia strong e.g. morphine
what is an aplastic crisis
- caused by parvovirus b19
- supportive mx
general mx of sickle cell
- avoid triggers
- up to date vaccines
- abx prophylaxis with pen V
- hydroxycarbamide
- crizanlizumab
- blood transfusion
- bone marrow transplant
types of leukaemia
- Acute myeloid leukaemia (can transform from myeloproliferative disorder)
- Acute lymphoblastic leukaemia (children)
- Chronic myeloid leukaemia
- Chronic lymphocytic leukaemia (assoc with warm haemolytic anaemia)
what condition is ALL associated with
Downs syndrome
what can CLL transform into
high-grade B-cell lymphoma (Richter’s transofrmation) (smear cells)
features of AML and acute promyelocytic leukaemia
- auer rods
General mx of leukaemia
- chemo + radio
- ALL: imatinib
- AML: ATRA
- CML: TKIs (imatinib), monoclonal antibodies e.g. rituximab
what is tumour lysis syndrome
- due to chemicals released when cells are destroyed by chemo
- High uric acid
- hyperkalaemia
- High phosphate
- Low calcium (as a result of high phosphate)
- need good hydration
types of lymphoma
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
RF for Hodgkin’s lymphoma
- HIV
- EBV
- RA and sarcoidosis
- FH
types of non hodgkin lymphoma
- diffuse large B cell
- Burkitt
- MALT
presentation of lymphoma
- lymphadenopathy
- Hodgkin: worse on alcohol, reed stenberg
- fever, weight loss, night sweats
what is myeloma
- cancer affecting plasma cells
- MGUS, smouldering and multiple myeloma
- CRAB mnemonic
- pepper pot skull on XR
- Mx: chemo, SCT, bisphosphonates, radio
myeloproliferative disorders
- can transform into AML
- Primary myelofibrosis
- Polycythaemia vera
- Essential thrombocythaemia
features of myelodysplastic syndrome
- anaemia
- neutropenia
- thrombocytopenia
- can see blasts on film
conditions that can cause thrombocytopenia
- Certain viral infections (e.g., EBV, CMV and HIV)
- B12 deficiency
- Folic acid deficiency
- Liver failure, causing reduced thrombopoietin production by the liver
- Leukaemia
- Myelodysplastic syndrome
- Chemotherapy
causes of increased platelet destruction
- sodium valproate
- methotrexate
- alcohol
- ITP
- TTP
- HIT
- HUS
Features of TTP
Thrombocytopenia
Purpura
Tissue ischaemia and end-organ damage
Features of ITP
- antibodies against platelets
- purpura
- Mx: prednisolone, IVIG, splenectomy
Features of VWD
- bleeding gums
- epistaxis
- easy bruising
- menorrhagia
- Mx: desmopressin, tranexamic acid, VWF infusion, Factor 8 + VWF
Haemophilia features
- X linked recessive
- A (8) and B (9)
- risk of spontaneous bleeding
- Mx: IV infusion of clotting factors
Thrombophilia conditions
- Antiphospholipid syndrome
- Factor V Leiden
- Antithrombin deficiency
- Protein C or S deficiency
- Hyperhomocysteinaemia
- Prothombin gene variant
- Activated protein C resistance
Ix for DVT
Wells score
likely: leg vein USS
unlikely: D-dimer
what is Budd-Chiari syndrome
obstruction to the outflow of blood from the liver caused by thrombosis in the hepatic veins or IVC. It is associated with hypercoagulable states It presents with a triad of:
- Abdominal pain
- Hepatomegaly
- Ascites
Mx: LMWH and warfarin, thrombolysis, TIPS, liver transplant
granulomatosis with polyangitis
- cANCA- directed against
proteinase 3 - URT (nosebleeds)
- LRT (haemoptysis)
- Renal (rapidly progressive
glomerulonephritis) - chest signs
- red cell casts
Eosinophilic
Granulomatosis with
Polyangiitis
pANCA- directed against
myeloperoxidase
Allergic asthma
Microscopic
Polyangiitis
pANCA- directed against
myeloperoxidase
LRT (haemoptysis)
Renal (rapidly progre
organisms causing post splenectomy sepsis:
Streptococcus pneumoniae
Haemophilus influenzae
Meningococci
(encapsulated organisms)
DIC typical blood picture
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
hodgkin lymphoma features
- reed stenberg cells
- painless lymphadenopathy
- pain in nodes after drinking alcohol
- B sx : fever, weight loss
- Mx- chemo
type of warm autoimmune haemolytic anaemia
SLE
lymphoma
CLL
methyldopa
Mx: steroids, splenectomy, immunosuppression
types of cold agglutinin disease
lymphoma
infections: EBV, mycoplasma
Mx: treat condition, avoid cold, chemo
how to manage acute haemolytic transfusion reaction
generous fluid resuscitation and termination of the transfusion.
what can CLL transform to
high-grade lymphoma (Richter’s transformation) making patients suddenly unwell –> diffuse large B cell non Hodgkin lymphoma
what can be seen in the blood film in coeliac disease
Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism
feature of B12/folate deficiency
hypersegmented neutrophils
what are schisctocytes associated with
they are fragmented RBC assoc with thrombotic microangiopathies.
cahracteristic blood film sign of myelofibrosis
tear drop poikilocytes
leukaemia with massive splenomegaly
CML
(other condition is myelofibrosis)
what is given to patients with polycythaemia vera to reduce thombosis
aspirin
mx of polycythaemia
venesection
hydroxycarbamide
aspirin
mx of ITP
- 1st line: prednisolone
- 2nd line: Pooled normal human immunoglobulin (IVIG)
blood film in DIC
schistocytes due to microangiopathic haemolytic anaemia
conditions with heinz bodies
- alpha-thalassaemia
- glucose-6-phosphate dehydrogenase deficiency
- chronic liver disease
sign of ABO incompatability
- hyperacute
- loin pain
