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Year 3 Conditions > Haem > Flashcards

Haem Flashcards

1
Q

Define microcytic anaemia

A

Anaemia associated with a decreased MCV
Microcytic (MCV <80 fL).

Haemoglobin (Hb) level <120 g/L in females and <140 g/L in males

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2
Q

Explain the aetiology / risk factors of microcytic anaemia

A 
Iron-deficiency:
- Blood loss
Anaemia of chronic disease:
- Usually normocytic, but can be microcytic
Thalassaemia
Sideroblastic anaemia:
- Abnormal haem synthesis
Lead poisoning:
- Globin and haem synthesis interference
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3
Q

Summarise the epidemiology of microcytic anaemia

A

most common cause is iron deficiency anaemia

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4
Q

Recognise the presenting symptoms of microcytic anaemia

A

Anaemia: lethargy, tiredness, dyspnoea, pallor, weakness

Lead poisoning: anorexia, nausea, vomiting, abdominal pain

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5
Q

Recognise the signs of microcytic anaemia on physical examination

A

Anaemia: pallor, brittle nails and hair, conjunctival pallor
Tachycardia in severe cases?
Glossitis, cheilitis
Lead poisoning: blue gum line, peripheral nerve lesions, encephalopathy

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6
Q

Identify appropriate investigations for microcytic anaemia and interpret the results

A

Bloods: FBC, serum iron, iron-binding capacity, serum ferritin, serum lead
Blood film:
- Iron-deficiency: microcytic, hypochromic, anisocytosis, poikilocytosis
- Sideroblastic anaemia: dimorphic blood film
- Lead poisoning: basophilic stripping
If >40/menopausal women:
- Upper GI endoscopy, colonoscopy

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7
Q

Generate a management plan for microcytic anaemia

A

Iron deficiency: iron supplements, consider parenteral if doesn’t work
Sideroblastic anaemia: treat cause (drugs), pyridoxine in inherited forms
Lead poisoning: remove source of poison, dimercaprol

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8
Q

Identify the possible complications of microcytic anaemia and its management

A

High-output cardiac failure, complications of cause

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9
Q

Summarise the prognosis for patients with microcytic anaemia

A

Depends on underlying cause

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10
Q

Define macrocytic anaemia

A

Anaemiais defined as Hb <120 g/L in females and <140 g/L in males
Macrocytic (MCV >100 fL)

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11
Q

Explain the aetiology / risk factors of macrocytic anaemia

A

Megaloblastic:
• B12 deficiency (Crohn’s, metformin, omeprazole)
• Folate deficiency (alcoholics, phenytoin)
• Drugs: methotrexate
Non-megaloblastic:
• Alcohol excess, liver disease

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12
Q

Summarise the epidemiology of macrocytic anaemia

A

More common in elderly and females

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13
Q

Recognise the signs of macrocytic anaemia on physical examination

A

Anaemia: pallor, tachycardia
Pernicious anaemia: lemon-tinted skin, glossitis, weight loss
B12 deficiency: peripheral neuropathy, ataxia

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14
Q

Recognise the presenting symptoms of macrocytic anaemia

A

Anaemia: tiredness, lethargy, dyspnoea

Family history of autoimmune disease

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15
Q

Identify appropriate investigations for macrocytic anaemia and interpret the results

A

Blood: FBC, LFTs, ESR, TFTs, B12, folate
Blood film: large erythrocytes
Schilling’s: radiolabelled B12 measured in urine

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16
Q

Generate a management plan for macrocytic anaemia

A

Pernicious anaemia: IV hydroxycobalamin

Folate deficiency: oral folic acid (treat B12 deficiency first, folate can worsen neuropathy)

17
Q

Identify the possible complications of macrocytic anaemia and its management

A

Risk of gastric cancer, pregnancy + folate deficiency predisposes to spinal cord abnormalities

18
Q

Summarise the prognosis for patients with macrocytic anaemia

A

Majority are treatable

19
Q

Define normocytic anaemia

A

Anaemia associated with a normal MCV

Anaemiais defined as Hb <120 g/L in females and <140 g/L in males
Normocytic (MCV 80-100 fL

20
Q

Explain the aetiology / risk factors of normocytic anaemia

A 
Loss of blood cells: 
	• Blood loss (peptic ulcers, oesophageal varices, trauma)
	• Hypersplenism (RBCs pool in the spleen)
	• Haemolytic disorders 
Reduced blood cell formation: 
	• Myelopathies 
	• Renal failure (secondary)
Plasma expansion: 
Pregnancy/overhydration
21
Q

Summarise the epidemiology of normocytic anaemia

A

Most common anaemia

22
Q

Recognise the presenting symptoms of normocytic anaemia

A

Anaemia: pallor, fatigue, dyspnoea

Anorexia, headache, bowel disturbances

23
Q

Recognise the signs of normocytic anaemia on physical examination

A

Koilonychia (iron deficiency), pallor, glossitis, tachycardia, wide pulse pressure, systolic ejection murmur

24
Q

Identify appropriate investigations for normocytic anaemia and interpret the results

A

Bloods: FBC, U&Es, eGFR, clotting screen

Pregnancy test

25
Q

Generate a management plan for normocytic anaemia

A

Treat underlying cause

Erythropoietin administration

26
Q

Identify the possible complications of normocytic anaemia and its management

A

Fatigue

27
Q

Summarise the prognosis for patients with normocytic anaemia

A

Dependant on cause

28
Q

Define aplastic anaemia

A

Diminished haematopoietic precursors in the bone marrow, and a deficiency of all blood cells (pancytopaenia)

29
Q

Explain the aetiology / risk factors of aplastic anaemia

A

Idiopathic (>40%): destruction due to autoimmune mechanisms
Acquired: drugs (chloramphenicol, gold), chemicals, radiation
Inherited: Fanconi’s anaemia

30
Q

Summarise the epidemiology of aplastic anaemia

A

Rare, 2-4:1,000,000

31
Q

Recognise the presenting symptoms of aplastic anaemia

A

Slow or rapid onset

Anaemia: lethargy, tiredness, dyspnoea Thrombocytopaenia: easy bruising, bleeding gums Leukopenia: increased infections

32
Q

Recognise the signs of aplastic anaemia on physical examination

A

Anaemia: pallor
Thrombocytopaenia: bruises, petechiae
Leukopenia: multiple infections

33
Q

Identify appropriate investigations for aplastic anaemia and interpret the results

A

Bloods: FBC (everything lowered, normal MCV)
Blood film: exclude leukaemia
Bone marrow trephine biopsy: for diagnosis and exclusion Criteria for severe aplastic anaemia (AA)
- Marrow with <25% normal cellularity
- Neutrophils <0.5 x 109/L
- Platelets <20 x 109/L
- Reticulocytes <40 x 109/L

34
Q

Define haemolytic anaemia

A

Shortened erythrocyte life span, due to premature breakdown (<120 days), with anaemia

35
Q

Explain the aetiology / risk factors of haemolytic anaemia

A 
Hereditary:
- Membrane defects
- Metabolism defects
- Haemoglobinopathies (sickle cell, thalassaemia)
Acquired:
- Autoimmune
- Isoimmune (transfusion reactions)
- Drugs (penicillin)
- Trauma
- Infection (malaria)
- Paroxysmal nocturnal haemoglobinuria
36
Q

Summarise the epidemiology of haemolytic anaemia

A

Common

Year 3 Conditions (8 decks)

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