Haem Flashcards

1
Q

What is anaemia?

A

Low haemoglobin concentratoin due to either a low red cell mass or an increased plasma volume.

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2
Q

What are the different types of anaemia? Name 3 causes of each?

A
Microcytic = iron deficiency, thalassaemia and chronic disease
Normocytic = acute blood loss, combined haematinic deficiency and chronic disease
Macrocytic = B12/folate deficiency, alcohol excess/liver disease, hypothyroidism and BM infiltration
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3
Q

Sx of anaemia?

A

Fatigue, dyspnoea, faitness, palpitations, headaches and pallor. Chronic = koilonychia and angular stomatitis

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4
Q

What is haemolytic anaemia, name 4 causes?

A

RBCs are destroyed faster than they are being made.

Sickle cell disease, thallasaemia, G6PD deficiency, SLE and lymphoma.

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5
Q

What casues iron-deficiency anaemia? How do you treat it?

A
Blood loss (menorrhagia or GI bleed), poor diet, malabsorption e.g. coeliac and hookworm.
Treat with Ferrous Sulphate
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6
Q

Name 5 causes of anaemia of chronic disease (secondary anaemia)?

A

Chronic infection, vasculitis, RA, malignancy, renal failure, SLE and UC

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7
Q

What is sickle cell anaemia? What symptoms do patients typically have?

A

AR condition resulting in the production of abnormal RBCs due to abnormal haemoglobin.
Homozygotes = sickle cell anameia
Hetrozygotes = sickle cell trait
Patients will have anaemia, increased infections, dactylitis and can have sickle cell crisis

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8
Q

Sx of a sickle cell crisis? What precipitates crises?

A

Vessels become blocked leading to severe bone pain (often in the hands/feet), pain in the chest, abdomen and joints.
Crises are precipitated by cold weather, dehydration and infection

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9
Q

Name 5 complications of sickle cell disease?

A

Stroke, pulomary hypertension, retinal disease, splelnic infarction (this increases infection risk), chronic renal failure and stunted growth.
Parovirus = sudden reduction in marrow production (especially RBCs) - transfusion may be required

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10
Q

Tx of sickle cell disease?

A

Hydroxycarabimide, long-term antibiotics, vaccination and BM transplant

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11
Q

What are the types of thalassaemia?

A

Globin chain disorder causing reduction in haemoglobin
Alpha thalassaemia = gene deletions
Beta thalassaemia = gene mutation - this is split further:
Minor = carrier state, is generally asymptomatic
Intermedia = moderate anaemia and splenomegaly
Major = presents at 3-6 months with severe anaemia and failure to thrive, hepatosplenomegaly and bossing of the skull

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12
Q

Tx of thalassameia?

A

Thalassaemia major requires regular blood transfusions (give iron chelators e.g. deferiprone to prevent iron overload), stem cell/BM transplant and hormone replacements

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13
Q

What are the 3 causes of excessive bleeding, how can you distinguish them?

A
Vascular defects (vessels do not vasoconstrict), platelet disorders (gaps cannot be plugged) and coagulation defects.
Prolonged bleeding, bleeding into skin (i.e. easy bruising) and bleeding from mucous membranes (i.e. epistaxis) = vascular/platelet
Delayed bleeding into joints/muscles = coagulation
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14
Q

What are the main causes of coagulation disorders?

A
Congenital = Haemophillia (X-linked A = Factor VIII deficiency, B = Factor IV deficiency) and von Willebrand's disease (low/abnormal vWF).
Acquired = anticoagulants, liver disease and vitamin K deficiency
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15
Q

Causes of polycythaemia?

A

Relative = dehydration or chronic HTN/obesity/alcohol excess/tobacco use
Absolute: Primary = Polycythaemia Rubra Vera
Secondary = Hypoxia (e.g. altitude, chronic lung disease or congenital heart problems) or excess EPO secretion e.g. renal tumour

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16
Q

Sx of polycythaemia rubra vera?

A

Headache, dizziness, tinnitus, visual disturbances, itching after a hot bath, plethoric complexion and splenomagaly

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17
Q

Tx of polycythaemia rubra vera?

A

Venesection, hydroxycarabimide and low dose aspirin

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18
Q

RF for DVT?

A

Increasing age/immobility
Surgery, Past dvt, Oestrogen, Trauma
Cancer/coagulation issues, Obesity, Pregnancy

19
Q

Sx of DVT?

A

Hot, swollen, red and tender calf, mild fever and pitting oedema

20
Q

Dx and Tx of DVT?

A

Calculate Well’s score:
If =< 1 perform D-dimer (if +ve do US)
If 2 or more perform D-dimer and US compression test
Tx = LMWH (e.g. enoxaparin) and long term warfarin/DOAC (e.g. apixiban)

21
Q

What are the 4 types of leukaemia?

A
ALL = Acute lymphoblastic leukaemia
CLL = Chronic lymphocytic leukaemia
AML = Acute myeloid leukaemia
CML = Chronic myeloid leukaemia
22
Q

Sx ALL?

A

COMMONEST CHILDHOOD CANCER!
BM failure = Anaemia, increased infections and easy bleeding.
Infiltrations = hepatosplenomegaly and lymphadenopathy

23
Q

Dx and Tx of ALL?

A

High WCC, blast cells seen on blood film. No Auer rods on BM biopsy.
Supportive = Blood/platelet transfusions, IV fluids, allopurinol
Fight the cancer = chemotherapy and BM transplant

24
Q

What is tumour lysis syndrome?

A

Spontaneous release of tumour cell content into the blood stream. Leads to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Leads to arrhythmia and renal failrure
Allopurinol helps prevent this

25
Q

Sx of CLL?

A

COMMONEST LEUKAEMIA - often asymptomatic

Aneamia, increased infections, weight loss, night sweats, hepatosplenomegaly and enlarged, rubbery non-tender nodes

26
Q

Dx and Tx of CLL?

A
Raised WCC (very high lymphocytes)
Supportive = transfusions and IV human immunoglobulin
Fight the cancer = Chemotherapy, radiotherapy, stem cell transplant
27
Q

Sx of AML?

A

BM failure = anaemia, increased infections and bleeding
Infiltrations = hepatosplenomegaly and gum hypertrophy
In adults this is more likely to be the diagnosis than ALL

28
Q

Dx and Tx of AML?

A

Auer rods present on bone marrow biopsy
Supportive = Blood/platelet transfusions, IV fluids, allopurinol
To treat the cancer = chemotherapy and BM transplant

29
Q

Sx of CML?

A

Weight loss, fatigue, fever, night sweats, easy bruising, anaemia, hepatosplenomegaly and gout

30
Q

Dx and Tx of CML?

A

Very raised WCC (esp. neutrophils, basophils and eosinophils), raised urate. Philadelphia chromosome is present in >80% (worse prognosis if not present).
Imatinib and stem cell transplant

31
Q

Sx of Hodgkin’s lymphoma?

A

MOST COMMON MALIGNANCY IN 15-24
Enlarged non-tender rubbery lymph nodes which become painful on alcohol consumption.
Fever, night sweats, weight loss, pruitus and lethargy

32
Q

Dx and Tx of Hodgkin’s lymphoma?

A

Lymph node biopsy. Reed-Sternberg cells are present

Radiotherapy and chemotherapy, stem cell transplant

33
Q

Sx of Non-Hodgkin’s lymphoma?

A

Enlarged non-tender rubbery lymph nodes.

Fever, night sweats, weight loss, anaemia, infection, easy bleeding. May be symptoms of gastrits.

34
Q

Dx and Tx of Non-Hodgkin’s lymphoma?

A

Marrow and lymph node biopsy. No Reed-Sternberg cells are present
R-CHOP regimen in high grade, radiotherapy or no treatment in low grade

35
Q

What is the difference between low grade and high grade N-HL?

A

Low grade = indolent so widely disseminated at the time of presentation, often incurable
High grade = more aggressive with nodal presentation - often curable

36
Q

Sx of myeloma?

A

Osteolytic bone lesions = backache, pathological fractures, vertebral collsapse
Hypercalcaemia = bone pain, renal stones, abdo pain, constipation, polyuria/polydypsia, weakness, anorexia, weight loss, confusion, depression
Pancytopenia = anaemia, frequent infections and easy bleeding
Renal insufficiency

37
Q

What is the diagnostic criteria for myeloma?

A

Monoclonal protein band in serum electrophoresis, increased plasma cells on BM biopsy, evidence of end-organ damage (hypercalcaemia, anaemia or renal insufficiency) and bone lesions seen on x-ray

38
Q

Tx of myeloma?

A

Analgesia for bone pain (avoid NSAIDs - due to renal issues), bisphosphonates, local radiotherapy/chemotherapy, autologous stem-cell transplant

39
Q

What are the 5 causative organisms in malaria?

A

P. falciparum, P. vivax, P. ovale, P. malariae, P.knowlesi

40
Q

Sx of malaria?

A

Fever, headache, malaise, myalgia, diarrhoea, cough

41
Q

Tx of malaria?

A

Quinine if P. falciparum

Chloroquinine if non P. falciparum

42
Q

Sx of sepsis?

A
Shiver/fever/very cold
Extreme pain/discomfort
Pale/discoloured skin
Sleepy/difficult to rouse/confused
I feel like I might die
Short of breath
43
Q

Tx of sepsis?

A
BUFALO - Sepsis 6
Blood cultures
Urine output (monitor)
Fluids
Antibiotics
Lactate measurement
Oxygen if hypoxic