Haem Flashcards
What is anaemia?
Low haemoglobin concentratoin due to either a low red cell mass or an increased plasma volume.
What are the different types of anaemia? Name 3 causes of each?
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
Sx of anaemia?
Fatigue, dyspnoea, faitness, palpitations, headaches and pallor. Chronic = koilonychia and angular stomatitis
What is haemolytic anaemia, name 4 causes?
RBCs are destroyed faster than they are being made.
Sickle cell disease, thallasaemia, G6PD deficiency, SLE and lymphoma.
What casues iron-deficiency anaemia? How do you treat it?
Blood loss (menorrhagia or GI bleed), poor diet, malabsorption e.g. coeliac and hookworm. Treat with Ferrous Sulphate
Name 5 causes of anaemia of chronic disease (secondary anaemia)?
Chronic infection, vasculitis, RA, malignancy, renal failure, SLE and UC
What is sickle cell anaemia? What symptoms do patients typically have?
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
Sx of a sickle cell crisis? What precipitates crises?
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
Name 5 complications of sickle cell disease?
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
Tx of sickle cell disease?
Hydroxycarabimide, long-term antibiotics, vaccination and BM transplant
What are the types of thalassaemia?
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
Tx of thalassameia?
Thalassaemia major requires regular blood transfusions (give iron chelators e.g. deferiprone to prevent iron overload), stem cell/BM transplant and hormone replacements
What are the 3 causes of excessive bleeding, how can you distinguish them?
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
What are the main causes of coagulation disorders?
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
Causes of polycythaemia?
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
Sx of polycythaemia rubra vera?
Headache, dizziness, tinnitus, visual disturbances, itching after a hot bath, plethoric complexion and splenomagaly
Tx of polycythaemia rubra vera?
Venesection, hydroxycarabimide and low dose aspirin
RF for DVT?
Increasing age/immobility
Surgery, Past dvt, Oestrogen, Trauma
Cancer/coagulation issues, Obesity, Pregnancy
Sx of DVT?
Hot, swollen, red and tender calf, mild fever and pitting oedema
Dx and Tx of DVT?
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)
What are the 4 types of leukaemia?
ALL = Acute lymphoblastic leukaemia CLL = Chronic lymphocytic leukaemia AML = Acute myeloid leukaemia CML = Chronic myeloid leukaemia
Sx ALL?
COMMONEST CHILDHOOD CANCER!
BM failure = Anaemia, increased infections and easy bleeding.
Infiltrations = hepatosplenomegaly and lymphadenopathy
Dx and Tx of ALL?
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
What is tumour lysis syndrome?
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
