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Haem - completed Flashcards

1
Q

Anaemia

A

Present when there is a decrease of haemoglobin in the blood below the reference level for the age and sex of the individual

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2
Q

RBC lifespan

A

120 days

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3
Q

3 types of anaemia:

These are classified by …

A
  • Hypochromic (pale) MICROCYTIC - low MCV
  • Normochromic NORMOCYTIC - normal MCV
  • MACROCYTIC - high MCV

MCV=mean corpuscular vol (av vol of RBC/ s their size)

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4
Q

Main causes of MICROCYTIC ANAEMIA

A

Main causes:
• Iron deficiency anaemia - the MOST COMMON CAUSE WORLDWIDE • Anaemia of chronic disease
• Thalassaemia (see inherited red cell disorders)

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5
Q

IRON DEFICIENT ANAEMIA can give …

A

Oral ferrous sulphate or ferrous glauconite if side effects bad, or IV iron/deep IM iron in extreme cases

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6
Q

NORMOCYTIC anaemia causes

A
  • Acute blood loss
  • Anaemia of Chronic Disease
  • Endocrine disorders such as hypopituitarism, hypothyroidism and hypoadrenalism
  • Renal failure
  • Pregnancy
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7
Q

MACROCYTIC ANAEMIA causes

A 
• Megaloblastic:
- Vitamin B12 deficiency (known as COBALAMIN) - Folate deficiency
• Non-megaloblastic: - Alcohol
- Liver disease
- Hypothyroidism
- Haemolysis
- Bone marrow failure (aplastic anaemia) - Bone marrow infiltration
- Antimetabolite therapy
- Myeloma
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8
Q

PERNICIOUS ANAEMIA aka …

Treatment …

A

B12 deficiency

Dietary= oral B12
Replenish stores= IM hydroxocobalamin

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9
Q

Folate deficiency treatment

A

Folic acid tablets daily for 4 months never without B12

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10
Q

HAEMOLYTIC ANAEMIA causes

A
  • RBC membrane defects:
    • Hereditary spherocytosis - Enzyme defects:
    • Glucose-6-phosphate dehydrogenase (G6PD) deficiency - Haemoglobinopathies:
    • B Thalassaemia
    • AThalassaemia
    • Sickle cell disease
  • Autoimmune haemolytic anaemia
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11
Q

HAEMOGLOBIN results

A

• Normal Hb (HbA) = Haem + 2 alpha chains + 2 beta chains
• Foetal Hb (HbF) = Haem + 2 alpha chains + 2 gamma chains • Hb delta (HbA2) = Haem + 2 alpha chains + 2 delta chains
• In an adult:
- HbA=97% - HbA2=2% - HbF=1%

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12
Q

Beta Thalassaemia =

Alpha Thalassaemia =

A

Reduced B chain synthesis

Reduced A chain synthesis

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13
Q

Beta thalassaemia treatment

A

(Transfusions)
Oral DEFERIPRONEE & SC DESDERRIOXAMINE (prevent iron overload)
Large doses of ascorbic acid

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14
Q

SICKLE cell ANAEMICA treatment

A

Oral hydroxycarbamide to increase HbF conc

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15
Q

APLASTIC ANAEMIA DUE TO BONE MARROW FAILURE Treatment

A

Immunosuppressive therapy with ANTITHYMOCYTE GLOBULIN (ATG) and CICLOSPORIN in those:
• Over 40
• Below 40 with severe disease who do not have a HLA identical sibling donor • Those who are transfusion dependent

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16
Q

POLYCYTHAEMIAVERA(PV) treatment:

Chemotherapy:

A

HYDROXYCARBAMIDE and low-dose BULSULFAN for those who do not tolerate venesection or have poorly controlled features of the disease e.g. thrombocytosis (too many platelets)
- Low dose ASPIRIN alongside above treatments
- RADIOACTIVE PHOSPHORUS but only in those over 70 due to increased risk
of acute leukaemia
- ALLOPURINOL to block uric acid production thereby reduce gout

17
Q

Arterial thrombosis treatment:

1: prevention
2: MI
3: Stroke

A
  • Prevention:
    • COX inhibitor e.g. ASPIRIN which inhibits platelet aggregation
    • P2Y12 inhibitor e.g. CLOPIDOGREL which inhibits ADP from binding to
    the P2Y12 receptor
    • DIPYRAMIDOLE inhibits phosphordiesterase-mediated breakdown of
    cyclic AMP which prevents platelet activation - MI:
    • ASPIRIN - inhibits platelet function as COX inhibitor
    • Thrombolytic therapy:
  • STREPTOKINASE
  • TISSUE PLASMINOGEN ACTIVATOR which generates plasmin
    and degrades fibrin clot
  • Stroke:
    • ASPIRIN or CLOPIDOGREL
    • TISSUE PLASMINOGEN ACTIVATOR (for brain attack, only have a narrow window)
    • Treat risk factors
18
Q

DVT drug treatment

A
  • Low molecular weight Heparin e.g. SC ENOXAPARIN for a minimum of 5
    days (at first)
  • ORAL WARFARIN with a target INR of 2.5 (2-3) for 6 months after
  • Direct acting Oral Anti-Coagulants (DOAC) similar to warfarin but do not need monitoring
19
Q

IMMUNETHROMBOCYTOPENIAPURPURA(ITP) treatment:

A
  • First line:
    • Corticosteroids e.g. PREDNISOLONE
    • IV immunoglobulin e.g. IV IgG - raises platelet count more rapidly than steroids - thus useful for surgery
  • Second line:
    • Splenectomy
    • If splenectomy fails then immunosuppression e.g. ORAL/IV AZATHIOPRINE
20
Q
  • THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP) drug treatment:
A
  • THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP):
21
Q
  • ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL): drug treatment
A
  • ALLOPURINOL (prevents tumour lysis syndrome)
22
Q
  • ACUTE MYELOID LEUKAEMIA (AML) drug treatment:
A
  • ALLOPURINOL (prevents tumour lysis syndrome)
23
Q
  • CHRONIC MYELOID LEUKAEMIA (CML) drug treatment:
A

ORAL IMATINIB - specific BCR/ABL tyrosine kinase inhibitor

24
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) drug treatment:

A
  • HUMAN IV IMMUNOGLOBULINS
25
Q
  • HODGKIN’S LYMPHOMA Drug treatment :
A

Combination chemotherapy - ABVD: • A - ADRIAMYCIN
• B - BLEOMYCIN
• V - VINBLASTINE
• D - DACARBAZINE

26
Q

NON-HODGKIN’S LYMPHOMA drug treatment:

A 
R-CHOP regimen:
• R - RITUXIMAB (monoclonal antibody - minimal side effects) • C - CYCLOPHOSPHAMIDE
• H - HYDROXY-DAUNORUBICIN
• O - VINCRISTINE (Oncovin brand name)
• P - PREDNISOLONE
27
Q

Myeloma drug treament:

A
  • Give all patients bisphosphonate e.g. ZOLENDRONATE as they reduce fracture rates and bone pain
  • Chemo: VAD - VINCRISTINE, ADRIAMYCIN and DEXAMETHASONE in fitter people - max 6 cycles
28
Q

FEBRILE NEUTROPENIA DEF:

A
  • Temperature recorded as above 38°C in a patient with absolute neutrophil count <1.0x109/L
29
Q

MALIGNANT SPINAL CORD COMPRESSION drug MANAGEMENT:

A

High does steroid eg oral DEXAMETHASONE

30
Q

TUMOUR LYSIS SYNDROME treatment & prophylaxis

A

ALLOPURINOL (xanthine oxidase inhibitor) or RASBURICASE (recombinant urate oxidase) both work to reduce uric acid production

31
Q

Hypercalcaemia drug treatment:

A
  • BISPHOSPHONATES e.g. ZOLENDRONATE, reduces Ca2+ production but takes a few days to come into effect

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