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ICM/FCM > Haem ICM > Flashcards

Haem ICM Flashcards

1
Q

Are the Hb values for women higher or lower than the values for men?

A

Lower:

Men - 130-180
Females - 115-165

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2
Q

What are some causes of anaemia to cause low Hb?

A
  • Blood loss (menorrhagia, trauma)
  • Increased cell destruction (Sickle cell, RA)
  • Decreased cell production (bone marrow infiltration)
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3
Q

What is erythrocytosis/Polycythaemia?

A

Where you have too many RBC making the blood thicker and harder to go through the vessels

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4
Q

What are some causes of erythrocytosis/Polycythaemia?

Think of Billy

A
  • Increased cell production (haemochromatosis)
  • Chronic hypoxia
  • Dehydration
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5
Q

Apart from Iron deficiency, name two other causes of microcytic anaemia?

A

Thalassemia - having less Hb than normal

Sickle cell disease - sickle shaped RBC making it harder to move across the body, alongside dying earlier

Sideroblastic anaemia - Body produces enough iron but it is unable to be stored into Hb

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6
Q

Apart from B12 and folate deficiencies, what else can cause macrocytic anaemia?

A

Alcohol consumption

Hypothyroidism

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7
Q

What are some causes of thrombocytopenia? (<150)

A

Bone marrow dysfunction

Acute blood loss

Drugs - Heparin induced thrombocytopenia

Autoimmune diseases - SLE

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8
Q

What are some causes of primary thrombocytosis? (>450)

A

Primary Thrombocythemia - rare blood clotting disorder

Polycythaemia Vera

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9
Q

What are some causes of secondary thrombocytosis?

A

Chronic bleeding from malignancy (bowel cancer)

Infections

Fe Deficiency

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10
Q

What is leucocytosis?

A

WCC > 11

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11
Q

What is leucopeania?

A

WCC < 4

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12
Q

What is the most important cause of Neutrophilia? <7.5

A

Haematological malignancies

- Myeloid leukaemia

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13
Q

What is acute myeloid leukaemia?

A

Condition where the bone marrow produces too many immature monocytes/granulocytes (WCC) and they are unable to fight properly against infection

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14
Q

What are other causes of neutrophilia?

A

Infection

Vomiting

Labour

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15
Q

What level of neutropenia should you be concerned about to consider a patient as immuno-compromised?
(Normal <2.0)

A

<0.5

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16
Q

How would a patient present to make you worry about neutropenic sepsis? (3 marks)

A

Fever >38

Neutropenia (<0.5)

Signs of sepsis

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17
Q

What are some causes of neutropenic sepsis?

A

Chemo

Infections

Bone marrow disorder

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18
Q

What blood tests would you order for neutropenic sepsis?

A 
FBC - check WCC
CRP - infection 
U&E / Creatinine - dehydration / AKI 
LFT - increased bilirubin and ALT (cholestasis - chemo induced) 
Clotting screen - DIC
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19
Q

Apart from blood sample, what other tests can you do to investigate neutropenic sepsis?

A

Blood gas - hypo/hyperglycaemia and hyperlactataemia

Blood cultures

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20
Q

Cause of lymphocytosis >4.5

Think of two causes beginning with L

A

Viral infections

Leukaemia

Lymphomas

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21
Q

Causes of lymphopenia (<1.5)

A

HIV

Sarcoidosis

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22
Q

If a patient is leucopenic (neutrophils and lymphocytes), spiking fevers and no improvement with abx, what should you be concerned about and how should you investigate this?

A

Fungal infection
- Serum galactomannan & Beta-d-glucan

First one checks for aspergillosis

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23
Q

What haematological conditions are associated with monocytosis? (>0.8)

A

Myelodysplastic syndrome (MDS) - not enough healthy blood cells

Hodgkin lymphoma - cancer of the lymphatic system

Acute myeloid leukaemia - cancer that starts from young white blood cells

24
Q

What type of cells would you see for Hodgkin’s lymphoma?

A

Reed-sternberg cells

25
Q

Causes of eosinophilia? (>0.4)

A

Allergy
Hodgkin’s lymphoma
AML
Eosinophilic leukaemia

26
Q

Causes of increased ESR

think of dad

A

HIV

Myeloma/MGUS

27
Q

Causes of decreased ESR

A

Polycythaemia

28
Q

How do you correctly identify iron status? (3 marks)

A

Serum iron
TIBC
Transferrin saturation

29
Q

Causes of prolonged thrombin time when checking clotting screen?

A

Vit K deficiency
Warfarin
DIC

30
Q

What is Haemoglobinopathies screening?

A

Group of tests to identify abnormal forms of Hb production to help screen for a Hb disorder

31
Q

If a patient is being screened for sickle cell or thalassemia for the first time, what else should you add to the sample?

A

Ferritin - to check for any iron deficiencies

32
Q

How long does it take for the screening result of sickle cell to come back?

A

< 1 hour

33
Q

What are the two confirmatory tests to screen for sickling disorders?

A

Hb Electrophoresis

High pressure liquid chromatography

34
Q

What bloods do you send off to screen for thalassemia’s and what would they show?

A

FBC - microcytic, hypochromic anaemia (small, pale)
- elevated WCC

Iron & Ferritin - raised

35
Q

What is a confirmatory test for thalassaemia?

A

Hb electrophoresis

36
Q

What findings on a blood test indicates multiple myeloma? (C.R.A.B)

A

C - Calcium - high

R - Renal failure

A - Anaemia (normocytic, normochromic –> same size and shape)

B - Bone lesions/pain

37
Q

What are the initial investigations for suspecting multiple myeloma/MGUS in a patient presenting with persistent bone pain and over 60? (4 marks)

A

FBC - low WCC
Calcium - high
ESR - high
Plasma viscosity - high

38
Q

If the bloods are positive for suspicion of multiple myeloma/MGUS, what are the other initial investigations that should be sent? (B.L.I.P)

A

B - Bence jones protein (urine electrophoresis) >500mg

L - Light chain assay (serum free)

I - Immunoglobulins (serum)

P - Protein electrophoresis (serum)

39
Q

What is direct antibody testing / coombs test?

A

Test to check for antibodies that are destroying the bodies RBC and causing haemolytic anaemia

40
Q

Besides haemolytic anaemia, what else does the direct antibody test, test for?

A

acute haemolytic transfusion reaction

41
Q

What is acute haemolytic transfusion reaction and what triad of symptoms would you see associated with this?

A

Reaction 24 hours after blood transfusion

Fever
Flank Pain
Reb/Brown urine

42
Q

Name some risk factors associated for causing acute haemolytic transfusion reaction

A
  • ABO incompatibility
  • Pregnancy
  • Prior history
43
Q

What is tumour lysis syndrome and what electrolyte abnormalities would you find with it?
EMERGENCY

A

Oncological emergency caused by the breakdown of cancer cells after chemo into the bloodstream, causing raised potassium, raised urea, raised phosphate and low calcium

44
Q

What is haemophilia and factors are deficient in haemophilia A and B?

A

Haemophilia is a bleeding disorder due to the deficiency of certain clotting factors

Haemophilia A - factor 8 (XIII)
Haemophilia B - factor 9 (IX)

45
Q

Why does haemophilia effect men more than women?

A

X linked recessive disorder

Women would need both of their X chromosomes to be affected

Men only have one X chromosome

46
Q

What is a classic feature of severe haemophilia?

A

Spontaneous bleeding into joints and muscles

47
Q

What two things would you want to investigate to diagnose haemophilia?

A

APTT - would be prolonged

Factor 8 & 9 coagulation assay - decreased/absent

(+ FBC, PT )

48
Q

What is thrombophilia / hypercoagulable state ?

A

A condition where your body forms clots too quickly and puts you at a higher risk of developing a DVT and PE

49
Q

What investigations would you do to check if someone has thrombophilia?

A

FBC - anaemia, raised WCC and raised or reduced platelet

aPTT - reduced or prolonged (need to distinguish baseline before starting anticoagulation)

Fibrinogen - high in prothrombotic state / low in DIC

PT - prolonged in DIC

D-dimer - normal or raised

Investigate nephrotic syndrome:
albumin - low
creatinine - high

50
Q

What findings would you see in iron deficiency anaemia?

A 
Low Hb 
Low MCV 
Low ferritin 
Low MCHC
High total iron binding capacity 
High RDW
51
Q

What group of patients have a higher risk of developing vit b12 / folate deficiencies?

A

Patients who have had a type of bariatric surgery

52
Q

How do you distinguish between Vit b12 or folate deficiency?

A

Fruits & Fegetables –> folate
Beef an bacon –> b12 (more seen in vegans)

If a patient is deficient in those types of food, it will lead to that deficiency

53
Q

How long after should you recheck a patients hb levels once they’ve started oral ferrous sulphate for iron deficiency anaemia?

A

2-4 weeks after

If good response to treatment –> 2-4 months

54
Q

Name two early signs of vit b12 deficiency and who is at risk of developing this?

A

Limb paraesthesia & peripheral neuropathy

Alcoholics

55
Q

In what situation would you use haemoglobin electrophoresis?

A

Microcytic anaemia with normal iron levels

ICM/FCM (16 decks)

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