Haem/onc Flashcards

1
Q

Is demand for iron high or low in early years?

A

High

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2
Q

How can giving cow’s milk too early cause anaemia?

A

Chronic microscopic bleeding

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3
Q

Are infants born with iron stores?

A

Yes

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4
Q

What iron intake do babies require to maintain stores? (daily)

A

400-700ng

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5
Q

Why is iron in breast milk well absorbed?

A

Lactoferrin (iron binding protein)

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6
Q

Are artificial formula feeds a good source of iron?

A

Yes generally sufficiently fortified with iron to prevent deficiency

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7
Q

When might babies need prophylactic iron supplementation? Across what time period?

A

LBW and solely breast fed

Start 4-6w until mixed feeding established.

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8
Q

Presentation of iron deficiency anaemia

A

Can be asymptomatic

Pallor

If severe- anorexia and irritability

Decreased neuro/intellectual functioning such as attention span and alertness (iron deficiency even in the absence of anaemia)

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9
Q

When do you investigate iron deficiency anaemia?

A

Only if failure to respond to treatment

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10
Q

What might blood film/count show in iron defic anaemia?

A

microcytic, hypochromic RBCs and poikilocytosis (abnormal shape RBCs)

Serum ferritin low

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11
Q

What investigations can you do other than blood count and film

A

Hb electrophoresis to r/o thalassaemia etc

U&Es- renal failure can cause low RBC via reduced EPO

Blood/urine culture for chronic infection (normocytic anaemia with low reticulocytes)

Bone marrow aspirate (leukaemia)

?Lead level- lead toxicity can cause microcytic anaemia

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12
Q

Management iron defic anaemia

A

R/o serious cause such as thalassaemia

ONLY IF DEMONSTRABLE IRON DEFICIENT STATE: oral iron salts

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13
Q

Dose oral iron salts?

A

3-6mg/kg (max 200g) daily in 2-3 divided doses

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14
Q

What do you need to consider when prescribing oral iron salts?

A

Each salt has different content of iron so specify the iron salt and elemental iron. Also consider the iron content of formula feeds.

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15
Q

How else can iron be given other than oral? When should it be given?

A

Parenterally

If oral unsuccessful for various reasons

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16
Q

Is parenteral better than properly taken oral iron?

A

Not really

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17
Q

Advice for parents re diet in iron deficiency?

A

1 pint milk per day max

Encourage more iron rich food

Tea can limit iron absorption so avoid

18
Q

How quickly does iron supplementation treatment work?

A

Within 1w Hb levels should start to increase. If not then check compliance or consider alternative

19
Q

Draw out flow chart of anaemias

A

see IDA notes

20
Q

What is the commonest cancer cause of death in children and young people?

A

Brain tumour

21
Q

60% brain tumour survivors are left with _____?

A

Life altering disability

22
Q

What are the 2 most common locations for brain tumour

A

Brainstem and cerebellum

23
Q

How do brain tumours present?

A

raised ICP or neuro signs

24
Q

What are two long term sequelae of brain tumour?

A

Endocrine and growth problems

25
What factor is implicated in haemophilia A?
VIII
26
What factor is implicated in haemophilia B?
IX
27
What factor is implicated in haemophilia C? Who is more likely to get it?
XI Ashkenazi jew (both sexes)
28
What factor is implicated in parahaemophilia?
V
29
How are haemophilia A and B inherited?
X linked
30
Could a female carrier of haemophilia A/B be at all affected?
Yes could have mild form e.g. heavy periods
31
Will a man with haemophilia A/B have affected children?
Can't have a son with haemophilia but could have carrier daughters
32
Can you get acquired haemophilia?
Yes- give steroids
33
True or false haemophilia has a high rate of new mutations?
True
34
Which clotting test is abnormal in haemophilia a and b?
APTT increased
35
What is the characteristic bleed in haemophilia?
Joint Haemarthrosis of elbows, knees, ankles. Can lead to permanent joint damage or dysfigurement
36
Why might haemophiliacs get nerve palsies and compartment syndromes?
Haematomas
37
When might haemophilia present?
Bruising as they learn to walk Following dental procedure, accident or surgery
38
Will clotting factor replacement always remain effective in haemophilia?
No they can develop immune inhibitor
39
What do you need to red flag for in haemophilia?
IC haemorrhage- confusion, severe headache, stiff neck, vomiting, slurred speech, double vision, poor balance- call ambulance
40
can you diagnose haemophilia before birth?
Yes amnio/cvs
41
How do you manage haemophilia pharmacologically
Desmopressin rapid IVI can increase factor VIII levels Clotting factor injections (in mild- only if injured and bleeding. In severe- regular) Injections should be given SC not IM Avoid contact sports Be careful taking aspirin and avoid anticoags Good oral hygiene and regular dentist checks
42
Haemophilia prognosis
Normal QoL, 10y shortened life expectancy. 1/3 die from ICH