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Year 3 core conditions > haematological > Flashcards

haematological Flashcards

1
Q

causes of macrocytic anaemia

A

vitamin B12 or folate deficiency

also alcohol, drugs, severe thyroid deficiency, pregnancy, haematological abnormalities

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2
Q

causes of vitamin B12 deficiency

A

pernicious anaemia (autoimune disorder = rediced production of IF) = most common

gastric causes - gastrectomy, gastric resection, atrophic gastritis, H.pylori, congenital IF deficiency or abnormalitit, inadequate intake of B12 (vegan longterm)

intestinal causes - malabsorption, ileal resection, crohns, chronic tropical sprue, HIV, radiotherapy to cervix, drugs

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3
Q

presentation of macrocytic anaemia

A 
fatigue and lethargy
dyspneoa
faintness
palpitations
headahce
tinnitus
anorexia
angina  - if pre existing CAD

susepct B12 deficiency if unexplained neurological symptoms - paraesthesia, numbness, cognitive changes or visual disturbance

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4
Q

signs on examination of macrocytic anaemia

A

anaemia - pallor, and if severe: tachycardia, flow murmurs, heart fialure

B12 def - juandice (haemolysis induced), glossitis, orophayngeal ulceration, neuroschiatric (irritability, depression, psychosis, dementia)
and neorlogical deficits

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5
Q

investigations for macroytic anaemia

A

bloods
- if haem low and MCV high check serum B12 and folate

  • f haem low and MCV normal check ferritin B12 and folate levels

iron deficiency anaemia or thallassaemia trait can mask macrocytosis

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6
Q

treatment of macrocytic anaemia

A

administer hydroxocobalamin 1mg IM initially every other day for 2 weeks then once every 3 months

if deficiency is diet, take cyanocobalamin tablets daily or injection 2x a year

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7
Q

causes of folate deficiency anaemia

A

folate deficiency due to malabsroption, excessive requirements, excessive urinary excretion or drugs

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8
Q

malabsopriton causes of folate deficiency

A 
ceolic disease
tropical sprue
congential specific malabsorption
jejunal resection
IBD
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9
Q

excessive requirment causes of folate deficiency

A 
pregnancy
prematurity
infancy
malignancy - leukaemia, carcinoma, lymphoma
blood disorders 
inflammation
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10
Q

excessive urinary excretion causes of folate deficiency

A

congestive heart failure
acute liver damage
chronic dialysis

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11
Q

presentation of folate deficiency anaemia

A

symptoms of anaemia - fatgue, letharfy, dyspnoea, faintness, palpitations, headache, tinnitus, anorexia, angina

and folate deficiecny - peripheral neuropathy or psychiatric disturbances

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12
Q

signs of folate deficiency anaemia

A

pallor and if severe - tachycardia, flow murmers and heart failure

folate defieicny - peripheral neuropathy and psychiatric changes

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13
Q

investigations for folate defieicny anaemia

A

if haemaglobin low and MCV high - check serum vitamin B12 and folate conc

if haemaglobin level low and MCV normal or low check ferritin, B12 and folate levels

sincwe iron def anaemia and thalassaemia can mask development or presence of macrytosis

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14
Q

treatment of folate deficiecny anaemia

A

dietary advice

prescribe oral folic acid 5mg daily
check B12 before starting folic acid

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15
Q

who gets iron deficiency anaemia?

A

women in childbearing years - lose iron through menstruation and pregnancy

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16
Q

causes of iron deficiency anaemia

A

GI causes - blood loss - NSAIDs, ulceration, carcinomas

gynaecological causes - menstruation , pregnanct

malabsroption - coeliac disease, gastrectomy, hpylori

blood donation etc

17
Q

presentation of iron deficiency anaemia

A

if chronic, can develop slowly with few symptoms

common - fatigue, dyspneoa, palpiations

iorn deficiency - hair loss, fatigue, lack of concentration, irritability

serious symptoms - angina, marked ankle oedema, dyspnoea

18
Q

signs of iron deficiency anaemia

A

pallor

glossitis, angular stomatits, nail changes, tachycarida, murmurs, cardiac enlargement, heartfialure

19
Q

investigation sof iron defcienyc anaemia

A

FBC
microcytic anaemia - low Hb and MCV
if found - messure ferritin

20
Q

treatment of iron defiicency anaemia

A

adress unerlying cause and treat
ferrous sulphate 200mg 2/3 times a day
monitor repsonse to treatmnet

21
Q

other cuases of microcytic anaemia

A

thallassaemia
sideroblastic anaemias
anaemia ofchronic disease
lead poisoning

22
Q

what are lymphomas

A

neoplastic transformations of B or T cells which reside predominantly in lymphoid tissues

23
Q

who gets hodgkin’s lymphoma

A

primary disease of young adults

previous infections with EBV thought to play a role

24
Q

difference between hodgkins and non hodgkins lymphoma

A

hodgkin has presence of reed sternberg cells

25
Q

presentation of hodgkin’s lymphoma

A

painless lymph node enlargement (often cervical)
rubbery consistency
hepatosplenomegaly
systemic B symptoms - fever, night sweats and weight loss

26
Q

presentation of non hodgkins lymphoma?

A

> 40yo
painless peripheral lymph node enlargement
systemic symptoms - fever, night sweats, weight loss
extranodal involvement
bone infiltration - anaemia, recurrent infections and bleeding

27
Q

investigations for hodgkins lymphoma

A

blood count may be normal
ESR raised
lactate dehydrogenase raised - prognostic marker
CXR show mediastinal widening
lymph node biopsy and histology showing reed-sternberg cells for diagnosis
disease staging by CT, PET increasing being used

28
Q

investigations for non-hodgkins lymphoma

A

blood count may show anaemia, elevated WCC or thrombocytopenia suggest bone marrow involvement. ESR raised

liver biochem abnormal if liver involvement

CXR, CT, PET and gallium scans useful for staigng

bone marrow aspiration and trephine biopsy confirm marrow invovlement

lymph node biopsy required for definitive diagnosis

29
Q

treatment of hodgkins lymphoma

A

early stage - brief chemo followed by involved field irradiation

later stage - cyclidal combination of chemo with irradiation at sites of bulk disease. PET/CT to detect disease activity after treatment

30
Q

treatment of non-hodgkin lymphoma

A

depends on subtype and stage

most common, diffuse large B cell lymphoma and first line treatment is cyclidal combination chemo immunotherapy with field irradiation for those with bulky disease
60-70% cured with this reigme

Year 3 core conditions (15 decks)

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