haematological Flashcards
causes of macrocytic anaemia
vitamin B12 or folate deficiency
also alcohol, drugs, severe thyroid deficiency, pregnancy, haematological abnormalities
causes of vitamin B12 deficiency
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
presentation of macrocytic anaemia
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
signs on examination of macrocytic anaemia
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
investigations for macroytic anaemia
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
treatment of macrocytic anaemia
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
causes of folate deficiency anaemia
folate deficiency due to malabsroption, excessive requirements, excessive urinary excretion or drugs
malabsopriton causes of folate deficiency
ceolic disease tropical sprue congential specific malabsorption jejunal resection IBD
excessive requirment causes of folate deficiency
pregnancy prematurity infancy malignancy - leukaemia, carcinoma, lymphoma blood disorders inflammation
excessive urinary excretion causes of folate deficiency
congestive heart failure
acute liver damage
chronic dialysis
presentation of folate deficiency anaemia
symptoms of anaemia - fatgue, letharfy, dyspnoea, faintness, palpitations, headache, tinnitus, anorexia, angina
and folate deficiecny - peripheral neuropathy or psychiatric disturbances
signs of folate deficiency anaemia
pallor and if severe - tachycardia, flow murmers and heart failure
folate defieicny - peripheral neuropathy and psychiatric changes
investigations for folate defieicny anaemia
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
treatment of folate deficiecny anaemia
dietary advice
prescribe oral folic acid 5mg daily
check B12 before starting folic acid
who gets iron deficiency anaemia?
women in childbearing years - lose iron through menstruation and pregnancy
causes of iron deficiency anaemia
GI causes - blood loss - NSAIDs, ulceration, carcinomas
gynaecological causes - menstruation , pregnanct
malabsroption - coeliac disease, gastrectomy, hpylori
blood donation etc
presentation of iron deficiency anaemia
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
signs of iron deficiency anaemia
pallor
glossitis, angular stomatits, nail changes, tachycarida, murmurs, cardiac enlargement, heartfialure
investigation sof iron defcienyc anaemia
FBC
microcytic anaemia - low Hb and MCV
if found - messure ferritin
treatment of iron defiicency anaemia
adress unerlying cause and treat
ferrous sulphate 200mg 2/3 times a day
monitor repsonse to treatmnet
other cuases of microcytic anaemia
thallassaemia
sideroblastic anaemias
anaemia ofchronic disease
lead poisoning
what are lymphomas
neoplastic transformations of B or T cells which reside predominantly in lymphoid tissues
who gets hodgkin’s lymphoma
primary disease of young adults
previous infections with EBV thought to play a role
difference between hodgkins and non hodgkins lymphoma
hodgkin has presence of reed sternberg cells
presentation of hodgkin’s lymphoma
painless lymph node enlargement (often cervical)
rubbery consistency
hepatosplenomegaly
systemic B symptoms - fever, night sweats and weight loss
presentation of non hodgkins lymphoma?
> 40yo
painless peripheral lymph node enlargement
systemic symptoms - fever, night sweats, weight loss
extranodal involvement
bone infiltration - anaemia, recurrent infections and bleeding
investigations for hodgkins lymphoma
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
investigations for non-hodgkins lymphoma
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
treatment of hodgkins lymphoma
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
treatment of non-hodgkin lymphoma
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
