Haematological Flashcards
Who does iron deficiency anaemia affect?
Higher incidence in women due to iron lost through menstruation and pregnancy
What are the causes of iron deficiency anaemia?
Excessive blood loss
- from GI tract most common (ulceration/carcinoma)
- menorrhagia most common in pre-menopausal women
Dietary inadequacy
- fairly uncommon
- vegetarians
- growing children/elderly people
Failure of iron absorption
- some drugs can bind to iron and prevent its absorption, tetracyclines and quinolones
- antacids and PPIs may impair absorption by ⬆️ pH
- malabsorption conditions - coeliac
Excessive iron requirements
- rapid growth in children
- pregnancy with twins
What are the risk factors for iron deficiency anaemia?
Poor iron intake or impaired absorption Drug history - NSAIDs SSRIs Recent blood donation Recent illness History of previous GI surgery Family history
What are the symptoms of iron deficiency anaemia?
Fatigue
Dyspnoea on exertion
Palpitations
Less common: Headache Tinnitus Taste disturbance Pruritis Changes in hair/hair loss
What are the signs of iron deficiency anaemia on examination?
May be no signs even if severe anaemia
Pallor (best seen on mucosa of tongue and mouth)
Less commonly Koilonychia and longitudinal riding Angular cheilitis Atrophic glossitis Tachycardia
What are the differential diagnoses of iron deficiency anaemia?
Other causes of microcytic anaemia:
Thalassaemia
Sideroblastic anaemia
Anaemia of chronic disease
Lead poisoning
What investigations are necessary to diagnose iron deficiency anaemia?
FBC (if show low Hb and low MCV = microcytic anaemia)
Check ferritin
Dyspepsia + iron deficiency anaemia = urgent endoscopy
What are the treatments for iron deficiency anaemia?
Treat with oral ferrous sulphate
Iron rich foods
Side effects of iron supplementation:
- constipation
- black stools
- Diarrhoea
- indigestion
- nausea
What is macrocytic anaemia?
When there is a fall on Hb levels in the blood
Macrocytosis means that the red blood cells are larger than normal
This occurs when there are problems with the synthesis of RBCs, as in B12/folic acid deficiency
Can be classed as megaloblastic or non-magaloblastic (megaloblastic is abnormality of erythroblasts in the bone marrow)
What is pernicious anaemia?
An autoimmune process that invokes gastritis, atrophy of all layers of the body and fundus of the stomach and the loss of normal gastric glands
How common is pernicious anaemia?
Accounts for 80% of megaloblastic anaemia
What causes pernicious anaemia?
Vitamin B12 deficiency
Folate deficiency
What are the symptoms of pernicious anaemia?
Fatigue & lethargy Dyspnoea Faintness Palpitations Headache Tinnitus Anorexia Exacerbation of angina
What are the signs of pernicious anaemia examination?
Pallor
Bounding pulse
Systolic pulmonary flow murmur
What are the signs of B12 deficiency?
Lemon tinge to skin
Glossitis
Oropharyngeal ulceration
Neuropsychiatric: irritability, depression, psychosis, dementia
What are the signs of folate deficiency?
Mild peripheral neuropathy
Psychiatric changes
What are the differential diagnoses for pernicious anaemia? (Non-megaloblastic causes of macrocytosis)
Alcohol
Severe thyroid deficiency
Pregnancy and neonatal period
Haematological abnormalities
What investigations are necessary to diagnose pernicious anaemia?
FBC
If Hb low and MCV high = check serum vit B12 and serum folate concentrations
If Hb low and MCV normal then check ferritin, vit B12 and folate levels
What are the treatments for pernicious anaemia?
Hydroxocobalamin 1mg IM
Folic acid supplementation
Dietary advice
What is Lymphoma?
Group of blood cell tumours
What are they types of lymphoma? And how common are they & who do they affect?
Non-Hodgkin lymphoma = 90% cases
- white people
- median age at presentation >50years
Hodgkin lymphoma = malignant tumour of lymphatic system
- peak incidence in young adults 20-34 years
What are the symptoms of non-Hodgkin and Hodgkin lymphomas?
NHL:
Low grade:
- painless slow progressive lymphadenopathy
- systemic symptoms (fatigue, weakness, fever, night sweats, weight loss,
Intermediate and high grade:
- rapidly growing and bulky lymphadenopathy
- systemic symptoms and extra nodal involvement
HL:
- enlarged Asymptomatic lymph node
- mediastinal masses
- chest discomfort with a cough or dyspnoea
- systemic symptoms (drenching night sweats and fever)
What are the signs of Hodgkin’s lymphoma on examination?
Lymphadenopathy
Hepatomegaly
Splenomegaly
SVC syndrome
What apinvestigations are necessary to diagnose Hodgkin’s and non-Hodgkin’s lymphoma?
Blood tests
- FBC
- ESR
- LFT
Chest X-ray
CT scans of chest neck and abdomen and pelvis to detect enlarged lymph nodes
