haematological Flashcards
iron deficiency anaemia:
- GI causes? 2
- gynae causes? 3
- other causes? 2
nb often multifactorial
most commonly seen in pre-menopausal women
- GI bleeds (most common cause in men + post-men women)
- malabsorption (IBD, coeliac, gastrectomy etc)
- menstruation (most common cause in pre men women)
- pregnancy
- PV bleeding (e.g. haemorrhage in childbirth)
- inadequate dietary intake (rare!! e.g. vegans)
- blood donation
nb hookworm common causes of PR bleeds in tropics
iron-deficiency anaemia:
- common symptoms? 4
- less common symptoms? 9
nb if develops chronically, often few symptoms as body adjusts
- fatigue
- dyspnoea
- faintness
- palpitations
- headache
- tinnitus
- taste disturbances
- pruritis
- lack of conc/irritability
- pica (abnormal food cravings)
- glossitis
- dysphagia
- impairment of body temp regulation (esp in preg)
iron deficiency anaemia:
- signs? 5
- blood tests? (incl findings) 2
- other investigations? 2
- pale palmar creases
- koilonycia
- glossitis
- angular chelitis
- pale conjunctiva
- FBC
= low Hb, low MCV, low MCH, low MCHC - ferritin
= low (nb also low in infection) - endoscopy
- colonoscopy
(- stool microscopy if hookworm suspected)
nb faecal occult blood rarely used as poor sensitivity
iron def anaemia:
- treatment? 2
- treat underlying cause
- ferrous sulphate tablets
iron def anaemia:
- differential diagnoses for microcytic anaemia? 4
- other? 3
- thalassaemia
- anaemia of chronic disease
- sideroblastic anaemia
- lead poisoning
- hypothyroidism
- heart failure
- cancers
(anything that presents with fatigue)
Macrocytic anaemia:
- causes of megaloblastic macrocytosis? 2
- causes of non-megaloblastic macrocytosis? 6
- which of above are two commonest causes of microcytic anaemia?
megaloblastic:
- B12 deficiency (80% = pernicious, can occur dt ileostomy or, rarely, dietary insufficiency)
- folate deficiency (dietary/malabsorption, some drugs - e.g. phenytoin, late pregnancy)
non-megaloblastic causes:
- medication (37%) (e.g. cytotoxic: azathioprine, hydroxycarbamide)
- alcoholism (26%)
- non-alcoholic liver disease
- bone marrow dysplasia (+some blood cancers)
- reticulocytosis
- severe hypothyroidism
macrocytic anaemia:
- mechanism of pernicious anaemia?
vit B12 binds to intrinsic factor (produced by parietal cells in stomach)
the B12-intrinsic factor complex is then absorbed in terminal ileum
in pernicious anaemia:
- autoimmune destruction of parietal cells +/or intrinsic factor -> malabsorption
nb B12 stores in liver can last up to 2-4 years so have to be deficient for a while before symptoms occur
macrocytic anaemia:
- symptoms? 5
- signs? 8
- SOB on exertion
- exacerbation of angina
- fatigue
- complain look pale
- palpitations
- pallor
- pale palmar creases
- koilonycia
- glossitis
- angular chelitis
- pale conjunctiva
- bounding pulse
- systolic pulmonary flow murmur
macrocytic anaemia:
- blood tests? 7 (w results)
- other possible investigations? 2
- FBC (high MCV)
- blood film
- reticulocytes (if high, may indicate high turnover of RBCs)
- serum folate/red cell folate
- serum vit B12
- LFTs (alcohol or other liver disease)
- U+E (routine)
other:
- Coombs test is suspect haemolysis
- bone-marrow sample is suspect problems there
macrocytic anaemia:
- two principles of treatment?
- how correct vit B12 deficiency? (incl drug name)
- how correct folate deficiency?
- correct underlying deficiency
- treat underlying condition that led to deficiency
- hydroxocobalamin IM injection every 3 months
- 5mg folic acid tablets (nb pregame women should be on these anyway)
if both folate and fit B12 deficiency, treat B12 FIRST as folate may aggravate the B12 deficiency and -> spinal cord damage
