Haematology Flashcards
What is the definition of anaemia?
Low haemoglobin (Hb) concentration due to low red cell mass or increased plasma volume
Which symptoms can commonly present in all caused of anaemia
Fatigue, faintness, dyspnoea, headache, tinnitus, anorexia
What are the signs of severe anaemia
Tachycardia, flow murmurs, cardiac enlargement
List the causes of microcytic anaemia (3)
Iron-deficiency anaemia
Thalassaemia
Sideroblastic anaemia
List the causes of normocytic anaemia (5)
Acute blood loss Anaemia of chronic disease Bone marrow failure Renal failure Pregnancy
List the causes of macrocytic anaemia (7)
B12/Folate deficiency Alcohol excess / liver disease Reticulocytosis Cytotoxics Myelodysplastic syndromes Marrow infiltration Antifolate drugs
What are the signs of iron deficiency?
Microcytic anaemia
Brittle hair and nails
Atrophic glossitis
Angular stomatitis
A patient is diagnosed with iron deficiency anaemia. What would you expect their serum ferritin to be?
Low
What are the signs of B12 deficiency?
Macrocytic anaemia
Neurological problems
What are the signs of haemolysis?
Normo or Macrocytic anaemia
Jaundice
Gall stones
Leg ulcers
What are the signs/symptoms of aplastic anaemia?
Pancytopenia
Increased susceptibility to infection
Increased susceptibility to bleeding/bruising
Fatigue, faintness, palpitations, headache
How is aplastic anaemia treated?
Remove causative agent
Platelet and blood transfusions
Unresponsive: immunosuppression +/- bone marrow transplant
What is the mechanism of sickle cell anaemia?
Changes in structure of alpha-haemoglobin. Faulty Hb complex. Distorted shape of RBCs when deoxygenated. Sickle RBCs are easily destroyed and occlude vessels.
How does sickle cell anaemia present?
Childhood: pain in hands and feet due to vessel occlusion.
Can lead to avascular necrosis
Anaemia: fatigue, faintness, palpitations, headache
How is sickle cell anaemia managed?
Folic acid supplementation
Pain relief
Bone marrow transplant (severe)
What causes thalassaemia?
Defective alpha or beta haemoglobin subunit.
How and when does each type of thalassaemia present?
Alpha - Neonatal
Beta - Infancy
Heterozygote can be asymptomatic
Homozygote - severe anaemia, failure to thrive, bone deformities
What is the mechanism of glucose-6-phosphate dehydrogenase deficiency?
Lack of enzyme that maintains glutathione, which protects against oxidant injury in the RBCs.
G6PD deficiency therefore = increased haemolysis
How does glucose-6-phosphate dehydrogenase deficiency present?
Neonatal jaundice
Haemolytic anaemia
Acute haemolysis
What is polycythaemia vera (pathophysiology)?
Malignant proliferation of a clone derived from one pluripotent stem cell. Excess proliferation of RBCs, WBCs and Platelets.
How is polycythaemia vera investigated
JAK2 gene mutation in 95%
High haematocrit
How does polycythaemia vera present?
Incidental finding on FBC
Hyperviscocity - headaches, dizziness, tinnitus, visual disturbance
Facial plethora
Splenomegaly
How is polycythaemia vera managed?
Low risk - Venesection
Older/high risk - hydroxycarbamide
What is the mechanism of hydroxycarbamide?
Decreases the production of DNA.
How does deep vein thrombosis present?
Can progress to PE as presentation Limb pain Tenderness Calf swelling Increase in limb temperature Pitting oedema
What are the risk factors for DVT?
Obesity Family history Male Smoking Increased age Cancer
Which score and test can be used to rule out DVT?
Well’s score
D-dimer
How is DVT managed?
Low molecular weight heparin or other anticoagulant medication
Describe immune thrombocytopenia (ITP)
Caused by antiplatelet antibodies.
May be acute or chronic
What is the course of chronic immune thrombocytopenia?
Fluctuating course of bleeding, purport, epistaxis and menorrhagia
How can immune thrombocytopenia be investigated?
Bone marrow biopsy shows increased megakaryocytes
