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Haematology Flashcards

1
Q

What does bone marrow require iron to produce?

A

Haemoglobin

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2
Q

What are the causes of iron deficiency?

A

Insufficient dietary iron
Iron requirements increase e.g. pregnancy
Bleeding - menorrhagia, GI cancer, gastritis, IBD
Inadequate absorption
Hookworm

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3
Q

Where is iron absorbed in the small intestine?

A

Duodenum and jejunum

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4
Q

Which carrier protein carries iron?

A

Transferrin

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5
Q

Total iron binding capacity (TIBC) means the total space on the transferrin molecules for the iron to bind. How would you calculate transferrin saturation?

A

Transferrin Saturation = Serum Iron / Total Iron Binding Capacity

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6
Q

What form does iron take when it is stored in cells?

A

Ferritin

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7
Q

What is suggestive of a high ferritin level?

A

Inflammation
Infection
Cancer

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8
Q

What happens to TIBC and transferrin levels in iron deficiency anaemia?

A

Levels increase

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9
Q

What is the normal range of serum ferritin?

A

41-400 ug/L

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10
Q

What is the normal range of serum iron?

A

12-30 umol/L

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11
Q

Which events can increase serum iron levels?

A

Iron supplementation

Acute liver damage

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12
Q

What are the signs and symptoms of iron deficiency anaemia?

A 
Kolionychia 
Glossitis 
Pallor
Angular stomatitis 
Tachycardia

Symptoms:
Fatigue 
Breathlessness 
Dizziness 
Headache
Palpitations
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13
Q

How would iron deficiency anaemia appear on a blood film?

A

Microcytic (MCV <80) hypochromic RBCs

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14
Q

How would you manage iron deficiency anaemia?

A

Oral ferrous sulfate
Iron infusion
Blood transfusion

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15
Q

What are the side effects of oral ferrous sulphate?

A

Constipation

Black coloured stools

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16
Q

Name some causes of microcytic anaemia.

A 
TAILS
T - thalassaemia
A - anaemia of chronic disease
I - iron deficiency anaemia 
L - lead poisoning 
S - sideroblastic anaemia
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17
Q

Name some causes of normocytic anaemia.

A 
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
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18
Q

What are the two broad types of macrocytic anaemia?

A

Megaloblastic - impaired DNA synthesis

Normoblastic

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19
Q

Name some causes of megaloblastic macrocytic anaemia.

A

B12 deficiency

Folate deficiency

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20
Q

Name some causes of normoblastic macrocytic anaemia.

A

Alcohol
Reticulocytosis
Hypothyroidism
Liver disease

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21
Q

Name some causes of anaemia of chronic disease.

A 
Chronic infection
Vasculitis 
RA
Malignancy
Renal failure
22
Q

How can you manage anaemia of chronic disease?

A

Treat underlying cause
Epo to raise Hb levels
Hepcidin inhibitors

23
Q

What are the causes of folate deficiency?

A 
Poor dietary intake 
Increased demand e.g. pregnancy 
Increased cell turnover e.g. malignancy, haemolysis
Coeliac disease
Alcohol excess
24
Q

Why is B12 and folate needed to make RBCs?

A

B12 and folate is needed for DNA synthesis. Without this, the RBCs cannot make enough DNA to divide and become arrested in development

25
What does maternal folate deficiency lead to in the foetus?
Neural tube defects
26
How would you manage folate deficiency?
Oral folic acid 5mg daily
27
Outline the pathophysiology of pernicious anaemia.
Autoimmune condition where antibodies form against the parietal cells in the stomach. These cells can therefore not produce intrinsic factor which is needed for the absorption of vitamin B12
28
Where is vitamin B12 absorbed?
Ileum
29
What are the signs of pernicious anaemia?
``` Mood changes: depression, irritability Paraesthesiae Peripheral neuropathy Loss of vibration sense Psychosis ```
30
How would an FBC appear for pernicious anaemia?
Very low Hb Very high MCV Low WCC and platelets
31
What is the gold standard test for diagnosing pernicious anaemia?
IF auto-antibodies | Gastric parietal cell auto-antibodies
32
How would you manage pernicious anaemia?
Oral B12 in dietary deficiency = Cyanocobalamin IM hydroxycobalamin in pernicious anaemia
33
If there is also folate deficiency it is important to treat the B12 deficiency first before correcting the folate deficiency. Treating patients with folic acid when they have a B12 deficiency can lead to what?
Subacute combined degeneration of the cord
34
Name the two cell lines in leukaemia
Myeloid | Lymphoid
35
In leukaemia, there is excessive production of a single type of cell, which can lead to suppression of the other cell lines causing underproduction of other cell types. What will this show on a FBC?
Pancytopenia: anaemia, leukopenia and thrombocytopenia
36
Which age does ALL present in?
Under 5 and over 45
37
Which age does CLL present in?
Over 55
38
Which age does CML present in?
Over 65
39
Which age does AML present in?
Over 75
40
What are the signs of leukaemia?
``` Fatigue Weight loss Fever Failure to thrive Pallor Petechiae Abnormal bruising Abnormal bleeding Lymphadenopathy Hepatosplenomegaly ```
41
Petechiae causes thrombocytopenia. What are the differential causes of petechiae?
``` Leukaemia Meningococcal septicaemia Vasculitis HSP ITP Non-accidental injury ```
42
What investigations would you do if you suspect leukaemia?
``` FBC, blood film LDH = lactate dehydrogenase Bone marrow biopsy - gold standard Lymph node biopsy Lumbar puncture CT ```
43
What chromosome is associated with ALL and CML?
Philadelphia chromosome (t(9:22) translocation)
44
What condition is associated with ALL?
Down's syndrome
45
Which cell proliferation is associated with ALL and CLL?
B-lymphocytes
46
Which disease can CLL develop into?
High grade lymphoma = Richter's transformation
47
What are the three phases of CML?
Chronic phase - asymptomatic Accelerated phase Blast phase
48
What characteristic feature do blast cells in AML have?
Auer rods
49
How would you manage leukaemia?
Chemotherapy Steroids Radiotherapy Bone marrow transplant
50
What are the complications of chemo?
Stunted growth and development Infections Infertility Tumour lysis syndrome
51
In tumour lysis syndrome, cells release a substance - what is this?
Uric acid

3a (13 decks)

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