Haematology Flashcards by Aneesa Sheikh

What is fetal haemoglobin

2 alpha, 2 gamma subunits

Greater affinity for oxygen (bind more easily, harder to release)

Fetal haemoglobin production starts to decrease at 32-36 weeks (replaced by adult haemoglobin, all adult by 6 months)

How well did you know this?

Not at all

Perfectly

What are the causes of anaemia in infants

Physiological anaemia of infancy (normal dip in Hb around 6-9 weeks)

Anaemia of prematurity (less time to get iron from mother, inadequate RBC production, reduced EPO levels, blood tests)

Blood loss

Haemolysis (haemolytic disease of the newborn, hereditary spherocytosis)

Twin-to-twin transfusion

How well did you know this?

Not at all

Perfectly

What are the causes of anaemia in older children

Iron deficiency anaemia (dietary insufficiency)

Blood loss

Sickle cell anaemia

Thalassaemia

Leukaemia

Hereditary spherocytosis

Hereditary elliptocytosis

Sideroblastic anaemia

How well did you know this?

Not at all

Perfectly

What are the causes of microcytic anaemia

TAILS

Thalassaemia

Anaemia of chronic disease

Iron deficiency anaemia

Lead poisoning

Sideroblastic anaemia

How well did you know this?

Not at all

Perfectly

What are the causes of normocytic anaemia

3 As and 2 Hs

Acute blood loss

Anaemia of chronic disease

Aplastic anaemia

Haemolytic anaemia

Hypothyroidism

How well did you know this?

Not at all

Perfectly

What are the causes of macrocytic anaemia

Impaired DNA synthesis

B12 deficiency

Folate deficiency

Alcohol

Reticulocytosis

Hypothyroidism

Liver disease

Drugs (azathioprine)

How well did you know this?

Not at all

Perfectly

What are the symptoms of anaemia

Tiredness

Shortness of breath

Headaches

Dizziness

Palpitations

Worsening of other conditions

Pica and hair loss (with iron deficiency anaemia)

How well did you know this?

Not at all

Perfectly

What are the generic signs of anaemia

Pale skin

Conjunctival pallor

Tachycardia

Raised respiratory rate

How well did you know this?

Not at all

Perfectly

What are the signs of anaemia that are specific to iron deficiency

Koilonychia

Angular cheilitis

Atrophic glottis

Brittle hair and nails

How well did you know this?

Not at all

Perfectly

What are the investigations for anaemia

Bloods (FBC, blood film, reticulocyte count, ferritin, B12, folate, bilirubin)

Direct Coombs test

Haemoglobin electrophoresis

How well did you know this?

Not at all

Perfectly

What is the management for anaemia

Treat underlying cause

Consider blood transfusion

How well did you know this?

Not at all

Perfectly

What are the causes of iron deficiency anaemia

Dietary insufficiency

Loss (heavy menstruation)

Inadequate absorption

How well did you know this?

Not at all

Perfectly

Where is iron absorbed

Duodenum and jejunum

How well did you know this?

Not at all

Perfectly

What medication interferes with iron absorption

PPIs

How well did you know this?

Not at all

Perfectly

What is the management for iron deficiency anaemia

Treat underlying cause

Dietician input

Oral supplements

Consider blood transfusion

How well did you know this?

Not at all

Perfectly

What is leukaemia

Cancer of particular line of stem cells in bone marrow

Unregulated production of blood cells (over production of one type, other types underproduced)

Get pancytopenia (low RBCs, low WBCs, low platelets)

How well did you know this?

Not at all

Perfectly

What are the types of leukaemia that affect children

Acute lymphoblastic leukaemia (age 2-3)

Acute myeloid leukaemia (under 2s)

Chronic myeloid leukaemia

How well did you know this?

Not at all

Perfectly

What are the risk factors for leukaemia

Radiation exposure (abdominal X-ray during pregnancy)

Conditions (Down’s, Klinefelter, Noonan)

How well did you know this?

Not at all

Perfectly

How might a patient with leukaemia present

Persistent fatigue

Unexplained fever

Failure to thrive

Weight loss

Night sweats

Pallor

Petechiae and abnormal bruising

Unexplained bleeding

Abdominal pain

Generalised lymphadenopathy

Unexplained bone or joint pain

Hepatosplenomegaly

What are the investigations for leukaemia

Refer immediately if have: unexplained petechiae, hepatomegaly

Very urgent FBC (48 hours)

Blood film (shows blast cells)

Bone marrow biopsy

Lymph node biopsy

Staging (chest X-ray, CT, lumbar puncture, genetic analysis)

What is the management for leukaemia

Chemotherapy

Radiotherapy

Bone marrow transplant

Surgery

What are the complications of chemotherapy

Failure to treat

Stunted growth and development

Immunodeficiency and infection

Neurotoxicity

Infertility

Secondary malignancy

Cardiotoxicity

What is idiopathic thrombocytopenic purpura

Spontaneous low platelet count causing a non-blanching rash

A type II hypersensitivity reaction

Can be triggered by viral infections

Usually in under 10s

How might a patient with idiopathic thrombocytopenic purpura present

Rash appears over 24-48 hours

Bleeding (gums, epistaxis, menorrhagia)

Bruising

What are the investigations for idiopathic thrombocytopenic purpura

Urgent FBC (look at platelet count)

What is the management for idiopathic thrombocytopenic purpura

Usually no treatment needed Monitor until platelets return to normal If active bleeding or severe: prednisolone, IV immunoglobulins, blood transfusion, platelet transfusion Education: avoid contact sports, avoid IM injections and lumbar punctures, avoid NSAIDs/aspirin/anticoagulants

What are the complications of idiopathic thrombocytopenic purpura

Chronic idiopathic thrombocytopenic purpura Anaemia Intracranial or subarachnoid haemorrhage GI bleeding

What is sickle cell anaemia

Crescent shaped red blood cells (more fragile, easily destroyed) A form of haemolytic anaemia Prone to sickle cell crisis Abnormal variant HbS Autosomal recessive Protective against malaria

What are the investigations for sickle cell anaemia

At risk mothers offered screening during pregnancy Newborn heel prick test

What is the management for sickle cell anaemia

Avoid dehydration Avoid triggers for crisis Ensure vaccines up to date Antibiotic prophylaxis (penicillin V) Hydroxycarbamide (protects against crisis, stimulates fetal Hb production) Bone marrow transplant Blood transfusion

What are the complications of sickle cell anaemia

Anaemia Increased risk of infection Stroke Avascular necrosis of large joints Pulmonary hypertension Priapism Chronic kidney disease Sickle cell crisis Acute chest syndrome

What is the management for sickle cell crisis

Low threshold for admission Treat any infection Keep warm Keep hydrated Simple analgesia Penile aspiration for priapism

What are the types of sickle cell crisis

Vaso-occlusive Splenic sequestration Aplastic Acute chest syndrome

What is thalassaemia

Genetic defect in the protein chains that make up haemoglobin Autosomal recessive Red blood cells more fragile Get splenomegaly Bone marrow expands (susceptibility to fractures, pronounced forehead, pronounced cheekbones)

How might a patient with thalassaemia present

Fatigue Pallor Jaundice Gallstones Splenomegaly Poor growth and development Pronounced forehead and cheekbones

What are the investigations for thalassaemia

FBC Haemoglobin electrophoresis DNA testing

What is iron overload

Due to: faulty creation of RBCs, recurrent transfusions, increased iron absorption Presentation: fatigue, cirrhosis, infertility, impotence, heart failure, osteoporosis, joint pain Management: limit transfusions, iron chelation

What is the management for thalassaemia

Monitor FBC Monitor for complications Blood transfusions Splenectomy Iron chelation Bone marrow transplant

What is hereditary spherocytosis

Sphere-shaped red blood cells Fragile, easily destroyed (when passing through spleen) Autosomal dominant

How might a patient with hereditary spherocytosis present

Jaundice Anaemia Gallstones Splenomegaly Episodes of haemolytic crisis Aplastic crisis

What are the investigations for hereditary spherocytosis

Blood film (spherocytes) FBC (high reticulocytes)

What is the management for hereditary spherocytosis

Folate supplements Splenectomy Blood transfusions

What is G6PD deficiency

X-linked recessive Crisis triggered by: infection, medications (primaquine, nitrofurantoin, trimethoprim) G6PD enzyme protects cells against reactive oxygen species damage Get haemolysis of red blood cells

How might a patient with G6PD deficiency present

Neonatal jaundice Anaemia Intermittent jaundice Gallstones Splenomegaly

What are the investigations for G6PD deficiency

Blood film (heinz bodies) G6PD enzyme assay

What is the management for G6PD deficiency

Avoid triggers