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Phase II Specialties > Haematology > Flashcards

Haematology Flashcards

1
Q

Where is erythropoietin produced?

A

Kidneys

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2
Q

What is erythropoietin secreted in response to?

A

Cellular hypoxia

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3
Q

Erythropoietin secretion stimulates RBC’s production from which tissue?

A

Bone marrow

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4
Q

Explain the process of erythropoiesis (cell types in each part of the process) - 7

A

Haemocytoblast –> proerythroblast –> Early erythroblast –> late erythroblast –> normoblast –> reticulocyte –> erythrocyte

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5
Q

Erythrocytes are derived from which common progenitor?

A

Myeloid

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6
Q

As well as erythrocytes, which cell types are also derived from common myeloid progenitor cells? (3)

A

Megkaryocyte
Mast cell
Myeloblast

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7
Q

In which part of the GI tract is the majority of Iron (Fe2+) absorbed?

A

Duodenum

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8
Q

What happens to Fe2+ once it has been absorbed via the GI tract?

A

Some stored as ferritin.

Most absorbed into blood via ferroportin 1 carrier

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9
Q

Folic acid is important for synthesis of what?

A

DNA/RNA

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10
Q

What is FE2+ used for?

A

Haemoglobin production

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11
Q

What type of anaemia is caused by folic acid deficiency?

A

Megaloblastic anaemia

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12
Q

Where in the GI system is vitamin B12 absorbed?

A

Terminal ilium

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13
Q

Which enzyme is typically absorbed alongside B12?

A

Intrinsic factor

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14
Q

Vit B12 is a co-factor for synthesis of what?

A

DNA synthesis

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15
Q

What type of anaemia is caused by Vit B12 deficiency?

A

Megaloblastic anaemia

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16
Q

Small RBCs, low MCV and low staining (low Hb) indicates which type of anaemia?

A

Microcytic anaemia

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17
Q

What is the MCC of microcytic hypochromic anaemia?

A

Fe2+ deficiency

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18
Q

LCC of mircocytic hypochromic anaemia (2)

A

Thalassaemia

Anaemia of chronic disease

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19
Q

RBC are a normal size and colour but RBC is low - this may indicate which type of aneamia?

A

Normocytic normochromic

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20
Q

MCC of normocytic normochromic anaemia

A

Blood loss

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21
Q

LCC of normocytic normochromic anaemia (3)

A

Bone marrow failure
Anaemic of chronic disease
Haemolysis

22
Q

Large RBC, high MCV and normal staining (Hb) indicates which type of anaemia?

A

Macrocytic normochromic

23
Q

MCC of macrocytic normochromic anaemia (2)

A

B12/folate deficiency OR pernicious anaemia

24
Q

LCC of macrocytic normochromic anaemia (3)

A

Liver disease
Excess ETOH intake
Bone marrow failure

25
Q

(5) DD for anaemia inc. red flag diseases

A
  • IDA
  • Vit B12 deficiency anaemia
  • Folate deficiency anaemia
  • Acute GI bleed
  • Leukaemia
26
Q

(3) causes of IDA

A
  1. Inadequate intake
  2. Increased iron loss
  3. Excessive iron requirements e.g. pregnancy, growth in childhood, menstruation, lactation
27
Q

What level of Hb is considered as anaemic (IDA)

A

<130g/L

28
Q

(4) causes of inadequate iron intake

A

Coeliac disease
Gastric surgery
Pica
Achlorhydria

29
Q

(8) causes of increased iron loss

A
  1. GI bleeding from unknown lesion
  2. Haemorrhoids
  3. Salicylate ingestion
  4. Peptic ulcers
  5. Hiatus hernia
  6. Diverticulosis
  7. Neoplasm
  8. Ulcerative colitis
30
Q

MCC of IDA

A

Blood loss (usually chronic)

31
Q

Why does IDA cause fatigue and SOB?

A

Impaired Hb synthesis plus anaemia type = decreased O2 carrying capacity

32
Q

What type of anaemia is IDA?

A

Hypochromic microcytic

33
Q

Risk factors for IDA (7)

A
  • Black female
  • Pregnancy
  • Vegan diet
  • Menorrhagia
  • Coeliac disease
  • NSAID use
  • Gastrectomy
34
Q

(3) examination findings of IDA

A

Koilonychia
Glossitis
Angular stomatitis

35
Q

Investigations for IDA (and what they show)

A
  1. Bloods + blood film –> low Hb, low haematocrit, normal/elevated platelets
  2. Haematinics –> low serum Fe2, raised Fe2 carrying capacity, low transferrin saturation, low serum ferritin
36
Q

1st line Tx for IDA

A

Iron replacement PO - FERROUS FUMURATE

37
Q

Which vitamin can be supplemented to aid iron absorption?

A

Vitamin C (ascorbic acid)

38
Q

Tx for Tx if symptomatic at rest with SOB, chest pain, pre-syncope etc?

A

RBC transfusion

39
Q

Risk factors for Vit B12 anaemia (5)

A 
Increased age (>65 yrs)
Vegan/vegetarian diets 
Pregnancy
Gastric surgery
Chronic GI disease
Medications
40
Q

Which group of medications can reduce B12 breakdown from foods? (2)

A

NAIDs

Metformin

41
Q

Vitamin B12 is necessary for the metabolism of which other micronutrient?

A

Folate

42
Q

How does pernicious anaemia relate to vitamin B12 deficiency?

A

Autoimmune destruction of parietal cells –> lack of IF —> impaired B12 absorption

43
Q

Examination signs of B12 deficiency (6)

A 
Ataxia
Positive Romberg test
Pallor
Petechia
Glossitis
Cognitive impairment
44
Q

Investigations (and findings) for B12 deficiency anaemia

A

FBC –> low Hb, raised mCV
Serum B12 <148 picomoles/L
Reticulocyte count –> low
Blood smear –> hyper-segmented polymorphonucleated cells

45
Q

Management of B12 deficiency anaemia

A

Hydroxocobalamin/cyanocobalamin Injections

46
Q

Folate deficiency causes what type of anaemia?

A

Megaloblastic anaemia

47
Q

Groups of people most affected by folate deficiency

A

People in countries with folic acid fortification.

Esp. Pre-school children, pregnant women, elderly

48
Q

Risk factors for folate deficiency (5)

A 
Low folate intake
>65 yrs
Alcoholism 
Pregnancy
Drug use
49
Q

Sx of folate deficiency (5)

A 
Diarrhoea
Headache
Weight loss
Anorexia 
Fatigue
50
Q

Examination findings of folate deficiency (5)

A 
SoB
Dizziness
Tachycardia 
Tachypnoea
Signs of heart failure or chronic alcohol abuse
51
Q

1st line Tx for folic acid deficiency

A

Oral folic acid supplements (multi-vit)

52
Q

Blood investigations for folic acid deficiency (and what each one will show)

A 
FBC --> low Hb, raised MCV, raised MCH
Blood smear --> macrocytosis
Reticulocyte count --> low
Serum folate --> low
Serum LDH --> elevated

Phase II Specialties (9 decks)

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