Haematology Flashcards
what is the range for anaemia?
<130 g/L for men
<120 g/L for women
what is iron deficiency anaemia?
when body stores of iron are low leading to reduced production of RBC
what is the most common cause of anaemia?
iron deficiency anaemia
what are the 3 causes of iron deficiency aneamia?
- reduced absorption of iron: diet, malabsorption (gastrectomy, CF, coeliac, IBD), drugs e.g. tetracylcines/quinolones, PPIs
- increased utilisation of iron: pregnancy, growth spurts
- blood loss: menorrhagia, GORD, ulcers, IBD, malignancy, hookworm, NSAIDs, trauma, haematuria, nose bleeds, blood donation, haemolysis
what are the RF of iron deficiency anaemia?
pregnancy, menorrhagia, vegetarian, hookworm, haemodialysis, coeliac, gastrectomy, NSAIDs
what is the presentation of iron deficiency anaemia?
history: dyspnoea, fatigue, headache, palpitations, pale skin/conjunctiva, others = hair loss and mouth ulcers
exam: conjunctival pallor, angular chelitis, atrophic glossitis, koilonychia, dry skin and hair
SEVERE: tachycardia, murmurs, HF (oedema), cardiomegaly
what are the symptoms of the underlying disease of iron deficiency anaemia?
dysphagia: oesophageal malignancy, stricture
dyspepsia: gastric cancer, peptic ulcer disease
abdo pain: coeliac, malignancy, IBD
change in bowel habit: bowel cancer, coeliac, IBD
rectal bleeding: anal fissures, rectal cancer, haemorrhoids, IBD
weight loss: IBD, bowel cancer
what are the investigations of iron deficiency anaemia?
FBC: low Hb, low MCV, reduced MCH, reduced MCHC
ferritin: presence of low ferritin can help confirm BUT ferritin is an acute phase reactant and may appear normal/raised in acute inflammation
transferrin and total iron-binding capacity (TIBC): can be useful in context of inflammation, low transferrin sat and raised TIBC
blood film: hypochromic cells
B12 and folate checked
underlying cause = coeliac serology (tissue transglutaminase antibody), urine dipstick (haematuria), stool exam (parasites), GI endoscopy and colonoscopy (malignancy)
what is the management of iron deficiency anaemia?
underlying > referral
oral iron e.g. oral ferrous sulphate x3 months; side effects = nausea and GI
IV iron for IBD or no response to oral; side effects = arthralgia and myalgia
what are the main causes of microcytic anaemia?
TAILS:
thalassaemia: microcytic hypochromic
anaemia of chronic disease: normocytic anaemia usually but also normochromic microcytic
iron deficiency anaemia: microcytic hypochromic
lead toxicity and copper def: RARE microcytic
sideroblastic: microcytic hypochromic
what are the 4 features of multiple myeloma?
CRAB:
high calcium, renal insufficiency, anaemia and bone lesions
what is the investigation for the diagnosis of multiple myeloma?
urinary bence jones proteins
what is the typical presentation of haemochromatosis?
abnormal liver function tests, skin discolouration and hyperpigmentation, diabetes, systemic symptoms such as weakness and lethargy, arthropathy and cardiomyopathy
in men: gonadal atrophy and erectile dysfunction
what do blood tests show in haemochromatosis?
raised iron, high transferrin sats, decreased total iron-binding capacity and a raised serum ferritin level
which condition is associated with isolated thrombocytopenia and anti-platelet antibodies?
idiopathic thrombocytopenia purpura
what is thrombotic thrombocytopenic purpura and what is it a/w?
a condition a/w a low platelet count due to clotting, and therefore platelet sequestration inside small vessels of the body
a/w: haemolytic anaemia, thrombocytopenic purpura, fever, and neuro and renal abnormalities
what are schistocytes? which condition has them on blood film?
fragments of blood cells
TTP
what is the investigation of TTP and what is the 1st line treatment?
urinary B-hCG to see if pregnant as this affects management
1st line: plasma exchange with fresh frozen plasma
what is the difference between ITP and TTP on blood film?
ITP presents similar to TTP but with petechiae and bruising
ITP is a/w isolated thrombocytopenia, without anaemia or leukopenia and ITP does not cause renal failure
how do you differentiate Conn’s from Cushing’s?
Conn’s has excessive mineralcorticoid production alone giving hypertension, hypernatraemia and hypokalaemia
you would NOT expect hyperglycaemia or to have raised cortisol levels
how to differentiate between Cushing’s disease and adrenocortical tumour?
both cause Cushing’s syndrome
with a tumour, there is a negative feedback and results in a very low/undetectable ACTH
what differentiates anaemia of chronic disease from iron deficiency?
increased ferritin in anaemia of chronic disease and decreased TIBC
is TIBC increased or decreased in iron deficiency anaemia?
increased
a 23 year old man has been previously admitted for recurrent chest pain and now presents with priapism. what is most likely found upon blood film investigation?
sickle cells
