Haematology Flashcards
Why can PPIs reduce iron absorbtion
Need acid to keep iron in soluble fe2+ form
4 Main causes of iron deficiency
Blood loss, Dietary insufficiency, poor absorption, pregnancy (requirements)
Microcytic anaemia causes
T - Thalassaemia
A - Anaemia of chronic disease
I - Iron deficiency
L - Lead poisoning
S - Sideroblastic anaemia
Causes of normocytic anaemia
3 As, 2 Hs
A - Acute blood loss
A - Anaemia of chronic disease
A - Aplastic anaemia
H - Haemolytic anaemia
H - Hypothyroidism
Causes of Macrocytic anaemia (megaloblastic)
B12 deficiency
Folate deficiency
Causes of macrocytic anaemia (normoblastic)
Alcohol
Reticulocytosis
Hypothyroid
Liver disease
Drugs (e.g. azathioprine)
First line mx for iron deficiency anaemia
- Correct cause
Then depending on severity either:
- Blood transfusion (corrects anaemia not deficiency)
- Oral ferrous sulfate tablets.
Name 5 Inherited Haemolytic anaemias (HHTSG)
Hereditary Spherocytosis
Hereditary Elliptocytosis
Thalassaemia
Sickle cell anaemia
G6PD deficiency
5 Acquired haemolytic anaemias (AAPMP)
Autoimmune haemolytic anaemia
Alloimmune haemolytic anaemia (tranfusion reactions + rhesus shenanigans)
Paroxysmal nocturnal haemoglobinuria
Microangiopathic Haemolytic anaemia
Prosthetic valve related haemolysis
Features of haemolytic anaemia
Anaemia
Splenomegaly (full of dead blood cells)
Jaundice (loads of bilirubin)
Investigations for haemolytic anaemia
FBC
Blood film
Direct coombs test
Describe hereditary spherocytosis + classic presentation
Sphere shaped RBCs that are easily destroyed, presents with jaundice, gallstones, splenomegaly & aplastic crisis (parvovirus)
Management of hereditary spherocytosis
Folate supplementation + splenectomy
Describe hereditary elliptocytosis
Same as spherocytosis but instead of sphere shaped RBCs are ellipse shaped
Commonest leukaemia in kids
ALL
Blood film for ALL + associated disease
Circulating lymphoblasts with little cytoplasm, associated with Down syndrome.
Good prognosis
Commonest leukaemia in adults
AML + CLL
Blood film of AML + associated disease
Auer rods in cytoplasm
Commonly transforms from other disorders e.g. myelofibrosis + polycythaemia)
Complications of AML
Leukostasis & Tumour lysis syndrome
Commonest leukaemia in adults
CLL
Blood film CLL
Smear/smudge cells, richters transformation
Rarest leukaemia
CML
Blood film of CML
Eoisinophilia, basophilia, immature granulocytes
Chromosome commonly present in CML
Philadelphia chromosome
Lymphoma presentaion
Fatigue, pruittus, non tender lymphadenopathy, cough, SOB, recurrent infections.
Hodgkins lymphoma cell finding
Reed sternberg cells (Googly eyes)
Hodgkins vs non-hodgkins
Hodgkins have better prognosis however less common.
Non-hodgkins lymphoma risk factors
EBV, HIV, H. Pylori.
What is myeloma
Cancer of plasma cells
Myeloma on blood film
Rouleax formation, RBCs stick together
Diagnosis of myeloma
Inc plasma cells on biopsy, monoclonal paraprotein, evidence of end organ damage
Calcium
Renal failure
Anaemia
Bone pain & lesions
Most common monoclonal paraprotein in myeloma
IgG
Thrombotic inherited clotting disorder
(most common clotting disorder)
Factor V leiden
Factor V cant be broken down by APC
More clotty
Acquired thrombotic clotting disorder
Antiphospholipid syndrome
C coagulation defect
L Livedo reticularis (mottled skin)
O obstetric complications
T Thrombocytopenia
Test for antiphospholipid syndrome
Anticardiolipin antibodies
Haemorrhagic inherited clotting disorder
Von willebrand disease (dont treat)
Haemophilias (x-linked recessive) most pts boys
A - factor 8
B - factor 9
Haemorrhagic acquired clotting disorder
Liver disease (less clotting factors produced)
DIC (sepsis, trauma, pregnancy all causes)
use up clotting factors so give heparin + consider platelets
What clotting disorder associated with SLE
Antiphospholipid syndrome
Reactions to transfusion
Febrile non-haemolytic, TACO, TRALI
What is TACO
Transfuision associated circulatory overload
Acute LVF too much fluid or given too quickly.
Mx, diuretics, oxygen, STOP
What is TRALI
transfusion related acute lung injury
Within 6 hrs of transfusion
ARDS, cough, SOB, Batwing on CXR
Mx, stop transfusion, senior help, supportive
Inheritance pattern of thalassaemia
Autosomal recessive
What is sickle cell disease
RBCs normal until they are stressed (hypoxia, infection, cold etc) then will transform to sickle shape.
Sickle cell prevents what
Malaria, therefore selective pressure for sickle cell
Complicatipns of sickle cell
Vaso-occlusive crisis, can block microcirculation anywhere => pain and ischaemia.
Aplastic crisis, temporary cessation of erythropoeisis
Sequestration crisis, sudden splenomegaly due to haemorrhage within it
Mx of sickle cell
Preventative
Prevent triggers
Prevent infection etc
