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DTM&H > Haematology > Flashcards

Haematology Flashcards

1
Q

What are the three most common causes of anaemia globally?

A

IDA
Vitamin A deficiency
Beta-Thalassaemia

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2
Q

How is anaemia diagnosed?

A

FBC
Haemo-cue
Hb Colour Scale
Blood Film

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3
Q

How much of the global population is affected by IDA?

A

20-50%
Probably 40-45% in LMICs
3rd leading cause of morbidity in pregnancy

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4
Q

What are the most common cause of IDA in LMICs?

A

Bacteraemia
Marlaria
Hookworm infectoin
HIV
G6PD
Vit A/B12 deficiency

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5
Q

What are classic clinical symptoms of IDA?

A

Koilonychia
Angular Stomatitis
Pale

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6
Q

How much of dietary iron can be absorbed in the gut each day?

A

3.5mg/day

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7
Q

How soon should Hb improve after Iron supplementation

A

0.5-1g/dL per week

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8
Q

How is IDA diagnosed?

A
  1. Blood Film: Hypochromic, microcytic, pencil cells (same picture as thalassaemia)
  2. FBC: Anaemia, low MCV, low MCH
  3. Fe in Bone Marrow aspirates
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9
Q

How is IDA managed?

A

Ferrous Sulphat 200mg TDS

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10
Q

What are the main risk factors for folate deficiency

A

Poor diet
ETOH abuse
Chronic Haemolytic anaemias

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11
Q

What are the clinical symptoms of folate deficiency?

A

Anorexia
Altered bowel habit
Glossitis

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12
Q

What does a blood film show in folate deficiency

A

Hypersegmented neutrophils, macrocytic

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13
Q

How do you managed folate deficiency?

A

5mg folic acid daily for at least 3/12

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14
Q

What autoimmune condition causes b12 deficiency

A

Pernicious Anaemia

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15
Q

What are neurological symptoms of B12 deficiency?

A

Posterolateral column degeneration
Low mood
Poor memory and cognition
Peripheral neuropathy
Optic nerve atrophy

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16
Q

How is B12 deficiency managed?

A

Hydroxycobalamin injections
1mg monthly

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17
Q

What are the three most common haemolytic anaemias?

A
  1. SCD
  2. G6PD deficiency
  3. Thalassaemia
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18
Q

What are the three cardinal signs/symptoms of of haemolytic anaemia?

A

Jaundice
Anaemia
Dark ‘coca cola’ urine

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19
Q

What are the lab findings in haemolytic anaemia?

A

Low Haemoglobin
high unconjugated bilirubin
Polychromasia

20
Q

What is the epidemiology of Sickle Cell Disease?

A

Follows area with high malaria transmission
Greatest burden in:
- Nigeria
- Ghana
- Central Africa
- Saudi Arabia
- India

21
Q

What is the pathophysiology of SCD?

A

B-globulin mutation –> destruction of the structure of RBCs, making them prone to destruction in times of altered O2 tension

RBCs become rigid and ‘sickled’ and cannot fit through normal blood vessels. This leads to an accumulation of cells within blood vessels, creates microthrombi etc.

There is also chronic haemolysis of the sickled RBCs

22
Q

What is the genetic cause of SCD?

A

Autosomal Recessive
HbSS

23
Q

What is the presentation of SCD?

A

Haemolytic Anaemia
BM expansion –> frontal bossing and maxillary enlargement
Stunting
Dactylitis

24
Q

What are the complications of SCD?

A

Splenic Sequestrtion
Aplastic Crises
Stroke
Acute Chest Syndrome of SCD
osteomyeltis
Infection/Sepsis
Pain Crisis

25
Q

How is SCD diagnosed?

A
  1. Neonatal screening (has reduced child mortality by 95%)
  2. FHx
  3. Blood Film –> sickled cells (Up to 80% will be sickled in HbSS)
  4. Hb Electrophoresis
  5. Sickle solubility test
  6. Genetic testing
26
Q

How do you generally manage SCD?

A
  1. Folic acid supplementation
  2. Regular penicillin-based prophylactic antibiotics (at risk of encapsulated bacterial invasion)
  3. Hydroxycarbamine
27
Q

What are 5 common encapsulated bacteria implicated in SCD infections?

A

Streptococcus pneumoniae
Klebsiella
Haemophilus influenzae
Neisseria meningitidis
Pseudomonas aeruginosa

28
Q

How does hydroxycarbamine aide in preventing complications of SCD?

A

Increased the production of HbF (which can replace HbS)

29
Q

What vaccinations should be given to patients with SCD?

A
  • Pneumococcal
    -HiB
  • Meningococcal
  • Influenza
30
Q

Who should be offered splenectomy in SCD?

A

Offer in patients with multiple episodes of Splenic sequestration before the age of 5

31
Q

What is Beta Thalassaemia?

A

Haemolytic Anaemia caused by a reduction in Beta Globulin

32
Q

What are the three types of Beta Thalassaemia?

A
  1. B Thal. Trait –> clincially well, with normal Hb in physiological steady states
  2. B Thal intermedia –> generally stable, but chronically low Hb of 70-80, which may require occasional Blood transfusions
  3. B Thal Major –> Significantly dysmorphic cells, with Hb of 20-30 without regular blood transfusions
33
Q

What is the epidemiology of Beta Thalassaemia?

A
  • Most common haemolytic anaemia
  • Mediterranean Basis, South East Asia
34
Q

What is the presentation of Beta Thal?

A

Haemolytic anaemia
Frontal bossing, maxillary widening
Hepato-splenomegaly

35
Q

How is Beta Thal diagnosed on blood film?

A
  1. Hypochromic, microcytic RBCs, Target cells, polychromatic RBCs
36
Q

How is beta thal managed?

A

Regular blood transfusions
Iron chelation

37
Q

What are the two drugs that can be used in iron chelation?

A
  1. IV desferrioxamine (expensive)
  2. PO deferiprone
38
Q

What is G6PD?

A

A compound in RBCs which prevents them from haemolysing prematurely in the presence of oxidative stress

39
Q

What is G6PD deficiency?

A

An inherited condition in which there is not enough G6PD in RBCs, leading to haemolytic anaemia from red cell oxidation

40
Q

How is G6PD genetically passed on?

A

X-linked

41
Q

Where is G6PD deficiency most common?

A

Mediterranean Basin
African continent

42
Q

What is the presentation of G6PD Deficiency?

A

Neonatal jaundice ± kernicterus

43
Q

What drugs can percipitate haemolysis in G6PD-D?

A

Aspirin
Primaquine
Dapsone
Sulfonamides
Nitrofurantoin

44
Q

What does a blood film look like in G6PD?

A

Bite Cells
Helmet Cells

45
Q

How is G6PD-D diagnosed?

A
  1. Blood Film
  2. Methaemoglobin reduction test
  3. Enzyme assay –> should be done 6-8 weeks after haemolytic episode
46
Q

How is G6PD-D managed?

A

Usually self limiting
± transfusion
± renal support

47
Q

What does a blood film in IDA look like?

A

Blood Film: Hypochromic, microcytic, pencil cells (same picture as thalassaemia)

DTM&H (29 decks)

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