Haematology Flashcards
Bloods in keeping of a iron def
Low ferritin - the intracellular store (can be raised slightly after acute illness)
Low serum iron - the extra cellular stores (variable, like INR - more affective by random things
Low transferrin sat - calculated from TIBC + iron = falls in def
High transferrin - the transported, trying to transport iron
What are beans, nuts, dried foot, whole grains, fortified cereals, dark green veg good source of
Iron
Guide for iron supplement
Take on an empty stomach
Recheck in 1 month - aiming 10-20g/l
If improvement - continue, recheck Hb. Once normal = for further 3months then stop
Low - adherence check, consider referral
How is the majority of B12 absorbed
Where is folate
Through IF - then at duodenum and small bowl/ileum
Terminal ileum and liver
Macroyostisis - but 1/4 will have normal MCV
What might anaemia, gloss it is and parathesia indicate
when do you recheck levels
Tx
B12 deficiency (control normal folate prior)
10 days
LOW levels = start Tx then check anti-instructions factor
Normal but still suspicious = start Tx + check second line tests
Intrinsic factor antibodies are a food rule in test (specific) but not a rule out (sensitive - only 50% will be positive)
Non-diet (PA, coeliac, IBD) = IM hydroxococbalamin 1mg 3x a week for 2 weeks
Then 2-3monthly for life
Diet = oral supplements of BD yearly injection
Increase meat, cod, eggs, milk, diary
Reflect FBC in 2 weeks, b12 6 months
Different cause of high MCV
Alcohol, liver disease, methotrexate, azothiprine, pregnancy (hence normal MCV in iron def)
What are asparagus, broccoli, brown rices, sprouts, chickpeas good source of
Duration of tx
Some drugs causes
Folic acid
5mg for 4 months
Trimethoprim, alcohol ,anticovulsatns, methotrexate
What parts of the FBC might indicate malignancy
MCV +/- low Hb - colorectal, lung ca
Thrombocytosis (platete >400) - LEGO-C - lung, endometrial, gastric, oesophageal, colorectal
Causes of thrombocytosis
Iron deficiency, infection (bacterial), rheumatoid, surgery/trauma, hyposlenism, splenectomy
Myeloproliferative neoplasms (essential thrombocythaemia, PCV,
LEGO-C
Causes of low platelets
Reduction production = BM failure, megblastic anaemia (myelodysplasic syndrome), alcohol
Reduce survival = preg, ITP, viral, DIP, TTP, hyper splenic
Heparin
Omeprazole, Fursomide, quinine, trimethorprim
> 60yr + persistent bone pain (particularly back pain) or unexplained fracture or hypercalcaemia or leucopenia
> 60y with renal dysfunction and anaemia
Consider myeloma screen
What are some of the complications of myeloma
Complications are consequent to paraproteinaemia: kidney failure, peripheral neuropathy, hyper-viscosity leading to thromboembolism, cognitive problems
What is the paraprotien cut of for urgent Is fro myeloma
> 30
Rate of conversion myeloma from MGUS
1%
Treatment course for B12 def
- when repeat FBC
- different between diet and non-diet related
- what if neuro symptoms
1mg IM three times a week for 2 weeks
Then 1mg every 2-3months
Repeat FBC on day 10
Maintenance treatment with hydroxocobalamin 1 mg intramuscularly every 3 months for life — where B12 deficiency is not thought to be diet related.
Maintenance treatment with oral cyanocobalamin tablets or a twice-yearly hydroxocobalamin 1 mg injection — where vitamin B12 deficiency is thought to be diet related.
neuro sym = urgent haem
Warfarin reversal
- INR 6, with minor bleed ?
Stop, give IV warfarin, restart when warfarin less than 5
osmotic fragility test is useful for diagnosis of?
The hereditary spherocytic hemolytic anemia.
Spherocytes are osmotically fragile cells that rupture more easily in a hypotonic solution than do normal RBCs
what are some causes of folate deficiency
6 drugs
Drugs — alcohol, anticonvulsants, nitrofurantoin, sulfasalazine, methotrexate, trimethoprim.
Excessive requirements in pregnancy, malignancy, blood disorders, or malabsorption.
Excessive urinary excretion.
Liver disease
what are the rules for Hb and reticuloytes monitoring in folate and b12 def
- Perform a full blood count and reticulocyte count:
Within 7–10 days of starting treatment.
A rise in the haemoglobin level and an increase in the reticulocyte count to above the normal range indicates that treatment is having a positive effect.
If there is no improvement, check serum folate level (if this has not been done already). - After 8 weeks of treatment, and also measure iron and folate levels.
The mean cell volume (MCV) should have normalised. - On completion of folic acid treatment to confirm a response. (3month)
No need yearly check unless symptoms
