Haematology Flashcards by Elizabeth Burley

What are the hallmark signs and symptoms of megaloblastic anaemia?

Fatigue
Dizziness
SOB
Loss of appetite
Weight loss

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What are the signs and symptoms of pancytopaenia?

Painful swallowing
Glossitis
Petechiae
Angular stomatitis

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What is pancytopaenia?

Reduction in red and white blood cells as well as platelets

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What are the signs and symptoms of haemolytic anaemia?

Pallor
Jaundice
Systolic murmur
Hepatospenomegaly

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What is the normal Hb level for women?

115-165 g/L

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What is the normal Hb level for men?

130-180 g/L

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What is the MCV in micro-, normo- and macrocytic anaemia?

Micro = <80
Normo = 80-100
Macro = >100

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Brief pathophysiology behind microcytic anaemia:

As there is a lack of Hb, an extra division of RBCs occurs to maintain adequate Hb concentration. This results in smaller and paler RBCs.

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Types of microcytic anaemia:

Iron deficiency anaemia
Sideroblastic anaemia
Thalassaemia

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What anaemia causes pica (strange cravings for non-food substances e.g. ice, soil or clay)?

Iron deficiency anaemia

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What anaemia shows the following on investigation?

MCV = <80
MCH = low
MCHC = low
Serum iron = low
Ferritin = low
Total iron-binding capacity = high

Iron deficiency anaemia

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Red flag signs and symptoms of iron deficiency anaemia:

Pica
Nail changes (e.g. koilonychia)
Atrophic glossitis
Angular stomatitis/cheilosis

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What type of anaemia shows small (microcytic), pale (hypochromic) red cells with variation in shape and size and pencil cells on peripheral blood smear?

Iron deficiency anaemia

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Treatment for iron deficiency anaemia:

Oral iron replacement
IV iron replacement
Red cell transfusion

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General symptoms of anaemia:

Fatigue
Dyspnoea
Faint/dizziness
Palpitations
Headache
Tinnitus
Anorexia
Angina (if pre-existing coronary artery disease)

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General signs of anaemia:

Pallor

Signs of severe anaemia (<80g/L Hb)?

Tachycardia
Heart murmurs
Cardiac enlargement
Retinal haemorrhages
Heart failure

Red flag for thalassaemia:

From Middle/Far East/South Asia or Africa
Abdominal distension
Spinal changes
Low height and weight
Large head
Hepatosplenomegaly
Jaundice
Chipmunk faces
Misaligned teeth

What anaemia shows the following on investigation?

MCV = <80
MCH = low
MCHC = normal
Serum iron = normal
Ferritin = normal

Thalassaemia

What type of anaemia shows microcytic red cells, tear drop cells, target cells (Mexican hat cells), some fragments and large number of nucleated red cells on a peripheral blood smear?

Thalassaemia

Management of Thalassaemia:

Depending on severity of disease, blood transfusions +/- chelation to prevent iron overload

What is the only cure for thalassaemia?

Allogenic haematopoietic stem cell transplant

Brief pathophysiology of sideroblastic anaemia:

Iron is stuck waiting in the body because the lack of protoporphyrin prevents the formation of haem. This results in iron building up in mitochondria, creating the pathognomonic ringed sideroblasts and anaemia

What anaemia shows the following on investigation?

MCV = <80
MCH = low
MCHC = low
Serum iron = high
Ferritin = high
Transferrin saturation = high
Total iron-binding capacity = normal to low

Sideroblastic anaemia

Causes of normocytic anaemia:

- Acute blood loss - Anaemia of chronic disease - Bone marrow failure (with low WCC +/- platelets) - Renal failure - Hypothyroidism - Haemolysis - Pregnancy

Types of megaloblastic anaemia:

- B12 deficiency - Folate deficiency - Non-megaloblastic macrocytic anaemia

What anaemia shows the following on investigation? MCV = >100 MCH = high Reticulocyte count = low

Folate deficiency or B12 deficiency

When is folinic acid used?

When patients are taking medications that inhibit dihydrofolate reductase (e.g. methotrexate) to prevent folate deficiency anaemia

What type of anaemia shows macrocytosis, hypersegmented neutrophils and anisocytosis (RBCs uneven in size) on a peripheral blood smear?

Folate deficiency anaemia

What type of anaemia commonly presents with neurological symptoms?

B12 deficiency

What neurological problems are commonly seen in B12 deficiency?

Symmetric paraesthesia or numbness and gait problems

What type of anaemia shows megalocytes and hypersegmented polymorphonucleated cells on peripheral blood smear?

B12 deficiency

Treatment for B12 deficiency:

Cyanocobalamin or hydroxocobalamin

What is pernicious anaemia?

An autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

Brief pathophysiology of disseminated intravascular coagulation (DIC):

Activation of coagulation pathways results in formation of intravascular thrombi and depletion of platelets and coagulation factors.

What is required in order for disseminated intravascular coagulation (DIC) to be considered?

A severe underlying disorder (can be anything)

Signs and symptoms of disseminated intravascular coagulation (DIC):

- Oliguria - Hypotension - Tachycardia - Gangrene - Purpura fulminans (rash) - Acrocyanosis (blue extremities) - Delirium/coma - Bleeding at at least 3 unrelated sites

What condition do the following investigations strongly indicate? Platelet count = low Prothrombin time (PT) = prolonged Fibrinogen = decreased D-dimer = elevated aPTT = prolonged

Disseminated intravascular coagulation (DIC)

Treatment for acute disseminated intravascular coagulation (DIC):

1st = treat underlying cause 2nd = platelet transfusion (if <20 x 10⁹/L) or <50 x 10⁹/L with active bleeding) 3rd = fresh frozen plasma to replace coagulation factors and inhibitors