Haematology Flashcards
Main causes of macrocyclic anaemia
(MCV>100)
Liver disease
Pregnancy
Hypothyroidism
High reticulocyte count (maybe they’re just bled)
Main cause of megakoblastic anaemia (oval macrocytes)
Ineffective DNA synthesis
B12 deficiency
Folate deficiency
What does B12 deficiency lead to
Anaemia (megaloblastic)
Peripheral neuropathy
Spastic paraparesis
Dementia
Smear findings in Megaloblastic anaemia
Oval macrocytes and neutrophils with hypersegmented nucleus
Blood work In megaloblastic
Hugh LDH Chemistry – very high LDH(>1000 often 4000+) due to ineffective erythropoiesis in marrow with cell lysis
Management of B12 malabsorption
Lifelong Monthly injections with B12
Causes B12 defiency (leading to megaloblastic)
Total gastro removal
Pathology of terminal ileum (small intestine)
Non specific malabsorption in elderly (medication)
Pernicious anaemia
How long do folate stores last
4months
Causes of folate defiency
-low intake (rare with food fortification)-increased requirements (pregnancy, haemolysis)-drugs-rarely malabsorption
Management of folate deficiency
Draw blood for S –B12 and s-folate
Start treatment with B12 injections and oral folic acid
Never give folate alone –may improve anaemia even in B12 deficiency – can lead to irreversible neurological damage
Do not transfuse unless in failure –one unit with diuretic cover
Monitor for hypokalaemia
How would you confirm haemolytic anaemia
High LDL and haptoglobin, high reticulocytess
What are some of the smear findings in haemolytic anaemia
Sickle cell (small red cells without central pallor, in autohaemolytic or erythrospherocytosis)- spleen break down part of cell membrane
Spherocytes (also in
Blister cells and bite cells (G6PD deficiency)
Test for autoimmune haemolysis
Coombs
List the causes of haemolysis
Red cell abnormalities(Inherited)-Membrane Spherocytosis-Enzyme G6pd Deficiency-Hemoglobin Sickle cell disease
Causes outside the red cell (Acquired)-Autoimmune Warm antibody Cold antibody Drugs -Fragmentation Valves MAHA-Hypersplenism-Infections Malaria Clostridia-Toxins-PNH
Causes of anaemia of pure red cell aplasia in HIV
Causes in HIV-Parvovirus – do PCR-ARV’S –lamivudine, rarely emtricitabine
Tx of Idiopathic Thrombocytopenia
-steroids –dexamethasone pulses or oral prednisone
-steroid sparing agents like azathioprine
-splenectomy
-monoclonal antibodies
-thrombopoetin receptor agonists
Platelet transfusions not indicated unless life-threatening bleed
Causes of DIC
SepsisObstetric causesTraumaMaligancies
Thrombotic microangiopathy
Lack of enzyme to break down Von Wildebrand or functional
When do we not give platelets
ITP
TTP
Causes of prolonged PTT
heparinclotting factor deficienciesInhibitors of clotting factorsLupus anticoagulant
Which clotting factors affected in haemophilia A
VIII
Which clotting factor is affected in haemophilia B
IX
Causes of prolonged INR
DIC
Liver disease
Vit K deficiency
Warfarin
Poor nutrition,
prolonged antibiotics
What to give in warfarin toxicity
Vit k
What are the differentials for splenomegaly
Infections
- viral:HIV,CMV
-bacterial-TB, IE
Parasitic-malaria
Infiltration
Malignancies
Amyloidosis
Storage disease Gaucher’s
Inflammatory
SLE
RA
Congestion
Cirrhosis
Portal vein thrombosis
Causes of massive splenomegaly
Gauchers
Thallasemia
Malaria
CML
Lymphoma
Idiopathic myelofibrosis
