Haematology Flashcards
How are haemophilia A and B inherited?
Sex linked recessive
What are the hallmarks of haemophilia?
Haemorrhage into joints
Bleeding with tooth extraction
Skin bruising
What are the blood laboratory findings in haemophilia?
Normal prothrombin time
Normal bleeding time
Normal fibrinogen level
Prolongation of the partial thromboplastin time
What factors are deficient in haemophilia A and B?
Haemophilia A - Factor VIII
Haemophilia B - factor IX - Christmas disease
What is multiple myeloma?
Bone marrow cancer affecting plasma cells, collections of abnormal plasma cells accumulate and interfere with production of other blood cells
Increased amounts of amyloid light chain can get deposited in multiple organs including the carpal tunnel
CRAB: elevated calcium, renal failure, anaemia, bone lesions
What are symptoms of anaemia?
Tiredness Fatigue Shortness of breath on exertion Angina Syncope or pre-syncope Failure to thrive in children
What are signs of anaemia?
Conjunctival pallor Tachycardia Postural hypotension Oedema/Heart failure Koilonychia Leuconychia Glossitis Angular chelitis
What are the main causes for anaemia?
Increased usage: Bleeding, Haemolysis
Decreased production: Iron/B12/folate deficiency, Renal failure (EPO), Haematological malignancies, Bone marrow failure syndromes
Anaemia of Chronic Disease: decreased iron utilisation
What questions are important in a history for a presentation of anaemia?
Diet: veganism, phytates, alcohol
Bowels: Malabsorption, changing habit, blood, pain
Menses and multiparity: menorrhagia
Family history: bowel Ca, ethnicity (sickle/thal)
Drugs: Antiplatelets/anticoagulants, PPI
Past medical history: Renal disease, chronic diseases
Systematic review: Features of malignancy (weight loss), Inflammatory disease processes (fevers, joint pains, rashes), Haemolytic features (dark urine, jaundice)
What clinical signs would you look for on examination of a patient presenting with anaemia?
Signs of malignancy: Cachexia, lymphadenopathy, masses
Signs of inflammatory diseases: Fevers, joint swelling, rashes
Signs of chronic infection: Such as ulcers, bronchiectasis, deep infections
Signs of heart failure: oedema, SOB, PND, arrhythmia, reduced exercise tolerance, pink sputum
Signs of liver disease: caput medusa, spider naevi, ascites, jaundice
Haemtological features: Hepatosplenomegaly
What are some causes of iron deficiency?
Blood loss: Menstrual, Multiparity, GI
Poor diet
Malabsorption: Diarrhoea, Gastrointestinal symptoms
What investigations would you do for iron deficiency anaemia?
FBC, MCV, MCH: microcytic, hypochromic Ferritin Serum Iron Transferrin Saturations Coeliac serology (anti-TTG antibodies and IgA) Upper and Lower GI endoscopy
In which patients might you find folic acid deficiency anaemia?
Hospital inpatients
Haemolytic states
Malabsorption, especially if combined deficiencies
What is b12 deficiency associated with?
Peripheral neuropathy and subacute combined degeneration of spinal cord
How is b12 absorbed? What clinical relevance does this have?
Bound to intrinsic factor in the terminal ileum
Malabsorptive states lead to deficiency
Intrinsic factor from stomach so gastrectomy can affect this
What investigations would you do to check a patient who has suspected b12 or folate deficiency?
Check serum B12 and serum folate
Coeliac screening
Intrinsic factor antibodies
What are causes of microcytic anaemia?
Iron deficiency
Late Anaemia of Chronic Disease
Haemoglobinopathies
What are causes of normocytic anaemia?
Bleeding
Haemolysis
ACD
Drugs
What are causes of a macrocytic anaemia?
B12/folate deficiency Hypothyroidism Paraprotein (multiple myeloma) Alcohol Drugs Haemolysis