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Medicine > Haematology > Flashcards

Haematology Flashcards

1
Q

What is aplastic anaemia?

A

Characterised by diminished haematopoietic precursors in bone marrow and a deficiency of all blood cell elements (Pancytopenia)

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2
Q

What are the causes of aplastic anaemia?

A

Idiopathic (40%)

Drugs:
GCS ma nigga
Gold, Chloramphenicol, Sulphonamides, Methotrexate, Nifedipine

Radiation

Viruses:
Parvovirus, HIV, EBV, Hep B and C

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3
Q

What are the symptoms and signs of aplastic anaemia?

A

Anaemia:
Lethargy, Tiredness, Dyspnoea
Pallor

Thrombocytopenia:
Easy bruising, Epistaxis, Bleeding gums
Petechiae

Leukopenia:
Recurrent Infections (severe)
Signs of infection

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4
Q

What are the investigations for aplastic anaemia?

A

Bloods:
FBC - Normocytic anaemia, thrombocytopenia, leukopenia, low or absent reticulocytes

Bone marrow biopsy:
Hypocellular marrow
Increased fat/adipose cells

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5
Q

What is the management of aplastic anaemia?

A

Stop any causative drugs

Supportive:
Blood/platelet transfusions
Antibiotics for infections

Haematopoietic stem cell transplantation

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6
Q

What are the differential diagnoses for aplastic anaemia?

A

Myeolodysplastic syndrome

Paroxysmal nocturnal haemoglobinuria

ALL/AML

(Other causes of pancytopenia eg sepsis and infection)

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7
Q

What is haemolytic anaemia?

A

Characterised by premature destruction of red blood cells causing a shortened life span
(Less than 120 days) and anaemia.

Haemolytic anaemia in general occurs due to a problem with the RBCs, which causes them to haemolyse and be removed from the circulation quicker than normal. This problem with the RBCs can be:

  1. Intrinsic (Defect within RBCs)
  2. Extrinsic (Something effects RBCs from outside)
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8
Q

What are the intrinsic causes of haemolytic anaemia?

A

3 main intrinsic causes - all end in opathies

  1. Haemoglobinopathies
    • Sickle cell anaemia
    • Thalassemia
    Misformed haemoglobin causes premature destruction
  2. Membranopathies
    • Hereditary spherocytosis (spherical RBCs)
    • Hereditary eliptocytosis
    Membrane of RBC is malformed which prevents the normal biconcave shape to form - Resultant RBCs more prone to haemolysis
  3. Enzymopathies
    • G6PD deficiency
    • Pyruvate kinase deficiencies
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9
Q

What are the extrinsic causes of haemolytic anaemia?

A

With extrinsic causes, the RBCs are normal and fully functional, but something extrinsic causes damage to them and hence their premature destruction.

  1. Autoimmune haemolytic anaemia
    • Immune system responds to antigens on the surface of the red blood cells —> Premature destruction.

Can be warm or cold

Warm = Usually associated with lymphoma/CLL or autoimmune conditions (SLE, RA, IBD)

Cold = Can be caused by infection - Mycoplasma, EBV, syphilis
• Precipitated by reduced body temperature.

  • Both are Coombs test positive
  1. Microangiopathic haemolytic anaemia
    - Abnormal clotting occurs in small blood vessels of body. As red blood cells come through, they hit along these clots and they shear and break up. This forms fragments of cells called schistocytes (Triangular)
    • Clotting can be caused by TTP or DIC
  2. Infection
    • Malaria, Sepsis.
  3. Isoimmune
    • Blood transfusion
    • Haemolytic Disease of newborn (Rhesus)
  4. Paroxysmal nocturnal haemoglobinuria
  5. Drugs eg penicillin, quinine
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10
Q

What are the symptoms and signs of haemolytic anaemia?

A

Fatigue, Tiredness, Dyspnoea

Jaundice, Icterus, Pruritus

Constitutional symptoms (Fever, Malaise)

Splenomegaly

Pallor

Gallstones

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11
Q

What are the investigations for haemolytic anaemia?

A

Bloods

FBC:

  • Low Hb
  • Normal MCV
  • Decreased haptoglobin
  • Increased LDH
  • Increased reticulocytes
  • Increased bilirubin

Urinalysis - May show haemoglobinuria

Direct Coombs test - identifies RBCs coated with antibodies using antihuman globulin.
• Cold and warm autoimmune haemolytic anaemia
• Drug induced haemolytic anaemia

Osmotic fragility test - To identify membrane abnormalities

Acidified serum lysis (Ham test) - Lysis of RBCs in acidified serum in PNH

Bone marrow biopsy - Erythroid hyperplasia

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12
Q

How do you manage autoimmune haemolytic anaemia?

A

Warm AHA

Folate supplementation
Steroids - Prednisolone
Splenectomy

Cold AHA
Avoid cold exposure
Folate supplementation
Rituximab

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13
Q

How do you manage Hereditary spherocytosis?

A

Folate replacement

Splenectomy

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14
Q

What is a macrocytic anaemia?

A

Anaemia associated with a high MCV of RBCs (>100fl)

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15
Q

What are the causes of macrocytic anaemia?

A

Megaloblastic:

Vitamin B12 deficiency
• Decreased absorption (Gastrectomy, pernicious anaemia, terminal ileal resection)
• Decreased intake (Vegans)

Folate deficiency
• Alcoholics, malnourished

Non megaloblastic:

  • Alcohol
  • Liver Disease
  • Hypothyroidism
  • Pregnancy
  • Myelodysplasia
  • Reticulocytosis
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16
Q

Symptoms and signs of macrocytic anaemia?

A

Tiredness, Lethargy, Dyspnoea

Hx of GI surgery may be there

Signs
Anaemia - pallor, tachycardia

Pernicious anaemia = Mild jaundice (Lemon tinted skin), glossitis, angular stomatitis, weight loss

Vitamin B12 deficiency = Peripheral neuropathy, Ataxia, subacute combined degeneration of spinal cord, optic atrophy, dementia.

17
Q

Investigations for macrocytic anaemia?

A

Bloods:
FBC = High MCV, Low Hb
(May be pancytopenia)

ESR, TFTs

Raised bilirubin

Intrinsic factor

Serum Vitamin B12

Blood film:
Large immature RBCs
Hypersegmented neutrophils

18
Q

Management of macrocytic anaemia?

A

Pernicious anaemia
• IM hydroxycobalamin (3x a week for 2 weeks, then every 3 months)

Folate deficiency
• Oral folic acid: 5mg/day for 4 months

19
Q

What is microcytic anaemia?

A

Anaemia associated with low MCV (<80)

20
Q

Causes of microcytic anaemia?

A 
Iron deficiency (Most common)
• Excess loss = Menorrhagia, GI bleed, haematuria, blood donation
• Increased requirements = Pregnancy, Lactation
• Low absorption = Coeliac/Crohns

Thalassaemia

Sideroblastic anaemia

Anaemia of chronic disease

Lead poisoning

21
Q

What are the investigations of microcytic anaemia?

A

Bloods:

FBC = Low Hb, Low MCV,

Iron studies = Low ferritin, Low serum Fe, High TIBC

Blood film:
Microcytic, Hypochromic
Pencil poikilocytes (Iron deficiency)

Medicine (5 decks)

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