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Y3 Core Conditions > Haematology > Flashcards

Haematology Flashcards

1
Q

What is the definition of anaemia?

A 
In men over 15 years of age - Hb concentration less than 13g/100mL
In women (non-pregnant) over 15 years of age - Hb concentrations less than 12g/100mL
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2
Q

What is megaloblastic macrocytic anaemia?

A

Megaloblastic anaemia is characterised by larger than normal developing red blood cells in the bone marrow (macrocytosis), with immature nuclei due to defective DNA synthesis.

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3
Q

What is the most frequent cause of megaloblastic macrocytic anaemia?

A

Deficiency of vitamin B12 or folate

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4
Q

What causes B12 deficiency? (5)

A
  1. Pernicious anaemia
  2. Gastric causes - gastric resection, gastrectomy, H.pylori infection
  3. Inadequate dietary intake e.g. vegan diet
  4. Intestinal causes - malabsorption, ileal resection, Crohn’s disease
  5. Drugs - colchicine, metformin, anticonvulsants
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5
Q

What is pernicious anaemia?

A

It is an autoimmune disorder which results in reduced production of intrinsic factor (which is vital for the absorption of B12). The autoimmune process involves gastritis, atrophy of all layers of both the body and fundus of the stomach, and loss of normal gastric glands, mucosal architecture, and parietal and chief cells.

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6
Q

What can cause folate deficiency? (5)

A
  1. Dietary deficiency - e.g. due to alcoholism
  2. Malabsorption - e.g. due to coeliac disease
  3. Excessive requirements - e.g. due to pregnancy, infancy, malignancy (leukaemia, carcinoma or lymphoma), blood disorders, inflammation (Crohn’s, TB), metabolic disorders
  4. Excessive urinary excretion - e.g. due to congestive heart failure, AKI
  5. Drugs - e.g. nitrofurantoin, sulfasalazine, methotrexate, trimethoprim
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7
Q

Pernicious anaemia accounts for what % of megaloblastic anaemia?

A

80%

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8
Q

What % of people over the age of 75 have a B21 deficiency?

A

10%

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9
Q

What are the complications associated with B12 deficiency, even if there are no changes in the blood count? (2)

A
  1. Neurological changes - paraesthesia, ataxia, peripheral neuropathy, memory loss
  2. Predisposes to neural tube defects in the fetus
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10
Q

What are the symptoms associated with a B12 or folate deficiency anaemia?

A
  1. Fatigue and lethargy
  2. Dyspnoea
  3. Faintness
  4. Palpitations
  5. Headache
  6. Tinnitus
  7. Anorexia
  8. Angina
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11
Q

What are the signs on examination of anaemia? (2)

A
  1. Pallor

2. If anaemia is severe - hyperdynamic circulation e.g. tachycardia or flow murmurs

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12
Q

What are the signs of vitamin B12 deficiency? (6)

A
  1. Lemon tinge to skin (due to pallor and haemolysis-induced jaundice)
  2. Glossitis (sore, red tongue)
  3. Oropharyngeal ulceration
  4. Neurological - impaired responses to touch, pain, vibration
  5. Neuropsychiatric - irritability, depression, psychosis and dementia
  6. Subacute combined degeneration of the spinal cord - classic triad includes extensor plantar reflexes, brisk knee jerk and absent ankle jerks
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13
Q

What are the signs of folate deficiency? (2)

A
  1. Mild peripheral neuropathy

2. Psychiatric changes e.g. depression

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14
Q

In someone with suspected B12 or folate deficiency anaemia, what are the recommended investigations to carry out? (2)

A
  1. Full blood count:
    - If Hb level is low and MCV is high - check serum B12 and serum folate concentrations.
    - If Hb levels are low and MCV is normal/low - check ferritin, B12 and folate levels.
    Conditions such as iron deficiency anaemia or thalassaemia can mask the development of macrocytosis.
  2. Serum anti-intrinsic factor antibodies
    - to determine if the underlying cause is pernicious anaemia
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15
Q

How might a blood film of someone with B12 or folate deficiency anaemia, appear? (3)

A
  1. Oval macrocytes and hypersegmented nuclei in neutrophils (six or more lobes)
  2. Low reticulocyte count
  3. WCC and platelet count may be reduced
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16
Q

Why may someone have a B12 deficiency, yet their serum B12 levels appear normal on blood film?

A

As the test measures the total amount of vitamin B12, not just the metabolically active.

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17
Q

What are the other causes of macrocytic anaemia, in addition to B12 and folate deficiency? (5)

A
  1. Alcohol
  2. Drugs e.g. hydroxycarbamide and azathioprine
  3. Severe thyroid deficiency
  4. Pregnancy
  5. Haematological abnormalities
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18
Q

If someone has a B12 deficiency and is displaying symptoms/signs suggestive of a neurological involvement, what is the recommended course of action to take? (2)

A
  1. Seek urgent specialist advice from a haematologist

2. If advice is not immediately available, administer hydroxocobalamin 1mg IM on alternate days

19
Q

What is the treatment for someone with B12 deficiency? (2)

A
  1. Hydroxocobalamin 1mg IM

2. If it is dietary related - offer dietary advice, and stop injection once B12 levels are restored

20
Q

What is iron deficiency anaemia?

A

It occurs in the more severe stages of iron deficiency, when the body is iron deficient to the degree that RBC production is reduced

21
Q

What are the causes of iron deficiency anaemia?

A
  1. GI causes
  2. Gynaecological causes
  3. Malabsorption - coeliac disease/gastrectomy
  4. Blood donation
22
Q

What are the GI causes that lead to iron deficiency anaemia? (8 in total 6,7 and 8 are rare causes)

A

Blood loss from the GI tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal woman. It can be caused by:

  1. Aspirin/NSAID use
  2. Colonic carcinoma
  3. Gastric carcinoma
  4. Benign gastric ulceration
  5. Angiodysplasia
  6. Oesophagitis
  7. Schistosomiasis
  8. IBD
23
Q

What are the gynaecological causes of iron deficiency anaemia? (3)

A
  1. Menstruation
  2. Pregnancy - physiological iron requirements are 3X higher in pregnancy
  3. Haemorrhage in childbirth
24
Q

What are the rare causes of iron deficiency anaemia? (3)

A
  1. Epistaxis
  2. Haematuria
  3. Inadequate dietary intake (for example in elderly people or vegans) - this is rare in the UK in women who are not pregnant, even the most iron-poor diets rarely cause iron deficiency anaemia except in growing children
25
Q

How many people are affected worldwide with iron deficiency anaemia?

A

Over 2 billion people

26
Q

What are the complications associated with iron deficiency anaemia? (3)

A
  1. Reduced work productivity, endurance and exercise capacity
  2. Cardiopulmonary complications
  3. Adverse effects on immune status and morbidity from infection
27
Q

What are the complications associated with iron deficiency anaemia in pregnancy? (5)

A
  1. Increased morbidity for the mother and infant
  2. Increased risk of preterm delivery
  3. Maternal postpartum depression and poor performance in mental tests by offspring
  4. Infant iron deficiency in the first three months of life
  5. Increased possibility of low birthweight
28
Q

What are the common symptoms associated with iron deficiency anaemia? (3)

A
  1. Fatigue
  2. Dyspnoea
  3. Palpitations
29
Q

What are the less common symptoms associated with iron deficiency anaemia? (6)

A
  1. Headache
  2. Tinnitus
  3. Taste disturbance
  4. Pruritis
  5. Pica - abnormal dietary cravings; e.g. for ice or clay
  6. Sore tongue
30
Q

What are the symptoms associated with iron deficiency without anaemia? (4)

A
  1. Fatigue
  2. Hair loss
  3. Lack of concentration
  4. Irritability
31
Q

Although with iron deficiency anaemia no signs may be present, what are the possible associated signs? (5)

A
  1. Pallor
  2. Atrophic glossitis
  3. Angular cheilosis
  4. Nail changes - koilonychia
  5. Tachycardia, murmurs, cardiac enlargement and heart failure - if Hb is less than 8g/100mL
32
Q

What investigations may be carried out in someone with suspected iron deficiency anaemia? (2)

A
  1. FBC - low Hb and low MCV - microcytic anaemia

2. Check ferritin levels - serum ferritin of less than 15 microgram/L confirms iron deficiency diagnosis

33
Q

What are the differential diagnoses for suspected iron deficiency anaemia?

A
  1. Thalassaemia
  2. Sideroblastic anaemias
  3. Anaemia of chronic disease
  4. Lead poisoning
34
Q

For people with thalassaemia that, would the MCV be raised, normal or low?

A

Very low, particularly for the degree of anaemia

35
Q

In someone with suspected iron deficiency anaemia, what is the management in primary care?

A
  1. Confirm the diagnosis
  2. Assess the person to determine the cause and severity of anaemia
  3. Refer for further tests
  4. Treat with ferrous sulphate first-line
  5. Offer dietary advice
  6. Monitor
36
Q

When taking a history from someone with suspected iron deficiency anaemia, what questions are important to ask? (9)

A

Ask about

  1. Diet
  2. Drug history
  3. History of overt bleeding or blood donation
  4. Menstrual history
  5. History of recent illness
  6. GI symptoms
  7. Weight loss
  8. Travel history
  9. Family history
37
Q

What is acute lymphoblastic leukaemia (ALL)?

A

This is a malignancy of lymphoid cells, affecting B or T lymphocyte cell lines, arresting maturation and promoting uncontrolled proliferation of immature blast cells, with marrow failure and tissue infiltration.

38
Q

What causes ALL?

A

It is thought to develop from a combination of genetic susceptibility and environmental triggers.

39
Q

What syndrome is associated with ALL?

A

Down’s syndrome

40
Q

There is an increased risk of ALL if the mother is exposed to what during pregnancy?

A

X-ray - ionising radiation

41
Q

What are the signs and symptoms of ALL? (symptoms/sign of marrow failure and infiltration)

A
  1. Marrow failure: anaemia, infection, bleeding

2. Infiltration: hepatosplenomegaly, lymphadenopathy

42
Q

What is the prognosis for children with ALL?

A

70-90% cure rates for children

43
Q

What is acute myeloid leukaemia (AML)?

A

This is a neoplastic proliferation of blast cells derived from marrow myeloid elements. It progresses rapidly (death in approx. 2 months if left untreated)

44
Q

What are the symptoms of AML?

A
  1. Marrow failure: anaemia, infection, bleeding

2. Infiltration: hepatosplenomegaly, gum hypertrophy, skin involvement.

Y3 Core Conditions (19 decks)

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