Haematology Flashcards
Microcytic anaemia
TAILS
Thalassaemia AoCD Iron deficiency Lead poisoning Sideroblastic
Normocytic anaemia
AoCD Acute bleed Pregnancy CKD Aplastic anaemia Bone marrow infiltration
Haemolytic anaemia
- G6PD
- Hereditary spherocytosis
- Sickle cell
Macrocytic anaemia
Folate
B12
Hypothyroid
Alcohol
Iron deficiency anaemia aetiology
Uptake in the duodenum
Excessive blood loss
- Menorrhagia
- GI bleed - Colorectal cancer in men, peptic ulcers
Inadequate dietary intake
- Meat and leafy greens
- Veggie diet is RF
Poor intestinal absorption
- Coeliac / Crohn’s
- Gastrectomy
Increased iron requirements
- Children
- Pregnant ladies
NSAIDs
Haemodialysis
Iron deficiency anaemia clinical features
Fatigue
SOBOE
Weakness
PICA - Abnormal craving for non-food substances
Restless leg syndrome
Kolionychia - Spoon nails
Glossitis
Angular stomatitis
Gastric difficulties
Hair loss
IDA investigations
History
- Change in diet
- Medication history
- Menstrual history
- Weight loss
- Change in bowel habit
FBC - Microcytic hypochromic + Low reticulocytes
Blood film - Anisopoikilocytosis - Red cells of different shapes and sizes
Iron studies
- MCH - Low
- Serum ferritin - Low
- TIBC - High
- Transferrin saturation - Low
Coeliac seriology
OGD if > 55 or red flags
IDA management
Treat cause
Ferrous sulphate
- Nausea
- Abdo pain
- Constipation
- Diarrhoea
- Black stools
Iron-rich diet
- Leafy greens
- Meat
- Iron-fortified bread
Pernicious anaemia pathophysiology
B12 deficiency
Normal absorption
- Oily fish, meat, dairy
- Parietal cells produce IF
- IF binds to B12
- Absorption in terminal ileum
Pathology
- AI disorder affecting gastric mucosa
- Antibodies to IF and/or gastric parietal cells
- Antibodies bind to IF - Block B12 binding site
- Gastric parietal cell antibodies - Reduce IF production
B12 important for…
- Erythropoiesis - Megaloblastic anaemia
- Nerve myelination - Neuropathy
Pernicious anaemia RFs and clinical features
Females > Males
AI disorders - Thyroid, DM, Addison’s, RA, etc.
Symptomatic anaemia
Peripheral neuropathy - Paraesthesia
Subacute combined spinal cord degeneration
- Progressive weakness
- Ataxia
- Paraesthesia
- Spasticity
- Paraplegia
Neuropsychiatric features
- Memory loss
- Poor concentration
- Confusion
- Depression
- Irritability
Pernicious anaemia investigations
FBC - Macrocytic anaemia
- WCC - Low
- Platelets - Low
Blood film - Hypersegmented polymorphs
B12 < 200
Antibodies
- Anti-IF antibodies
- Anti-GP cell antibodies
Schilling test
- Radiolabelled B12 administered
- Once without IF + Once with oral IF
- Urine B12 measured
Pernicious anaemia management and complications
B12 replacement therapy - IM
- 3 injections per week for 2 weeks
- Then 3 monthly
- More frequently if neurological symptoms
Folic acid supplementation
Complications - Increased risk of gastric cancer
Folate deficiency aetiology
Leafy green vegetables
Converted to tetrahydrofolate
Involved with DNA/RNA synthesis
Dietary deficiency Malabsorption - Coeliac/IBD Pregnancy and breast-feeding Prematurity Alcohol excess
Iatrogenic
- Phenytoin / Phenobarbitol
- Trimethoprim
- Methotrexate
- Sulfasalazine
- Pyrimethamine
- Anticonvulsants
Folate deficiency clinical features and investigations
Symptomatic anaemia
Exfoliative dermatitis
Weight loss / LOA
Headaches
Serum folate - Low
Blood film - Hypersegmented neutrophils
Reticulocytes - Low
FBC - Macrocytic anaemia
- Hb - Low
- MCV ^
- MCH ^
Folate deficiency management
Folic acid - 5mg
Preventing NTD during pregnancy
- 400mcg folic acid until 12th week of pregnancy
- Higher risk of NTD - 5mg folic acid before conception to 12th week
Increased risk of NTD
- Either partner has NTD
- Previous pregnancy affected by NTD
- Family history of NTD
- Anti-epileptic drugs
- Coeliac disease
- DM
- Thalassaemia
- Obesity
Haemolytic anaemia clinical features
Jaundice - Unconjugated bilirubin ^
Pallor
Dark urine
G6PD deficiency
Haemolytic anaemia - X-linked
Clinical features - Haemolytic anaemia following a precipitant
- Abx - Nitro
- Anti-malarial - Chloroquine
- Infection
- Fava beans
Investigations - Normocytic anaemia with high reticulocytes
Blood film
- Heinz bodies
- Bite cells
- Hemi-ghosts
Management - Supportive
- Transfusion if severe
- Avoid precipitants
Hereditary spherocytosis
Haemolytic anaemia - AD
Defect in RBC membrane synthesis
Spherical RBCs removed by spleen
Reduced RBC lifespan
Patients from Northern Europe - Finland, etc.
Clinical features = Haemolytic anaemia + Splenomegaly
Investigations - Normocytic anaemia with high reticulocytes
- Blood film - Spherocytes
- EMA binding test
Management
- Acute crisis - Supportive + Transfusion
- Long-term - Folic acid + Splenectomy
Sickle cell pathophysiology
Haemolytic anaemia - Autosomal recessive
Glutamate to Valine
Abnormal HbS
HbS turns sickle shaped when deoxygenated
Results in haemolysis and capillary obstruction
Precipitants
- Hypoxia
- Cold
- Exercise
- Dehydration
- Infection
Sickle cell crises
Thrombotic - Painful / vaso-occlusive crises
- AVN femoral head
- Hand-foot syndrome in children
- Lungs
- Spleen
- Brain - CVA
- Mesenteric ischaemia
Sequestration - Sickling with organs
- Spleen or lungs
- Pooling of blood with worsening anaemia
Acute chest syndrome
- Dyspnoea
- Chest pain
- Pulmonary infiltrates
- Low pO2
Aplastic - Infection with parvovirus
- Sudden fall in Hb
Haemolytic - Fall in Hb due to increased haemolysis
Sickle cell investigations and crisis management
Guthrie heel-prick test
FBC - Normocytic anaemia with high reticulocytes
Protein electrophoresis
- HbAS/HbSS
- HbF ^
Blood film - Howell jolly bodies
Crisis management - Treat cause
- O2
- IV fluids
- Analgesia
- Transfusion
Sickle cell long-term management and complications
Avoid triggers! Hydroxyurea - Stimulates HbF production Vaccinations - Influenza and pneumococcal Prophylactic abx - Penicillin Repeated transfusions Bone marrow transplant
Complications
- CVA
- Stunted growth
- Developmental delay
- Crises
- Osteomyelitis - Salmonella
Aplastic anaemia aetiology
Peak incidence 30 years old
Idiopathic Congenital - Fanconi or dyskeratosis congenita Toxins - Benzene Infection - Parvovirus and Hepatitis Radiation
Iatrogenic
- Cytotoxics
- Chloramphenicol
- Sulphonamides
- Phenytoin
- Gold
Aplastic anaemia clinical features / investigations / management
Symptomatic anaemia
Neutropenia - Infections
Thrombocytopenia - Bleeding and bruising
Investigations
- Normocytic hypochromic anaemia
- Hypoplastic bone marrow
- Pancytopenia
- Reticulocytes - Low
Management - Monitoring
- Immunosuppressants
- Transfusions
- Prophylactic abx
Autoimmune haemolytic anaemia
Warm vs Cold - According to what temperature the antibodies cause haemolysis
Investigations
- Direct antiglobulin test - Coombs’ test - Positive
- FBC - Haemolytic anaemia
Management
- Corticosteroids
- Immunosuppression
- Splenectomy
Warm AIHA - IgG
Haemolysis best caused at body temperature
Haemolysis at extravascular sites - E.g. spleen
Aetiology
- AI disease - SLE
- Neoplasia - Lymphoma / CLL
- Iatrogenic - Methyldopa
Clinical features - Haemolytic anaemia
Cold AIHA
Haemolysis best caused at 4c
Haemolysis mediated by complement
More commonly intravascular
Aetiology
- Neoplasia - Lymphoma
- Infections - Mycoplasma / EBV
Clinical features
- Haemolytic anaemia
- Raynaud’s
AoCD
Inflammation mediated reduction in RBC production
Aetiology
- IBD
- RA
- JIA
- Malignancy
Clinical features - Symptomatic anaemia
Investigations - Normocytic anaemia with low reticulocytes
- Iron - Low
- TIBC - Low
- Transferrin saturation - Low
- Ferritin - High
Management - Treat cause
- Transfusion
- ESAs - Epoetin Alfa
- Iron supplementation - Sodium ferric gluconate complex
Sideroblastic anaemia aetiology
Microcytic - X-linked
Defect in synthesis of protoporphyrin ring
Iron can’t bind haem
Free iron circulating
Leads to iron overload picture
Aetiology - X-linked
- Alcohol
- Lead
- Myelodysplasia
- TB medication
Sideroblastic anaemia clinical features / investigations / management
Symptomatic anaemia + Iron overload
- Heart
- Liver
- Kidneys
Investigations
- FBC - Hypochromic microcytic anaemia
- Ferritin ^
- TIBC - Low
- Iron ^
- Bone marrow biopsy - Sideroblasts
Management - Treat cause
- Desferoxamine
- Pyridoxine
Alpha thalassaemia
Hypochromic microcytic
SE Asia
Deficiency of alpha chains in Hb
2 separate alpha-globulin genes located on each Ch16
1 or 2 alleles affected - Normal Hb
3 alleles affected
- HbH disease
- Splenomegaly
All 4 alleles affected
- Death in utero
- Hydrops fetalis
- Bart’s hydrops
Beta thalassaemia aetiology
Trait - Hypochromic microcytic - Mediterranean
Major - Hypochromic microcytic
- Absence of beta chains
- Ch11
Thalassaemia clinical features / investigations / management
Haemolytic anaemia
Present in first year of life
- FTT
- Hepatosplenomegaly
Skull bossing
Major - Hydrops fetalis
Investigations - Unconjugated bilirubin ^ Hb electrophoresis - HbA2 ^ - HbF ^ - HbA - Absent in major
Management
- Transfusion
- Desferoxamine
Polycythaemia aetiology
Myeloproliferative disorder
Clonal proliferation of a marrow stem cell
Increased red cell volume
Overproduction of neutrophils and platelets
Peak incidence aged 60-70
Congenital - JAK2 mutation
Acquired - Chronic hypoxia
- OSA
- COPD
- Altitude
Associated with Budd-Chiari syndrome
Polycythaemia clinical features
Ruddy appearance - Flushed Pruritus - Palms and soles - Worse after a bath Headaches Tinnitus Angina Dizziness Splenomegaly HTN - 1/3 patients VTE risk Haemorrhage - Secondary to abnormal platelet function
Polycythaemia investigations / management / prognosis
FBC
- Hb ^
- Crit ^
- Neutrophils ^
- Basophils ^
- Platelets ^
Mutation screen - JAK2
Management - Venesection
- Hydroxyurea
- Phosphorous-32 therapy
- VTE prophylaxis - Low-dose Aspirin
Prognosis
- Thrombotic events cause morbidity
- Myelofibrosis
- Acute leukaemia
Multiple myeloma aetiology
Malignant proliferation or plasma cells
Increased production of Ig - Paraproteins
Accumulation in the renal system - Bence-Jones proteins
Median age 70 years old
Multiple myeloma clinical features
CRAB-E
Calcium - Hypercalcaemia - Increased osteoclast activity
- Constipation
- Nausea
- Anorexia
- Confusion
Renal (AKI) - Light chain deposition within renal tubules - Bence-Jones protein
- Dehydration
- Increasing thirst
Anaemia - Pancytopenia
- Symptomatic anaemia
- Infections
- Bleeding/bruising
Bones - Bone marrow infiltration by plasma cells + Cytokine mediated osteoclasts
- Lytic bone lesions
- Back pain
- Fragility fractures
- Raindrop skull
ESR ^ - Increased risk of VTE
Multiple myeloma investigations and diagnosis
BM biopsy - Monoclonal plasma cells Serum/urine electrophoresis - Monoclonal paraprotein Calcium profile - Isolated calcium ^ U&E - Urea/creatinine ^ FBC - Pancytopenia ESR Blood film - Rouleaux formation
Skeletal survey - WBCT / MRI
- Raindrop skull - Numerous dark spots seen on XR
- Osteopenia
- Osteolytic lesions
- Pathological fractures
Diagnosis
- Monoclonal plasma cells in BM
- Monoclonal proteins within serum/urine on electrophoresis
- Evidence of end-organ damage - Hypercalcaemia, AKI, etc.
Multiple myeloma management and complications
Chemo - Induction therapy
- Stem-cell transplant suitable - Bortexomib + Dex
- Stem-cell transplant NOT suitable - Thalidomide + Alkylating agent + Dex
Manage symptoms
- Hypercalcaemia - Hydrate + Bisphosphonates
- Renal - Hydrate
- Hyperviscosity - VTE prophylaxis
Complications
- Pain - Analgesia
- Pathological fractures - Zoledronic acid
- Infection - Vaccinations + Prophylactic Ig
- VTE - Aspirin
- Fatigue
Hodgkin’s lymphoma aetiology
Malignant proliferation of lymphocytes
20-30
60-70
Risk factors
- EBV
- H.Pylori
- Ionising radiation
- Family history
- T-cell disorders
Hodgkin’s lymphoma clinical features
Painless lymphadenopathy - More painful after drinking alcohol SOB Cough + Haemoptysis Hepatosplenomegaly B-symptoms
Investigations
- FBC - Hb and Pt - Low
- ESR ^
- CXR - Mediastinal mass
- PET-CT - Staging
- USS + Lymph node biopsy - Reed Sternberg cells
Hodgkin’s lymphoma staging and management
Ann-Arbor classification 1. Single lymph node 2. 2 or more lymph nodes on the same side of the diaphragm 3. Nodes on either side of the diaphragm 4. Metastatic spread beyond lymph nodes A. No systemic symptoms B. Systemic symptoms
Management - Chemo/Radio - ABVD
- Doxorubicin - Adriamycin
- Bleomycin
- Vinblastine
- Dacarbazine
Non-Hodgkin’s lymphoma aetiology
Malignant proliferation of lymphocytes
B-cells or T-cells
1/3 cases over the age of 75
Risk factors
- Caucasian
- History of viral infection - EBV
- Family history
- Certain chemical agents - Pesticides / solvents
- Chemo/Radio
- Immunodeficiency - Transplant, HIV, DM
- AI disease - Sjogren’s, SLE, Coeliac
NHL clinical features
Painless lymphadenopathy
Hepatosplenomegaly
Testicular mass
B-symptoms
Extranodal disease - More common in NHL
- Gastric - Dyspepsia, dysphagia, weight loss, abdo pain
- Bone marrow - Pancytopenia, bone pain
- Lungs
- Skin
- CNS - Nerve palsies
NHL investigations and management
FBC - Pancytopenia
Blood film - Nucleated RBCs + Left shift
USS + Lymph node biopsy
LDH ^
Staging - Ann-Arbor
Management - RCHOP 21 days
- Rituximab
- Cyclophosphamide
- H - Doxorubicin
- O - Vincristine
- Prednisolone
AML
Acute leukaemia in adults
Clinical features - BM failure
- Anaemia
- Neutropenia
- Thrombocytopenia
- Hepatosplenomegaly
- Bone pain
- Lymphadenopathy
Investigations
- FBC - Macrocytic pancytopenia
- Blood film - Blasts + Auer rods
- BM biopsy - Blasts + Auer rods
Classification - French-American-British - FAB
Management - Chemo/Radio
ALL
Acute leukaemia in children
Clinical features
- Pancytopenia
- Hepatosplenomegaly
- Bone pain
- Fever
- Testicular swelling
Types
- Common - 75%
- T-cell only - 20%
- B-cell only - 5%
Investigations
- FBC - Pancytopenia
- Blood film - Leukaemic lymphoblasts
- BM biopsy - Lymphoblast infiltration
Management - Chemo/Radio
CML aetiology and clinical features
Philadelphia chromosome!
Malignant clonal disorder of haematopoietic stem cells
Clinical features - 60-70
- Anaemia
- Weight loss
- Diaphoresis
- Splenomegaly - Abdo discomfort
CML investigations
FBC
- Anaemia
- WCC ^
- Thrombocytopenia
Blood film
- Maturing myeloid cells
- Basophils
- Eosinophils
BM biopsy - Granulating hyperplasia
Genetic testing - Philadelphia chromosome
Management - Chemo/Radio
- Imatinib - Tyrosine kinase inhibitor
- Hydroxyurea
- Interferon-Alpha
- BM transplant
CLL
Monoclonal proliferation of well-differentiated lymphocytes
Almost always B cells
Clinical features - Asymptomatic
- Anaemia
- Lymphadenopathy
- Splenomegaly
Investigations
- FBC - Anaemia + WCC ^
- Blood film - Smudge/smear cells
- Immunophenotyping
Management - Chemo/Radio
DVT aetiology and clinical features
Clot in a major deep vein of leg, thigh, pelvis, abdomen
Impaired venous flow = Leg swelling and pain
May occur in upper extremities
- Portal vein
- Mesenteric vein
- Ovarian vein
- Retinal vein
- Cerebral venous sinus
Clinical features
- Calf swelling
- Localised pain along deep venous system
- Asymmetric oedema
- Prominent superficial veins
Wells score
Wells score
- Active cancer - 1
- Calf swelling > 3cm - 1
- Prominent superficial veins - 1
- Pitting oedema - 1
- Swelling of entire leg - 1
- Localised pain - 1
- Immobilisation - 1
- Bed rest > 3 days or surgery with GA in last 12 weeks - 1
- Previous DVT/PE - 1
- Alternative diagnosis more likely (-2)
DVT investigations and management
Wells score
D-dimer if Wells < 2
USS if Wells > 2 or D-dimer +ve
USS not available within 4 hours - Anticoagulate - Rivaroxaban
Management - Anticoagulate - 3 months if provoked, 6 months if unprovoked
- DOAC - Rivaroxaban
- Renal impairment - LMWH
Antiplatelets
Always assess HASBLED!
ACS/PCI
- Aspirin - Lifelong
- Ticagrelor - 12 months
- Clopidogrel - Lifelong
Ischaemic stroke / TIA
- Clopidogrel - Lifelong
- Aspirin - Lifelong
- Dipyridamole - Lifelong
PAD
- Clopidogrel - Lifelong
- Aspirin - Lifelong
Clopidogrel
P2Y12 inhibitor
Prasugrel
Ticagrelor
Ticlopidine
Interactions - PPIs may alter efficacy
DOACs
Dabigatran - Thrombin inhibitor - Renal excretion
Rivaroxaban - Factor Xa inhibitor
Apixaban - Factor Xa inhibitor
NICE indications
- Prevention of VTE following hip/knee surgery
- Treatment of DVT/PE
- Prevention of stroke in non-valvular AF
DIC aetiology
Activation of coagulation pathways
Formation of intravascular thrombi
Depletion of platelets and coagulation factors
Thrombi lead to vascular obstruction and multi-organ failure
Spontaneous bleeding may occur
Triggers
- Sepsis
- Major trauma
- Obstetric complications - Amniotic fluid embolism, haemolysis, HELLP
- Malignancy
- Major vascular disorders
DIC clinical features
Systemic signs of circulatory collapse
- Oliguria
- Tachycardia
- Hypotension
Purpura fulminans, gangrene, acral cyanosis
Delirium / Coma
Petechiae, ecchymosis, oozing, haematuria
DIC investigations
Platelets - Low PT ^ aPTT ^ Bleeding time ^ Fibrinogen - Low D-dimer ^ Blood film - Shistocytes - Microangiopathic haemolytic anaemia
Management - Treat cause + Transfusion
- Platelets
- FFP
- Cryoprecipitates
- Fibrinogen concentrates
Clotting studies interpretation
Warfarin
- PT - Prolonged
- aPTT - Normal
- Bleeding time - Normal
- Platelet count - Normal
Aspirin
- PT - Normal
- aPTT - Normal
- Bleeding time - Prolonged
- Platelet count - Normal
Heparin
- PT - Prolonged
- aPTT - Prolonged
- Bleeding time - Normal
- Platelet count - Normal
DIC
- PT - Prolonged
- aPTT - Prolonged
- Bleeding time - Prolonged
- Platelet count - Low
High INR
Major bleeding
- Stop Warfarin
- Vitamin K - 5mg IV
- Prothrombin complex concentrate
- It not available - FFP
INR > 8
- Stop Warfarin
- Vitamin K - 1-5mg (PO if stable, IV if bleeding)
- Check INR after 24 hours
- Repeat vitamin K if necessary
- Restart Warfarin when INR < 5
INR 5-8 + Minor bleeding
- Stop Warfarin
- Vitamin K - 1-3mg IV
- Restart Warfarin when INR < 5
INR 5-8 - No bleeding
- Withhold 1 or 2 doses of Warfarin
- Reduce subsequent maintenance dose
Overdose management
Paracetamol
- Activated charcoal < 1 hour
- NAC
Salicylate
- Urinary alkalisation - IV bicarb
- Haemodialysis
Opioid - Naloxone
Benzos - Flumazenil (seizure risk)
Tricyclics - IV bicarb
Lithium
- Volume resus - NaCl
- Haemodialysis
Warfarin - Vitamin K + Prothrombin
Heparin - Protamine sulphate
BBs
- Bradycardia - Atropine
- Resistant - Glucagon
Digoxin - Digoxin-specific antibody fragments
Poisoning management
Ethylene glycol / Methanol
- Fomepizole
- Ethanol
- Haemodialysis
Organophosphate insecticides - Atropine
Iron - Desferroxamine
Lead
- Dimercaprol
- Calcium edetate
CO - Hyperbaric 100% O2
Cyanide
- Hydroxycobalamin
- Amyl nitrate / Sodium nitrate / Sodium thiosulphate
ITP
Immune thrombocytopenia - Well patient with thrombocytopenia
- Autoimmine
- Adults - Chronic
- Children - Acute following infection or vaccination
Clinical features - Incidental finding?
- Petichae / Purpura
- Bleeding - Epistaxis
Investigations - Isolated platelet count < 100
Management
- Pred PO
- IVIG
- Splenectomy
- Rhesus positive - Anti-G Ig
- Children - Platelet transfusion
Evan’s syndrome - ITP + AIHA
TTP aetiology and clinical features
Thrombotic thrombocytopenic purpura - Unwell patient with thrombocytopenia
- Antibodies against enzyme that cleaves vWF
- Large vWF multimers leading to platelet aggregation
Clinical features - PENTAD
- Microangiopathic haemolytic anaemia
- Thrombocytopenic purpura
- Neuro dysfunction
- Renal dysfunction
- fever
TTP investigations and management
FBC/LFT - Haemolytic anaemia Platelets - Low Blood film - Shistocytes Urinalysis - Proteinuria Urea and creatinine ^
Management
- Plasma exchange
- Prednisolone PO
Lymphadenopathy DDx
Infective
- Infectious mononucleosis - EBV
- HIV
- Eczema
- Rubella
- Toxoplasmosis
- CMV
- TB
- Roseola infantum
Neoplastic - Leukaemia / Lymphoma
Others
- AI - SLE/RA
- Graft vs host disease
- Sarcoidosis
Drugs
- Phenytoin
- Allopurinol
- Isoniazid
EBV clinical features
HHV4
- Fever
- Pharyngitis
- Lymphadenopathy
Malaise Palatal petechiae Splenomegaly - Risk of rupture Haemolytic anaemia Maculopapular rash in patients who take amoxicillin!
EBV investigations and management
FBC - Lymphocytosis + Haemolytic anaemia
EBV-specific antibodies
Monospot test - Heterophile antibodies - Non-specific
LFTs ^
Management - Supportive - Resolves in 2-4 weeks
- Avoid sport for 8 weeks - Risk of splenic rupture
- Airway obstruction - Pred
- Thrombocytopenia - Pred or IVIG
CMV aetiology
Beta-Herpes virus
Asymptomatic in individuals with normal immune function
Infected cells have “owls eye” appearance
Risk factors - Immunocompromise
CMV manifestations
Congenital CMV
- Growth retardation
- Pinpoint petechial “blueberry muffin” skin lesions
- Microcephaly
- SN deafness
- Encephalitis - Seizures
- Hepatosplenomegaly
CMV mononucleosis
- Similar to infectious mononucleosis
- May develop in immunocompetent individuals
CMV retinitis
- Common in HIV patients with low CD4 < 50
- Visual impairment - Blurred vision
- Fundoscopy shows retinal haemorrhages and necrosis - Pizza retina
- Treatment - IV Ganciclovir
CMV encephalopathy - HIV patients with low CD4 < 50
CMV pneumonitis
CMV colitis
CMV
Other clinical features / investigations / management
Fever
Malaise
N/V
Diarrhoea
FBC
- Immunocompetent - Lymphocytosis
- Immunocompromised - Pancytopenia
LFTs ^
CMV serology
CD4 count
CXR
Management
- Immunocompetent - Supportive
- Immunocompromised - IV Ganciclovir
HIV aetiology
Retrovirus Destruction of CD4 cells HIV1 - Global epidemic HIV2 - Less pathogenic - Restricted to West Africa AIDS - Develops over 10-15 years
IVDU
Unprotected sex
Needle-stick injury
Vertical transmission
HIV investigations and management
HIV PCR
P24 antigen tests
Antiretroviral therapy
Counselling
Manage comorbidities
Prophylaxis - Vaccinations - Live vaccines CI
- Pneumococcal
- Meningococcal
- Influenza
- Hep B
- HPV
- DTP
HIV vertical transmission
25-30%
Factors to reduce risk of transmission…
- Maternal ART
- Bottle feeding
Method of delivery
- Viral load < 50 - Vaginal
- Viral load > 50 - CS + Zidovudine infusion 4 hours prior
Neonatal ART
- Maternal viral load < 50 - Zidovudine PO
- Maternal viral load > 50 - Triple ART for 4-6 weeks
Malaria aetiology and protective factors
- Plasmodium falciparum
- Plasmodium vivax - Benign
- Plasmodium ovale - Benign
- Plasmodium malariae - Benign
Protective factors
- Sickle-cell trait
- G6PD deficiency
- HLA-B53
- Absence of duffy antigens
Risk factors - Travel to endemic areas - Tropics
Malaria clinical features and investigations
Fever > 39 Headache Weakness Myalgia Arthralgia Anorexia Diarrhoea
Blood film - Schizonts Rapid diagnostic tests - RDTs FBC - Anaemia and thrombocytopenia BM - Hypoglycaemia ABG - Acidosis
Malaria management and complications
Chloroquine
Complications
- Cerebral malaria - Seizures/coma
- Acute renal failure
- ARDS
- Hypoglycaemia
- DIC
