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Haematology Flashcards

1
Q

Microcytic anaemia

A

TAILS

Thalassaemia
AoCD
Iron deficiency
Lead poisoning
Sideroblastic
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2
Q

Normocytic anaemia

A 
AoCD
Acute bleed
Pregnancy
CKD
Aplastic anaemia
Bone marrow infiltration

Haemolytic anaemia

  • G6PD
  • Hereditary spherocytosis
  • Sickle cell
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3
Q

Macrocytic anaemia

A

Folate
B12

Hypothyroid
Alcohol

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4
Q

Iron deficiency anaemia aetiology

A

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

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5
Q

Iron deficiency anaemia clinical features

A

Fatigue
SOBOE
Weakness

PICA - Abnormal craving for non-food substances
Restless leg syndrome
Kolionychia - Spoon nails

Glossitis
Angular stomatitis

Gastric difficulties
Hair loss

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6
Q

IDA investigations

A

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

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7
Q

IDA management

A

Treat cause

Ferrous sulphate

  • Nausea
  • Abdo pain
  • Constipation
  • Diarrhoea
  • Black stools

Iron-rich diet

  • Leafy greens
  • Meat
  • Iron-fortified bread
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8
Q

Pernicious anaemia pathophysiology

A

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
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9
Q

Pernicious anaemia RFs and clinical features

A

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
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10
Q

Pernicious anaemia investigations

A

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
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11
Q

Pernicious anaemia management and complications

A

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

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12
Q

Folate deficiency aetiology

A

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
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13
Q

Folate deficiency clinical features and investigations

A

Symptomatic anaemia
Exfoliative dermatitis
Weight loss / LOA
Headaches

Serum folate - Low
Blood film - Hypersegmented neutrophils
Reticulocytes - Low

FBC - Macrocytic anaemia

  • Hb - Low
  • MCV ^
  • MCH ^
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14
Q

Folate deficiency management

A

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
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15
Q

Haemolytic anaemia clinical features

A

Jaundice - Unconjugated bilirubin ^

Pallor
Dark urine

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16
Q

G6PD deficiency

A

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
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17
Q

Hereditary spherocytosis

A

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
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18
Q

Sickle cell pathophysiology

A

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
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19
Q

Sickle cell crises

A

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

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20
Q

Sickle cell investigations and crisis management

A

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
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21
Q

Sickle cell long-term management and complications

A 
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
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22
Q

Aplastic anaemia aetiology

A

Peak incidence 30 years old

Idiopathic
Congenital - Fanconi or dyskeratosis congenita
Toxins - Benzene
Infection - Parvovirus and Hepatitis
Radiation

Iatrogenic

  • Cytotoxics
  • Chloramphenicol
  • Sulphonamides
  • Phenytoin
  • Gold
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23
Q

Aplastic anaemia clinical features / investigations / management

A

Symptomatic anaemia
Neutropenia - Infections
Thrombocytopenia - Bleeding and bruising

Investigations

  • Normocytic hypochromic anaemia
  • Hypoplastic bone marrow
  • Pancytopenia
  • Reticulocytes - Low

Management - Monitoring

  • Immunosuppressants
  • Transfusions
  • Prophylactic abx
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24
Q

Autoimmune haemolytic anaemia

A

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
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25
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
26
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
27
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
28
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
29
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
30
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
31
Beta thalassaemia aetiology
Trait - Hypochromic microcytic - Mediterranean Major - Hypochromic microcytic - Absence of beta chains - Ch11
32
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
33
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
34
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 ```
35
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
36
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
37
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
38
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 1. Monoclonal plasma cells in BM 2. Monoclonal proteins within serum/urine on electrophoresis 3. Evidence of end-organ damage - Hypercalcaemia, AKI, etc.
39
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
40
Hodgkin's lymphoma aetiology
Malignant proliferation of lymphocytes 20-30 60-70 Risk factors - EBV - H.Pylori - Ionising radiation - Family history - T-cell disorders
41
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
42
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
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
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
51
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
52
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)
53
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
54
Antiplatelets
Always assess HASBLED! ACS/PCI 1. Aspirin - Lifelong 1. Ticagrelor - 12 months 2. Clopidogrel - Lifelong Ischaemic stroke / TIA 1. Clopidogrel - Lifelong 2. Aspirin - Lifelong 2. Dipyridamole - Lifelong PAD 1. Clopidogrel - Lifelong 2. Aspirin - Lifelong
55
Clopidogrel
P2Y12 inhibitor Prasugrel Ticagrelor Ticlopidine Interactions - PPIs may alter efficacy
56
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
57
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
58
DIC clinical features
Systemic signs of circulatory collapse - Oliguria - Tachycardia - Hypotension Purpura fulminans, gangrene, acral cyanosis Delirium / Coma Petechiae, ecchymosis, oozing, haematuria
59
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
60
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
61
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
62
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
63
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
64
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
65
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 1. Microangiopathic haemolytic anaemia 2. Thrombocytopenic purpura 3. Neuro dysfunction 4. Renal dysfunction 5. fever
66
TTP investigations and management
``` FBC/LFT - Haemolytic anaemia Platelets - Low Blood film - Shistocytes Urinalysis - Proteinuria Urea and creatinine ^ ``` Management - Plasma exchange - Prednisolone PO
67
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
68
EBV clinical features
HHV4 1. Fever 2. Pharyngitis 3. Lymphadenopathy ``` Malaise Palatal petechiae Splenomegaly - Risk of rupture Haemolytic anaemia Maculopapular rash in patients who take amoxicillin! ```
69
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
70
CMV aetiology
Beta-Herpes virus Asymptomatic in individuals with normal immune function Infected cells have "owls eye" appearance Risk factors - Immunocompromise
71
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
72
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
73
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
74
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
75
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
76
Malaria aetiology and protective factors
1. Plasmodium falciparum 2. Plasmodium vivax - Benign 3. Plasmodium ovale - Benign 4. Plasmodium malariae - Benign Protective factors - Sickle-cell trait - G6PD deficiency - HLA-B53 - Absence of duffy antigens Risk factors - Travel to endemic areas - Tropics
77
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 ```
78
Malaria management and complications
Chloroquine Complications - Cerebral malaria - Seizures/coma - Acute renal failure - ARDS - Hypoglycaemia - DIC

3B (23 decks)

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