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PR3154 Haematology & Musculoskeletal > Haematology - Anaemia & Blood dyscrasias > Flashcards

Haematology - Anaemia & Blood dyscrasias Flashcards

1
Q

How do we first work up a pt w suspected anaemia?

A
  1. FBC - Hb, Serum ferritin, TIBC, MCV
  2. Vit B12
  3. Folate
  4. Reticulocyte count
  5. Peripheral smear
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2
Q

If pt presents with microcytic anaemia, low MCV, what are the next steps?

A

Investigate serum ferritin.
If low serum ferritin (Fe stores) –> IDA
If high serum ferritin, look at TIBC. If low TIBC –> Anaemia of chronic inflamm

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3
Q

If pt presents w macrocytic anaemia (high MCV), what are the next steps?

A

Work up for vit B12 and folate levels

If normal vit B12 and low folate levels –> folate def anaemia
If low vit B12 and normal folate levels –> Vit B12 def anaemia

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4
Q

What is the possible aetio of IDA?

A

Impaired absorption of Fe thru acidic env of stomach
Atrophic gastritis
Gastrectomy
Celiac disease
PPI, H2RA
Ca rich foods
H.pylori infection
Blood loss

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5
Q

What is the possible aetio of B12 def anaemia?

A

Auto Ig to intrinsic factor
Dietary def
PPI, H2RA
H.pylori infeciton

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6
Q

What is the possible aetio of folate def anaemia?

A

Dietary def

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7
Q

What are the possible aetio of anaemia of chronic inflammation?

A

CHF
CKD, ESRD
Rheumatoid arthritis
Malignancy
COPD
HIV infection
IBD
Castleman disease

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8
Q

What is the recommended management for IDA?

A

Fe supplementation. Min 1000-1500 mg elemental Fe for complete supplementation, treat for 3-6mo.
(Provided “leak” is plugged, and CKD - lifelong)
ESA

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9
Q

What are the % elemental Fe in common commercial preparations?

A

Fe polymaltose - 100%
Ferrous gluconate - 12%
Ferrous fumarate, sulfate ~33%

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10
Q

What is the recommended management for Vit B12 def anaemia?

A

Pernicious anaemia (parenteral)
- 1000 microg daily vit B12 x 1/52 f/b
- 1000 microg 1/7 vit B12 x 4/52 f/b
- 1000 microg 1/12 vit B12 for life

Other B12 suppl (PO)
- 1000 or 2000 microg daily vit B12

ESA

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11
Q

What are cyanocobalamin, pyridoxine, thiamine?

A

Cyanocobalamin = B12
Pyridoxine = B6
Thiamine = B1

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12
Q

What is the recommended management for folate def anaemia?

A

1mg daily folic acid for 1-4mo or until haematologic recovery is achieved

ESA

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13
Q

What is aplastic anaemia?

A

May affect all 3 of the cell lines (rbc, wbc, thrombocytes)

Any 2 of the three
1. WBC count <= 3500 cells/mm3 (3.5x10^9/L)
2. Platelet count <= 55000 cells/m3 (55x10^9/L)
3. Hb <= 10g/dL (100g/L, 6.21mmol/L) + reticulocyte count <= 30 000 cells/m3(30x10^9/L)

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14
Q

What are the drugs assoc w aplastic anaemia?

A

Cytotoxic, radiation chemotherapies
Chloramphenicol
ASM - CBZ, PHT, PB
Thyroid meds
Sulfonamides
Diuretics - Furosemide, Thiazides
NSAIDs

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15
Q

What is the recommended management of aplastic anaemia?

A

Infections:
If wbc count < 500 cells/mm3 (0.5x10^9/L) prophylactic abx & antifungal treatment
Febrile neutropenia: start broad spectrum abx
Immunosuppressants, glucorticoids, ciclosporine

Bleeding:
Transfusion of erythrocytes & platelets

If bone marrow failure severe:
GM-CSF or G-CSF, IL-14
Haematopoietic stem cell transplant

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16
Q

What is agranulocytosis/ drug induced neutropenia?

A

Neutropenia = ANC < 1500/microL

17
Q

What are the drugs assoc w drug induced neutropenia?

A

Antipsychotics: clozapine & other phenothiazines
- Onset 2-15 weeks (peak onset bet 3-4weeks)
- Strict monitoring protocols

Thyroid meds: carbimazole, PTU
- Onset within 2mo
- More freq in pts >40y.o.

Betalactam abx
- Rapid onset
- Accum of drug to toxic [ ] cld be the cause

Sulfonamides

18
Q

What is the recommended management for agranulocytosis/drug induced neutropenia?

A

NEVER restart offending agent

If neutrophil nadir <100 cells/mm3 (0.1x10^9/L): filgrastim G-CSF SQ 300 mcg/day

Routine weekly monitoring of wbc, particularly for those treated w clozapine. Shld return to normal within 2-4 weeks (frequently within 4-24d)

19
Q

What are the drugs associated with megaloblastic anaemia?

A

Antimetabolite (chemothera) e.g. Methotrexate
Azathioprine
Cloramphenicol
Colchicine
5-Fluorouracil
OCs
ASMs: PHT, PB
Cotrimoxazole
Tetracycline

20
Q

What is the recommended management of megaloblastic anaemia?

A

Withdrawal of causative agent

For cotrimoxazole: esp when folate/vit B12 def
- Folinic acid 5-10 mg up to QDS

For PHT, PB:
- Folic acid 1mg daily (controversial)

21
Q

What is haemolytic anaemia?

A

Bursting of rbc

22
Q

What are the drugs assoc w haemolytic anaemia?

A

Methyldopa
Quinine, quinidine

Abx
- Penicillins, Cephalosporins, Streptomycin
- Beta-lactamase inihb: Clavulanate, tazobactam, sulbactam
- Fluoroquinolones, Cotrimoxazole
- Chloroquine and hydroxychloroquine

ASM: PHT, PB
NSAIDs
Sulfonamides
SUs

23
Q

What is drug induced thrombocytopenia?

A

Platelet count < 100, 000 cells/m3 or >50% from baseline
Typically presents 1-2 weeks after drug ini
May present immediately after a dose when an agent has been used intermittently in the past e.g. UFH (late onset HIT)
- Recovery begins within 1-2d of discontinuation of the offending agent and is complete at one week
- Ig to that agent may persist for years so pts shld be advised to avoid the drug indefinitely
Rapid onset may also occur w GpIIb/IIIa inhib

24
Q

What are the drugs assoc w drug induced thrombocytopenia?

A

Heparin
GpIIb/IIIa inhib

All 1st gen ASM

Antimicrobials:
- Clarithromycin, Linezolid, Azoles, Penicillins, Cotrimoxazole, Ciprofloxacin
- All TB drugs

Sulfonamide
NSAIDs: aspirin, diclofenac, nalidixic acid, naproxen
Amiodarone, digoxin, GTN

25
Q

What is the recommended management of drug induced thrombocytopenia?

A

Withdrawal of causative agent whenever possible
Immunosuppressants
Platelet transfusion can be given if clinically sig bleeding

26
Q

Which blood dyscrasias are ASM implicated in?

A

Aplastic anaemia, hemolytic anaemia, drug induced thrombocytopenia

27
Q

Which blood dyscrasias are thyroid medications implacted in?

A

Aplastic anaemia, agranulocytosis

28
Q

Which blood dyscrasias are sulphonamides/cotrimoxazole implicated in?

A

Aplastic anaemia, Agranulocytosis, Megaloblastic anaemia, Hemolytic anaemia, drug induced thrombocytopenia

29
Q

Which blood dyscrasias are NSAIDs implicated in?

A

Aplastic anaemia, Hemolytic anaemia, Drug induced thrombocytopenia

30
Q

What is the 4T criteria for HIT?

A

Thrombocytopenia
Timing of platelet count fall (onset bet 5-10d, <= day 1 w Hx of heparin exposure within 30d)
Thrombosis or other sequelae (stroke, new thrombosis confirmed, skin necrosis, acute systemic rxn post IV UFH bolus)
Other causes of thrombocytopenia (None apparent)

Each pt goes on 0-2 scale. 4-6 pts: int-high probability

PR3154 Haematology & Musculoskeletal (12 decks)

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