IC7 Flashcards
What to check for low MCV?
Serum ferritin
Low serum ferritin hints at which type of anaemia?
Iron-deficiency anaemia
What to test if serum ferritin is high/normal?
TIBC
Type of anaemia: High/normal serum ferritin, low TIBC
Anaemia of chronic disease
Cause of High/normal serum ferritin, high/normal TIBC
Suspect lead intoxication, thalassemia or sideroblastic anaemia
What to check for high MCV?
Folate and B12 level
Significance of normal folate and normal B12
Consider
- hepatic disease
- drug-induced anaemia
- hypothyroidism
- reticulocytosis
What to measure if Hb is low, to determine cause of anaemia?
MCV
What to measure if normal MCV?
Reticulocyte count
Cause of anaemia: Normal MCV, high reticulocyte
Haemolysis, acute blood loss, splenic sequestration
Side effect for too much iron
GI side effects e.g. constipation
Examples of anaemia of chronic disease
CKD, IBD, rheumatoid arthritis
Anaemia of chronic disease is also known as anaemia of ____
inflammation
Two types of microcytic anaemia
1) Iron-deficiency anaemia
2) Anaemia of inflammation
Vegetarian obtain minimal ___ from diet
Vitamin 12 (usually found in meat)
Role of intrinsic factors
Absorb vit B12
Cobalamin is also known as ____
Vit B12
Treatment for pernicious anaemia
Parenteral (IM or SQ) vitamin B12:
1) 1000 𝝻g daily for 1 week followed by
2) 1000 𝝻g weekly for 4 weeks followed by 3) 1000 𝝻g monthly for life
Treatment for Vit B12 (excluding pernicious anaemia)
Oral vit B12: 1000 𝝻g or 2000 𝝻g daily
Cause of pernicious anaemia
Autoimmune condition - presence of autoantibodies to intrinsic factor
Folate is also known as ____
Vit B9
Treatment for folate deficiency
1 mg/d of folate for 1 to 4 months or until hematologic recovery is achieved.
Vitamin B12, 1000 𝝻g orally given daily, is absorbed by ____, not relying on the action of _____
mass action; intrinsic factor
Vit B12 / folate deficiency anaemia is also known as _____
Megaloblastic anaemia
Diagnosis of aplastic anaemia
Presence of any 2:
1) WBC count ≤ 3,500 cells/mm3 (3.5 × 10^9/L)
2) Platelet count ≤ 55,000 cells/mm3 (55 × 10^9/L)
3) Haemoglobin value ≤ 10 g/dL (100 g/L; 6.21 mmol/L) + reticulocyte count ≤ 30,000 cells/mm3 (30 × 10^9/L)
Goal of therapy: aplastic anaemia
Improve peripheral blood counts, limit the requirement for transfusions, and minimize the risk for infections.
Infection in aplastic anaemia: when to give prophylactic antibiotics/ antifungals?
when neutrophil counts are below 500 cells/mm3 (0.5 × 109/L)
Definition of neutropenia
Absolute neutrophil count (ANC) < 1500/𝝁L
Definition of agranulocytosis
Absence of granulocytes (ie, ANC of zero), although the term is often used loosely to indicate severe degrees of neutropenia (ie, ANC <100, <200 or even <500/microL)
Drugs causing agranulocytosis
Beta lactams, methimazole, sulfonamide, propylthiouracil, clozapine
Agranulocytosis: can offending agent be restarted?
Not recommended, but can consider restarting penicillin at lower dose (after the neutropenia has resolved without any recurrence of drug-induced agranulocytosis)
Drugs unsafe in G6PD deficiency
- FQ (-xacin)
- SU e.g. glipizide
- primaquine, tafenoquine
Chemical/food unsafe in G6PD deficiency
- Fava beans
- Henna compounds
- Naphthalene (moth ball, lavatory deodorant)
Is chloroquine/ hydroxychloroquine safe in G6PD deficiency?
Yes
Definition of thrombocytopenia
Platelet count ≤ 100,000 cells/mm3 (100 × 109/L) or > 50% reduction from baseline values
