ic7 (anaemia) Flashcards
What are some physical examinations that indicate anaemia
Pale / Pallor
Jaundice - indicate haemolytic anaemia, liver cannot clear bilirubin
What is the cut off for severe anaemia in women (non pregnant and pregnant), males
Females (non pregnant) and Males: < 8
Pregnant: < 7
What is Microcytic anaemia
What to test?
What are the types of anaemia?
What to exclude?
Smaller cells than normal
Need to test for serum ferritin and TIBC
If ferritin (stores low),
= iron deficiency anaemia
If ferritin normal or high (means inflammation), TIBC low
= Anaemia of Chronic Disease
Need to exclude bleedingas it is main cause of iron deficiency anaemia
What causes iron deficiency anaemia? (2 points)
1) Decreased iron absorption (due to gastric inflammation, bypass)
2) Blood loss, active bleed
Treatment for iron deficiency anaemia?
PO 200mg elemental iron for 3-6 months
Use iron polymaltose
What kind of anaemia is iron deficiency anaemia?
Microcytic anaemia, with low serum ferritin
What kind of anaemia is Anaemia of Chronic Disease?
Microcytic anaemia, high ferritin, low TIBC (transferrin)
Causes of Anaemia of chronic disease? (6 points)
Rheumatologic disorders
Cancer
Heart failure
Renal insufficiency (CKD)
COPD
HIV
What is macrocytic anaemia?
What to test for?
High MCV
test for folate vitamin b9, cobalamin vitamin b12 levels
what kind of anaemias can gastric bypass / malabsorption cause?
megaloblastic (vit b12 deficiency)
microcytic (iron deficiency)
Where is vitamin b12 found?
How is vit b12 deficiency caused
in meat
Caused by reduced Intrinsic Factor or Gastric disruption
Vegetarian
PPI, H.pylori infection
Treatment for Pernicious anaemia
(if due to absorption issues)
IM or SQ 1000ug daily for 1 week,
then 1000ug weekly for 1 month
then 1000ug monthly for life
(Other causes) 1000 - 2000ug daily oral or parenteral
Treatment for Folate deficiency
1mg Folic Acid OD for 1-4 months
3 drugs associated with Megaloblastic anaemia
How to treat?
1) Methotrexate
Hold off
2) Co-trimoxazole
Give folinic acid 5-10mg QDS
3) Phenytoin, Phenobarbital
Inhibit folate absorption or Catalyse folate catabolism
Folic acid 1mg/day
What is aplastic anaemia
How to diagnose Aplastic Anaemia?
All 3 lines of haem disorders
(Have 2 of)
WBC ≤ 3.5 X 10^9 / L
Platelet count ≤ 55 x 10^9
Haemoglobin ≤ 10 + Reticulocyte count ≤ 30 x 10^9 / L
Drugs that can cause Aplastic Anaemia (5 points)
Cytotoxic therapy
Radiation therapy
Furosemide
Anti-thyroid eg. Carbimazole, PTU
Chloramphenicol
Treatment for Aplastic anaemia (5 points)
1) Hold off offending drug
2) (if neutrophil counts below 0.5 x 10^9) Prophylactic antibiotics and antifungals
3) (during febrile neutropenia) Start broad spectrum antibiotics
4) Provide blood transfusion with rbc and platelets
If heavily transfused, iron chelation therapy with Deferoxamine, Deferasirox needed to avoid iron overload
5) May require allogeneic hematopoietic stem cell transplant and Ciclosporine (immunosuppressive therapy)
To treat the cause of Drug Induced Aplastic Anaemia (which is immunogenic in nature)
What is Neutropenia
Absolute Neutrophil Count (ANC) < 1500 / uL
What is Agranulocytosis
ZERO granulocytes
Also refer to severe Neutropenia (ANC < 500 / uL)
3 causes of Agranulocytosis
1) Thyroid medications eg. PTU,Carbimazole
HLA alleles associated
2 months of initiating
2) Clozapine and other Phenothiazines
Peak onset 3-4 weeks
3) Beta lactam antibiotics
Rapid onset
Need to renally adjust dose
Treatment of Agranulocytosis (3 points)
Stop offending drug
If neutrophil less than 0.1 x 10^9
Use GCSF eg. Filgrastim SQ 300mcg OD
Restart Penicillins at lower dose
Which antibodies cause haemolytic anaemia
IgG, IgM
medical condition that causes haemolytic anaemia?
Which drugs or food can cause haemolytic anaemia? (3 points)
G6PD Deficiency
Ciprofloxacin
Glipizide
Fava beans
How to diagnose Thrombocytopenia?
Platelet count ≤ 100 x 10^9 / L
OR
Greater than 50% reduction of platelets from baseline
