ic7 (anaemia)

Question 1

What are some physical examinations that indicate anaemia

Answer 1

Pale / Pallor
Jaundice - indicate haemolytic anaemia, liver cannot clear bilirubin

Question 2

What is the cut off for severe anaemia in women (non pregnant and pregnant), males

Answer 2

Females (non pregnant) and Males: < 8
Pregnant: < 7

Question 3

What is Microcytic anaemia

What to test?

What are the types of anaemia?

What to exclude?

Answer 3

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

Question 4

What causes iron deficiency anaemia? (2 points)

Answer 4

1) Decreased iron absorption (due to gastric inflammation, bypass)

2) Blood loss, active bleed

Question 5

Treatment for iron deficiency anaemia?

Answer 5

PO 200mg elemental iron for 3-6 months
Use iron polymaltose

Question 6

What kind of anaemia is iron deficiency anaemia?

Answer 6

Microcytic anaemia, with low serum ferritin

Question 7

What kind of anaemia is Anaemia of Chronic Disease?

Answer 7

Microcytic anaemia, high ferritin, low TIBC (transferrin)

Question 8

Causes of Anaemia of chronic disease? (6 points)

Answer 8

Rheumatologic disorders
Cancer
Heart failure
Renal insufficiency (CKD)
COPD
HIV

Question 9

What is macrocytic anaemia?

What to test for?

Answer 9

High MCV

test for folate vitamin b9, cobalamin vitamin b12 levels

Question 10

what kind of anaemias can gastric bypass / malabsorption cause?

Answer 10

megaloblastic (vit b12 deficiency)
microcytic (iron deficiency)

Question 11

Where is vitamin b12 found?

How is vit b12 deficiency caused

Answer 11

in meat

Caused by reduced Intrinsic Factor or Gastric disruption
Vegetarian
PPI, H.pylori infection

Question 12

Treatment for Pernicious anaemia

Answer 12

(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

Question 13

Treatment for Folate deficiency

Answer 13

1mg Folic Acid OD for 1-4 months

Question 14

3 drugs associated with Megaloblastic anaemia

How to treat?

Answer 14

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

Question 15

What is aplastic anaemia

How to diagnose Aplastic Anaemia?

Answer 15

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

Question 16

Drugs that can cause Aplastic Anaemia (5 points)

Answer 16

Cytotoxic therapy
Radiation therapy
Furosemide
Anti-thyroid eg. Carbimazole, PTU
Chloramphenicol

Question 17

Treatment for Aplastic anaemia (5 points)

Answer 17

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)

Question 18

What is Neutropenia

Answer 18

Absolute Neutrophil Count (ANC) < 1500 / uL

Question 19

What is Agranulocytosis

Answer 19

ZERO granulocytes

Also refer to severe Neutropenia (ANC < 500 / uL)

Question 20

3 causes of Agranulocytosis

Answer 20

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

Question 21

Treatment of Agranulocytosis (3 points)

Answer 21

Stop offending drug

If neutrophil less than 0.1 x 10^9
Use GCSF eg. Filgrastim SQ 300mcg OD

Restart Penicillins at lower dose

Question 22

Which antibodies cause haemolytic anaemia

Answer 22

IgG, IgM

Question 23

medical condition that causes haemolytic anaemia?

Which drugs or food can cause haemolytic anaemia? (3 points)

Answer 23

G6PD Deficiency

Ciprofloxacin
Glipizide
Fava beans

Question 24

How to diagnose Thrombocytopenia?

Answer 24

Platelet count ≤ 100 x 10^9 / L
OR
Greater than 50% reduction of platelets from baseline

Question 25

What are some drugs that can cause Thrombocytopenia?

Answer 25

Heparin
LMWH (rarely)
Eptifibatide

Question 26

How to treat Heparin Induced Thrombocytopenia?

Answer 26

Treat HIT with Dabigatran (off label)
Avoid drug indefinitely