Interactive Cases (Haematology) Flashcards
What do symptoms of anaemia depend on (3)
Age
Severity of anaemia
Speen of onset of anaemia
What are some symptoms of anaemia (5)
Weakness/fatigue Shortness of breath Lethargy Palpitations Cardiac failure (SOBOE, orthopnoea, PND, swollen ankles)
What are the general signs of anaemia (3)
Pale mucous membranes
Tachycardia
Cardiomegaly/CCF
What are some specific signs of anaemia (3)
Koilonychia (spoon nails) = iron deficiency
Glossitis (inflamed tongue) = B12 defiency
Jaundice = haemolysis
What are some causes of low MCV (3)
Iron deficiency
Thalassaemia
Anaemia of chronic disease (low or normal)
What are some useful investigations in a patient with anaemia (5)
FBC (including WCC, Hb, MCV) Reticulocyte count Haemolgobin electrophoresis Iron studies e.g. ferritin, transferrin saturation Blood film
What is a normal physiological response to anaemia
Reticulocytosis
What are some causes of reticulocytosis (3)
Haemolysis
Haemorrhage
Haematinics
When is anaemia present WITHOUT reticulocytosis (3)
Inadequate haematinics
Bone marrow failure (e.g. infiltration)
Acute major haemorrhage… reticulocyte response within 6 mouths which increases over 6-10 days.
What will be seen on the blood film in iron deficiency (4)
Pencil cells
Anisocytosis
Poililocytosis
Hypochromic
What are some sources of blood loss in iron deficiency anaemia (2)
Uterine - menstruation/ pregnancies
GI
What can cause pancytopenia (e.g. low Hb, low WBC, low platelets) (5)
Aplastic anaemia Leukaemia Infiltration (e.g. lymphoma, carcinoma) Drugs (e.g. chemotherapy) B12/folate deficiency
What are some useful investigations in pancytopenia (4)
Blood film
Vitamin B12 levels
Folic acid levels
Bone marrow
What are the principles of management in AML (2)
Supportive
Disease Related management
What are the principles of supportive care in AML (3)
Red cell transfusions
Platelet transfusions
Nurse in isolation - prompt antibiotics
What will cause anaemia and thrombocytopenia (2)
Not making platelets
Premature destruction of platelets
What are some causes of not making platelets (2)
Drugs (chemotherapy, thiazides)
Bone marrow disorders (leukaemia, aplastic, myelodysplasia, myeloma, infiltration with carcinoma)
What are some causes of premature destruction of platelets (3)
ITP (auto-immune)
Disseminated intravascular coagulation
Heparin
What are some investigations for thrombocytopenia (5)
Coagulation screen Blood film Bone marrow aspirate/trephine ANA/RAPA HIV
What will cause a low platelet and abnormal clotting (4)
DIC
Alcohol
Drugs
Leukaemia
What investigations could you do with low platelets and abnormal clotting (5)
Blood film D-dimer/FDPs Fibrinogen Blood cultures/CSR/MSU (septic screen) LFTs
What is the management for DIC (4)
Liase with the haematology team and the haem lab
Antibiotics
Blood products….Red cells, platelets, cryoprecipitate, FFP
Regular blood tests to assess response to products
