JB-Blood Flashcards
Where is most iron absorbed
Duodenum and jejunum
One medication and two conditions most associated with poor iron absorption
PPIs
Crohns and Coeliac
(Menstruation)
When is iron contraindicated
In patients with sepsis as ‘feeds’ infection
Key question to ask in anaemia hx
Menstruation history
GI
Difference between anaemia of chronic disease and iron deficiency
TIBC low in AOCD, high in IDA
Ferritin high in AOCD, low in IDA
5 causes of microcytic anaemia
TAILS
Thalassaemia
Anaemia of chronic disease
IronDA
Lead poisoning
Sideroblastic anemia
Test for pernicious anaemia
FBC + B12
Intrinsic factor antibodies
Group of symptoms found in pernicious anaemia
Neurological
Peripheral neuropathy
Loss of vibration and proprioception
Visual changes and mood changes
Pernicious anaemia treatment
Oral B12 only works in pts with dietary deficiency
B12 IM (hydroxycobalamin) 3 times weekly for 2 weeks then 3 monthly
In patients with B12 and folate deficiency what must be treated first
B12 first
Folic acid to B12 deficiency patients can cause degeneration of cord
How to differentiate IronDA and minor thalasemia on FBC
MCV very very low in minor thalassemia (20/30)
IDA, glossitis and dysphagia/ oesophageal web
Plummer Vinson syndrome
When are hypersegmented neutrophils seen
Macrocytic anaemia (B12)
Clinical difference between B12 and folate deficiency
No neurological defect in folate deficiency
Disease where swellings get more painful with alcohol
Lymphoma (normally non-tender rubbery)
Age distribution of lymphoma
Bimodal
20 and 75 years
Key finding on biopsy in patients with Hodgkin lymphoma
Reed-Sternberg cells present
Appearance of Reed Sternberg cells
Abnormally large B cells
Multiple nuclei
(look like an owl)
Staging criteria in lymphoma
Ann Arbor
What infection is MALT lymphoma associated with
H pylori
Key diagnostic history in diffuse large B cells lymphoma
Rapidly growing single painless mass in pt over 65
Unique chemical risk factor in lymphoma
Pesticide (trichloroethylene)
What is myeloma a cancer of
Plasma cells (B antibodies)
What is MGUS
Monoclonal gammopathy of undetermined significance
An excess of a single type of antibody which out features of cancer.
It may progress to myeloma so must be closely monitored
What is Smouldering myeloma
Progression of MGUS
Increasing number of antibodies are formed.
Increased chance of myeloma
What is Smouldering myeloma
Progression of MGUS
Increasing number of antibodies are formed.
Increased chance of myeloma
What is a Bence Jones protein and why is it significant
Protein in urine of patients with myeloma from Ab breakdown
Urine test in myeloma patients
Bence Jones protein
Calcium level in myeloma
Raised
Increased osteoclast activity as increased cytokines from all the plasma cells
Myeloma effect on bones
Increased osteoclast and suppressed osteoblast activity
More bone is absorbed than constructed
Pathological fractures and osteolytic (thin) bone
Effect of myeloma on kidneys
Myeloma renal disease
High ab levels block flow of blood through tubules
High levels of Ca2+ and therefore dehydration
4 key features of myeloma
CRAB
Calcium (raised)
Renal failure
Anaemia (normocytic)
Bone lesions
Two key investigations if patient has signs of myeloma on routine bloods
Serum protein electrophoresis
Urine Bence-Jones protein
Myeloma effect of blood viscosity
Increased
(?sticky blood as more Ab’s)
Effect of myeloma on FBC
Anaemia (normal MCV)
Low WBCs
ESR raised
Plasma viscosity raised
Investigation to confirm myeloma
Bone marrow biopsy
X ray signs of myeloma
Punched out lesions
Lytic lesions
Raindrop skull
What is Thalassemia
A inherited condition which results in a reduction in the production of haemoglobin
What blood film is seen in thalassemia
Schistocytes (fragments of RBCs)
What special test is used to diagnose autoimmune haemolytic anaemia
Direct Coombs test
What is the most common cause of haemolytic anaemia (in Europeans
Hereditary spherocytosis
Most common presentation in patients with undiagnosed hereditary spherocytosis
Aplastic crisis (with parvovirus infection), jaundice, gallstones, splenomegaly.
Treatment of hereditary spherocytosis
Folate and splenectomy (+/- cholecystectomy)
Blood film finding in patients with G6PD deficiency
Heinz bodies
Inheritance of G6PD
X linked
Common causes of G6PD triggers
Fava beans, antimalarials, ciprofloxacin sulfasalazine, sulfonyureas (other sulphonamide drugs)
Two types of Autoimmune Haemolytic Anaemia
Warm - idiopathic
Cold - antibodies attach themselves to RBC at temperatures below 10C. Often secondary to other conditions (blood cancers, SLE, EBV, HIV)
What type of Autoimmune Haemolytic Anaemia is normally secondary?
Cold - blood cancers, SLE, EBV, HIV
Two types of Alloimmune Haemolytic Anaemia
Transfusion reactions and haemolytic disease of the newborn
Key complication of prosthetic heart valves
Haemolytic anaemia
Inheritance of thalassemia
AR
Possible effect on facial features in thalassemia
Pronounced forehead
Malar eminences (cheek bones)
Caused by expanding bone barrow
MCV in thalassemia
Low
Diagnosis of thalasseamia
Haemoglobin electrophoresis/ DNA testting
Offered to pregnant women at booking
Most common complication of thalassaemia
Iron overload
What is Richter’s transformation
CLL transforms to high grade non-Hodgkin lymphoma.
Patients become suddenly unwell with B symptoms
CLL -> lymphoma non-Hodgkin transformation name
Richters
How is sickle cell anaemia confirmed
Haemoglobin electrophoresis
Key drug in sickle cell management
hydroxyurea
Increases HbF
