NICE Flashcards
megaloblastic anaemia has immature nuclei due to what
defective DNA synthesis
most common cause of severe vitb12 deficiency in the UK
pernicious anaemia
drugs that can cause folate deficiency
alcohol and anticonvulsants
If folate levels are low, and the history suggests malabsorption, tests for anti-endomysial or anti-transglutaminase antibodies should be done (depending on the local laboratory) to exclude
coeliac
how to treat if got vitb12 def in people with neurological involvement
IM hydrococobalamin on alternate days then every 2 months
tretmetn for vitb12 def with no neurologiccal involvemetn
Initial treatment with hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks.
Maintenance treatment, usually with hydroxocobalamin 1 mg intramuscularly every 3 months for life — where B12 deficiency is not thought to be diet related.
what is the maintenace treatment if the vitb12 def is thought to be diet related
oral cyanocobalamin tablets or a twice-yearly hydroxocobalamin 1 mg injection
There is no gold standard test for measuring vitamin B12 deficiency, but the likelihood of deficiency can be determined by measuring
serum cobalamin
drugs that can cause vitb12 deficiency
Drugs — colchicine, metformin, nitrous oxide, protein pump inhibitors, H2-receptor antagonists.
maternal folate deficiency is associated with
prematurity
severe neuropathy does not occur with what deficinecy
folate
what is the onset of megaloblastic anaemia like
insidious
oval macrocytes, hypersegmented neutrohphils adn circulatig megaloblasts in
macrocytic anaemia
cobalamin levels are less accurate for determining b12 def in what pts
women taking contraceptive and in pregnancy
what levels indicate b12 and foalte defic
folate - seum folate
b12- serum cobalamin
what is the main cause of a rasied MCV in the abscence of anaemia
alcohol
should do what 7-10days after starting treatment for b12 or folate def
FBC and reticulocyte count
when to not prescribe folic acid
Pernicious anaemia or undiagnosed megaloblastic anaemia (unless also prescribing vitamin B12) — use of folic acid alone may precipitate subacute combined degeneration of the spinal cord.
Malignant disease (unless megaloblastic anaemia caused by folate deficiency is an important complication).
Hydroxocobalamin should not be given until
vitb12 def has been confirmed
what test most reliably correlates with relative total body iron stores
serum ferritin level - remeber is an acute phase protein
should get 2 week cancer referral if iron deficiency and over what age
60
hypochormic refers to
MCH -mean cell haemoglobin
what is the most common cause of iron deficiency anaemia in adult men or post menopausal woman
GI blood loss eg apsirin, nsaids, cancer
restless leg syndrome may be a sign of
iron deficiency anaemia
anisocytosis is the
variation in size of rbcs
poikilocytosis is the
presence of irregularly shaped rbcs
blood film of iron deficiency anaemia may show microctyic and hypochromic and characterisitc pencil cells in who
preg woman
hypochromia may also occur in what
thalassamias
what are both associated with an increase in serum iron and ferritin and a low total iron binding capacity
thalassaemia and sideroblastic anaemia
what may be a cuase of reversible sideroblastic anaemia
alcoholism
these can do what:
Zinc or magnesium salts (for example in antacids).
Calcium (for example in milk and dairy products).
Tannins (for example in tea, coffee, and cocoa).
Phytates (present in cereal grains, legumes, nuts, and seeds).
reduce the absorption of iron
what are reversible inhibitors of factor Xa
apixaban, rivaroxaban and edoxaban
what is dabiagtran
reversible inhibitor of free thrombin, fibrin-bound thrombin, and thrombin-induced platelet aggregation.
what anticoagulatns are licenesed for after elective hip or knee replacement surgery
DOACs
what DOAC is licensed for prophylaxis of atherothrombotic events following an acute coronary syndrome (in combincation with aspirin alone or aspirin and clopidogrel)
rivaroxaban
why are anticoagulatns less good in arteries
as in arteries thrombi are mainly composed of platelets with little fibrin
what 4 things is warfarin licensed for
-Prophylaxis of systemic embolism in people with rheumatic heart disease and atrial fibrillation.
-Prophylaxis after insertion of prosthetic heart valves.
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Transient ischaemic attacks.
delayed reaction eg haemorrhage 24hrs after a dental extraction suggests a coagualtion disorder such as
haemophilia
brusing or excessive bleeding but occurs soon after trauma suggest what kind of disorder
platelet
ix if likely to have dvt based on wells score
US scan of leg
what are dalteparin, enoxaparin, and tinzaparin
LMWH- these should be adminsitered subcutaneously in cases of DVT
how should rivaroxaban be taken
with food
if prescribing warfarin for DVT what also needs to be prescribes for at least the first 5 days
LMWH or fondaparinux
what is the most common complication of anticancer tretemnt
febrile neutropenia - presence of fever in a person with neutropenia
symptoms that may occur with neutropenic sepssi
dysuria, diarrhoea, productive cough
drug that can mask an elevated temp
steriods
what might a first line choice for neutropenic sepsis be
piperacillin/ tazobactam
do platelets have a nucleus
no
leukemia that can cause thrombocytosis
CML
medication that can cause thrombocytopenia
heparin
the initial clinical manifestation in CML can be
isolated thrombocytosis
full blood count shows normochromic or macrocytic red blood corpuscles (RBCs) and morphological abnormalities such as oval macrocytic RBCs and granulocytes with the pseudo-Pelger-Huet anomaly (hypogranular and hypolobulated granulocytes).
myelodysplastic syndromes
erythrocytosis leads to increased what
blood viscocity
how to tell the difference between primary and secondary erythrocytosis
primary- reduced erythropoietin
second- raised erythropoietin
headache in hyperviscocity may be described as
sense of fullness in the head and neck
itch on contact with warm water think
polycythaemia vera
what 2 doacs can be given for PE as interim
apixaban or rivaroxaban
what globin chain is abnormal in sickle
beta
suddent onset of pain, infection, anaemia or priapism should suspect
sickle
what is a common presenting symptom in infants aged 9-18 months for sickle cell
dactylitis (painful swelling of the bones of the hands and feet)
what is the % chance that affected with sickle passes into onto their child
1 in 2
