Random Flashcards
> 60 w Iron def. anaemia pathway
2 week wait colonoscopy
Causes of IDA
Blood loss
Diet
Malabsorption
How to treat IDA
Ferrous sulphate tablets for 4 weeks at least, continue until normal MCV +RBC
Continue for further 3 months
When give iral monofer and ferijet in IDA
True intolerance to oral iron
Malabsorption eg IBD
What do you look for in severe hypoperfusion?
Deranged LFTs -> ischaemia of liver
What bloods do in haemorrhaging
Group and save, crossmathc coag panel, FBC, U+Es
Haemorrhaging management
Bloods
ECGs
Transfusion O nrgative RBC - 4 initially
Fresh frozen plasma - 1:1 with bloob
ECG,CXR
Causes if thrombocytopenia
AI
Infection - EBV/CMV
Pregnancy
Drugs -> bone marrow failure
ITP
TTP
Chemo
Aplastic anaemia
Deranged clotting + clinically unwell = DIC
Rule for platelet transfusions
<10 = transfuse
ITP - dont trasnfuse, steroids instead
Prolonged PT causes
Liver disease
Warfarin
Vit K deficiency
Factor deficiency
#DIC
Antiphoph. antibodies
Haemorrhagic stroke
INR thin/thick what level
4 = v thin blood
<1 = v thick
What is TACO
transfusion acute circulatory overload
What is TRALI
TRALI = Transfusion related acute lung injury
TACO vs TRALI
TACO -> raised BP
TRALI - hypotnesive
Treatment for TACO/TRALI
STOP INFUAION
ocygen
Diuretics, treat HF
ICU
Acute chest syndrome in sickle cell treatment
Bronchodilator nebs
Management for acute chest syndrome in sickle cell
A-E
Pain control
ABG
Hydroxyalbumide - incentive spirometry
Transfusion
Antiphospholipid syndrome
Miscarriages, prolonged APTT with clots
What artery would cause speech changes and R sided heiparesis in TIA
LAnterior cerebral artery
What bloods would be raised in primary proliferative polycythaemia
Hb, WCC, platelets
Why mihgt someone with polycythaemia have IDA
+raised haemotaocrit
Overproducition of RBC exhausts iron stores
CML vs primary proliferative polycythaemia
CML - normal Hb, v high WCC w neutrophils and myelocytes
myelofibrosis and myeloma affect on Hb
Anaemia - low
What causes primary polycythameia
Haemotopoietic stem cell defect
Mutation in JAK2 gene
How can PCKD, HCC and COPD cause polycythaemia
PCKD ad HCC -> inappropriate EPO production
COPD - tissue hypoxia increases EPO
What anaemia can hypothyroidism cause
Macrocytic
What would an abdominal mass in primary polycythaemia represent
Enlarged spleen - US abdomen, exclude renal carcinomas that can also cause EPO
Treatment options polycythaemia
Weekly vensection til Hct 0.45
Aspirin - antiplatelet
Cyto-reductive therapy - reduce platelets w interferon or hydroxycarbamide
What is an elevated Hct ass with
Cerbro vascular events and MIs
Do you need to test for H pylori before treating with duodenal ulcer
no - immediately commence no need for CLO test
Non invasice tests for h PYLORI
Stool test
Urea breath test
What do with gastric ulcer w h.pylori therapy
Recommend test first as less are due to HP - confirm status before treat + biopsy helps rule out malignancy (CLO test invasice)
Invasive tests H.pylori
CLO
Histolgical exam and culture
pH rises above 6.0 with H.pylori due to urea -> ammonia in half na hour
Complication of polypectomy casuing rebound tenderness
Colonic perforation
What should not be used in sickle cell ciris pain managmenet
Pethidine - only if severly allergic to opioids
What monitor opioid patients for
RR, sedation and hypoxia
When use transfusion in sickle cell
Symptomatic anaemia, falling Hb or low reticulocyte count
20 Hb below steady state
When give IV fluids in sickle cell crisis
When cn no longer tolerate oral 2-3L per day
Complications of sickle cell
CVA, seizures, hearing loss
Avascular necrosis of hip
Renal papillary necrosis - haematuria, rneal tubular defects, difficulty concentrating urine
Arthritis
Osteomyeltiis
Chronic leg ulceration
Visual - proliferative retinopathy esp in HbSC disease - retinal screening
Is splenic rupture a complication of sickle cell
NO -. hyposlpenism
B12 deficiency causes
Crohns
Veganism
Post fastrecetomy
Pernicious anaemia - AI gastritis B12 intrinsic factor. Ass with other AI disorders
AI disorders ass with pernicious anameia
s Hashimoto’s hypothyroidism, hypoparathyroidism, Addison’s disease and vitiligo
If low in B12 and folate how replace and why
B12 first then folate
Risk of Subacute combined degne of spinal cord if folate without B12
Polycythaemia signs and symptoms
headaches
confusion
dizziness
blurred vision
night sweats
itching (pruritis)
extreme tiredness (fatigue)
unusual bleeding such as nosebleeds, bruising easily or heavy periods
red-looking eyes
red-looking skin (this may be harder to see on darker skin tones)
a swollen spleen, causing a feeling of fullness or pain after eating small amounts
gout, causing pain in your joints.
Splenomegaly
What type of disease is PV
myeloproliferative neoplasms (MPNs).
Risk in polycythaemia
Increased blood viscosity - increased incidence of VTE eg stroke, MI, DVT/PE
Secondary causes of Polycythaemia vera
hronic lung disease or congenital heart disease, or inappropriate erythropoietin production e.g. from hepatocellular carcinoma.
