Red Cells Continued Flashcards

1
Q

What does PNH stand for?

A

Paroxysmal nocturnal haemoglobinuria

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2
Q

What is PNH?

A

Acquired disorder leading to haemolysis (mainly intravascular) of haematological cells

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3
Q

Pathology of PNH

A

Increased sensitivity to the cell membranes of complement due to the lack of GPI

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4
Q

What are patients with PNH more prone to?

A

Thrombosis

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5
Q

Presentation of PNH

A
Haemolytic anaemia
May have pancytopenia
Haemoglobinuria 
Thrombosis e.g. Budd chiari syndrome 
Some patients may develop aplastic anaemia
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6
Q

What is haemoglobinuria?

A

Classically dark coloured urine in the morning

Can occur throughout the day

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7
Q

Investigation of PNH

A

Hams test

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8
Q

What is hams test?

A

Acid induced haemolysis (normal red cells would not)

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9
Q

Treatment of PNH

A

Blood product replacement
Anticoagulation
Stem cell transplant

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10
Q

What is the most common cause of haemolytic anaemia in patients with G6PD deficiency?

A

Ciprofloxacin

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11
Q

Who with sickle cell anaemia should have a low threshold for hospital admission?

A

In a child
Person with temp over 38C (risk of rapid deterioration)
Person with chest symptoms (as acute chest syndrome may develop quickly)

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12
Q

Investigation for hereditary spherocytosis

A

EMA binding test

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13
Q

When does intravascular haemolysis occur?

A

RBCs rupture in the vessel and are bound to haptoglobin to be excreted in the urine

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14
Q

When does extravascular haemolysis occur?

A

Phagocytosis of RBCs

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15
Q

What systemic disease is a cause of autoimmune haemolytic anaemia?

A

SLE

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16
Q

How long does oral iron tablets take to work?

A

2 - 4 weeks

17
Q

How long does it take for oral iron tablets to change blood results?

A

2 - 3 months

18
Q

What is mixed anaemia and what may it present as?

A

Both vit B12 and iron deficiency anaemias

Normocytic anaemia

19
Q

What crises are recognised with sickle cell disease?

A
Chest crisis
Thrombotic 'painful' crisis
Sequestration 
Aplastic
Haemolytic
20
Q

Thrombotic crisis is also known as what?

A

Painful crisis

Vaso-occlusive crisis

21
Q

What is thrombotic crisis precipitated by?

A

Infection
Dehydration
Deoxygenation

22
Q

Features of thrombotic crisis

A

Infarcts occur in various organs including

  • Bones (e.g. avascular necrosis of the hip)
  • hand foot syndrome in children
  • lung
  • spleen
  • brain
23
Q

Explain sequestration crisis

A

Sickling within organs such as the spleen or the lungs, causing pooling of blood with the worsening of anaemia
Increased reticulocytes

24
Q

What is the most common cause of death in sickle cell disease after childhood?

A

Acute chest crisis

25
What is aplastic crisis caused by?
Infection with parovirus
26
What does aplastic crisis cause?
Sudden fall in Hb | Reduced reticulocytes
27
Pathology of haemolytic crisis
Fall in Hb due to an increased rate in haemolysis
28
How often do sickle cell patients receive a pneumococcal vaccine?
Every 5 years
29
What type of diet is a risk factor for B12 deficiency?
Vegan
30
What anaemia does sickle cell disease cause?
Normocytic with increased retics
31
Explain hand foot syndrome in children
Sickling of RBCs interfering with the circulation in the hands and feet Results in swelling, pain and erythema with a sudden onset Sickle cell disease
32
What symptom would point towards splenomegaly?
"Stomach fullness"
33
In all people with iron deficiency anaemia, what should they be screened for?
Coeliac disease
34
What does a disproportionally low microcytic anaemia indicate?
Beta-thalassaemia trait
35
What can parovirus precipitate if you have hereditary spherocytosis?
Haemolytic crisis