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47 Cards in this Set

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Indications for blood transfusion? (4)
Hb<7g/dL
Acute>chronic bleed
Co-morbidity e.g. isch heart disease
Patient symptomatic
Giving transfusion to patients with heart failure, what can be added to ensure patient safety?
Co-prescribe furosemide
Common cause of B12 deficiency causing anaemia? (4)
Alcoholism
Pernicious anaemia
IBD - crohns + UC
Dietary (vegans)
What is schilling's test?
Investigation pernicious anaemia

Patient given radioactive B12 - im + oral and measure B12 in urine.
Where is Vit B12 absorbed in the gut?
Terminal ileum (hence decreased in crohns)
What is a megaloblastic anaemia?
B12 + folate deficiency lead to megaloblastic anaemia.

A megaloblast is a cell with immature nuclei.

Blood film often shows hypersegmented neutrophils.

Causes: Pernicious anaemia, folate + B12 def, coeliac disease
Non megaloblastic cause of macrocytic anaemia?
Alcohol
Haemolysis
Liver disease
Hypothyroidism
Pregnancy
What is aplastic anaemia?
Bone marrow fails to produce sufficient blood cells = Pancytopenia usually idiopathic.

Can be secondary to bone marrow failure (myeloma, acute leukaemia, myelodysplasia, lymphoma, tumours, myelofibrosis, SLE, hypersplenism)
What is fanconi anaemia?
Autosomal recessive disorder leading to an aplastic anaemia.
Features assoc fanconi anaemia?
Increased risk AML
Absent radii
Short stature
Microcephaly
Syndactyly (fingers fused)
Cryptorchidism (absence 1 or both testis)
Deafness
Low IQ
Causes normochromic normocytic anaemia?
Chronic disease
Aplastic anaemia
Blood loss
Haemolytic anaemia (some)
Ix autoimmune haemolytic anaemia?
Normochromic normocytic anaemia
Unconjugated hyperbilirubinaemia
Direct coombs test +ve

NB can subdivide these into warm + cold types based on whether coombs test bind best under or over 37 C
Common cause of warm autoimmune haem anaemia?
SLE
Diagnosis of AML
Myeloblasts in marrow + blood
Intrinsic pathway is.....
8,9,11,12

Measure APTT
Extrinsic pathway is....
7, 10

Measure INR (PT)
Final common pathway....
Prothrombin, thrombin, fibrinogen, fibrin, XIII
Rx DVT in pregnancy?
Warfarin (INR2-3)
Rx PE in pregnancy
Thrombolysis
Rx patients with peptic ulcer disease (not currently bleeding) needing anti-coagulation after surgery?
Low molecular weight heparin (e.g. enoxaparin)
Rx patient AF where warfarin is contraindicated?
Phenindione
Rx antiphospholipid syndrome?
Warfarin aim INR 3-4.5
Sx antiphospholipid syndrome?
AA + VV thrombosis
Migraine
Miscarriages
Thrombocytopenia
Livedo reticularis

Rx lifelong warfarin
aspirin decreases risk miscarriage
FBC suggesting megaloblastic anaemia?
Macrocytosis
Neutropenia
Anaemia

2nd B12 or folate def
Phenytoin can cause what anaemia?
Folate def in epileptics (megaloblastic anaemia)
A microcytic anaemia presenting at pregnancy is suggestive of?
beta Thalassaemia minor

Suggested by a fall in MCV with an increase in RCC
Multiple myeloma is commoner in who?
Afro-carribean
Men
Elderly

IX: boney pain + hypercalcaemia
Causes of eosinophilia? (8)
Metazoa (not protozoa) infection.

Hookworm
Hodgkins lymphoma
Asthma
Bronchial aspergilloma
Churg straus
PAN
Loefflers endocarditis
Pulmonary eosinophilia
Increased bleeding time in....(2)
vW disease
Immune thrombocytopenic purpura

NB increased in factors affecting platelets. In factors affecting clotting factors e.g. haem A + B no increase is seen.
Iron levels in Fe def anaemia? (3)
Serum iron + ferritin levels are low.
TIBC often raised
Microcytic anaemia is due to? (4)
Thalassaemia
Fe def
Vit A+C def
Megaloblastic anaemia is due to deficiency of...? (3)
B12
Folate
Cobalamin
Where is Fe absorbed?
Duodenum
Red cell destruction is associated with which biochemical results?
Decreased haptoglobulins - these bind free haemoglobin and may drop if severe haemolysis

Increased methaemalbumin - which is the way haemoglobin when needs cannot be met by haptoglobins

Haemosiderinuria - brown urine secondary to haemolysis. Yet another haemoglobin storage structure lost in urine.
What is haemolytic anaemia of the newborn?
ABO mediated autoimmune reaction

Is less severe than Rh mediated haemolysis
Ix of DIC?
Increased APTT, PT, TT
Decreased fibrinogen
High d-dimer/fibrin degrad products
Shistocytes (fragmented RBCs - microangiopathic haemolysis)
Crisis in sickle cell disease?
Aplastic - 2nd to parvovirus B19 infect

Veno-occlusive - with priapism and mesenteric dysfunct

Sequestration - hypersplenism leading to anaemia and shock
Use of hydroxyurea in sickle cell disease?
Raise HbF to prevent painful crisis

SE = neutropenia
Low TIBC suggests?
Fe def anaemia
Anaemia chronic disease
Causes of low MCV?
Fe def anaemia
Thalassaemia
Anaemia chronic disease
Sideroblastic anaemia
Lead poisoning
What is sideroblastic anaemia?
Ineffective erythropoiesis leading to increased iron absorption

Causes: idiopathic, myelodysplasia, chemo, radio
Causes of macrocytic anaemia?
2 Types
1) Megaloblastic - B12, folate

2) Non megaloblastic - alcohol, liver disease, hypothyroidism, pregnancy, reticulocytosis, drugs (chemo, azathioprine)
What is ITP?
Immune thrombocytopenic purpura - antiplatelet autoantibodies. Assoc with illness in kids.

Sx: epistaxis + menorrhagia in women

Ix: thrombocytopenia
Appearance FBC in B12 def
Megaloblastic anaemia

+

Hypersegmented neutrophils

+

thrombocytopenia
Ix vWf disease?
APTT + PT = normal
Decreased platelet adherance = increased bleeding time

Rx: recombinant factor VIII
Appearance of blood film in pt with hereditory Elliptocytosis?
Elliptocytes (cigar shaped red blood cells)
Where is folate absorbed?
Jejunum (therefore coeliac disease can lead to a macrocytic anaemia - fe def more common)