Anemia: TIBC finding to differentiate iron deficiency vs. chronic disease
TIBC levels at the:
Anemia causes (simplified)
ANEMIA:
- Anemia of chronic disease
- No folate or B12
- Ethanol
- Marrow failure & hemaglobinopathies
- Iron deficient
- Acute & chronic blood loss
Anemia (normocytic): causes
ABCD:
- Acute blood loss
- Bone marrow failure
- Chronic disease
- Destruction (hemolysis)
Anemia: non-megaloblastic causes of macrocytic anemia
HAND LAMP:
- Hypothyroidism
- Aplastic anaemia
- Neonates
- Drugs
- Liver disease
- Alcohol
- Myelodyplasia
- Pregnancy
Blood disorders: commoner sex
- HE (male) gets:
- HEmophilia (X-linked)
- HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
- HEmochromatosis (male predominance)
- HEart attacks (male predominance)
- HEnoch-Schonlein purpura (male predominance)
- SHE (female) gets:
- SHEehan's syndrome
Haematology: key numbers
- 3 and 4 are key in in haematology:
- 1.34 cm3 of oxygen is carried by a gram of hemoglobin.
- There's 3.4mg of iron in each gram of hemoglobin.
- There's an average of 3.4 lobes per neutrophil.
- There's 34mg bilirubin from each gram of hemoglobin
Hemoglobin and myoglobin: binding strengths, sites
"ABC" of glycosylated Hb (Hb1c):
*Glucose binds to Amino terminal of Beta Chain.
"HbF binds Forcefully":
*HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left.
Stored blood is SOS:
*Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG.
2,3 BPG binding site is BBC:
*BPG binds to Beta Chain of Hb.
Myoglobin binding strength is MOM:
*Myoglobin binds Oxygen More strongly than Hb.
Hemolytic anemia: types
SHEEP TIT:
- Sickle cell
- Heriditary splenocytosis
- Enzyme deficiencies: [G6P, pyruvate kinase]
- Erythroblastosis fetalis
- Paroxysmal nocturnal hemoglobinuria
- Trauma to RBCs
- Immunohemolytics: [warm Ab, cold Ag]
- Thalassemias: [alpha, beta]
Hemophilia: type A factor
- Hemophilia A: problems with VIII factor (number V as an inverted A).
Hodgkin's lymphoma: classification
- A: Asymptomatic
- B: Bad
Leukemias: acute vs. chronic rules of thumb
ABCDE
- Acute is:
- Blasts predominate
- Children
- Drastic course
- Elderly
- Few WBC's (so Fevers)
*Chronic is all the opposites:
- Mature cells predominate
- Middle aged
- Less debilitating course
- Elevated WBC's, so not a history of fevers and infections
Macrocytic anemia: causes
ABCDEF:
- Alcohol + liver disease
- B12 deficiency
- Compensatory reticulocytosis (blood loss and hemolysis)
- Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
- Endocrine (hypothyroidism)
- Folate deficieny/ Fetus (pregnancy)
Macrocytic anaemia: differential
FAT RBC:
- Fetus (pregnancy)
- Alcohol
- Thyroid disease(ie hypothyroidism)
- Reticulocytosis
- B12 and folate deficiency
- Cirrhosis and chronic liver disease
Marble bone disease: signs and symptoms
MARBLES:
- Multiple fractures
- Anemia
- Restricted cranial nerves
- Blind & deaf
- Liver enlarged
- Erlenmeyer flask deformity
- Splenomegaly
*Eponymous name: Marbles = Albers-Schonberg (anagram).
Megaloblastic anemia: vitamin B12 deficiency vs. folate deficiency
- Vitamin B12 deficiency also affects Brain (optic neuropathy, subacute combined degeneration, paresthesia).
*Folate deficiency is not associated with neurological symptoms.
Microcytic anemia: causes
"Find Those Small Cells":
- Fe deficiency
- Thalassemia
- Sideroblastic
- Chronic disease
Pancytopaenia: differential
"All Of My Blood Has Taken Some Poison":
- Aplastic anaemias
- Overwhelming sepsis
- Megaloblastic anaemias
- Bone marrow infiltration
- Hypersplenism
- TB
- SLE
- Paroxysmal nocturnal haemoglobinuria
Polycythemia Rubra Vera (PRV): common symptoms
PRV:
- Plethora/ Pruritis
- Ringing in ears
- Visual blurriness
Sickle cell disease: complications
SICKLE:
- Strokes/ Swelling of hands and feet/ Spleen problems
- Infections/ Infarctions
- Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
- Kidney disease
- Liver disease/ Lung problems
- Erection (priapism)/ Eye problems (retinopathy)
Symptoms of TTP/HUS
"Nasty Fever Ruined My Tubes":
- Neurological symptoms
- Fever
- Renal failure
- Microangiopathic hemolytic anemia
- Thrombocytopenia
Thrombotic thrombocytopenic purpura: signs
FAT RN:
- Fever
- Anemia
- Thrombocytopenia
- Renal problems
- Neurologic dysfunction
TTP: clinical features
Thrombosis and thrombocytopenia PARTNER together:
- Platelet count low
- Anemia (microangiopathic hemolytic)
- Renal failure
- Temperature rise
- Neurological deficits
- ER admission (as it is an emergency)