Medicine

• Causes of microcytic anaemia < 80 =

  • Iron deficiency
  • Thalassaemia trait
  • anaemia of chronic disease
• Causes of normocytic anaemia 80 - 100 =

  • renal failure
  • MDS + myeloma
  • haemolysis + recent bleed
• Causes of macrocytic anaemia > 100 =

  • B12 / folate deficiency
  • liver disease - alcohol excess
  • pregnancy
  • hypothyroidism
• Hb and MCV

  A) haematocrit

  B) polycythaemia

  
• Multiple myeloma =

  Progressive malignant disease characterised by

  • proliferation of abnormal plasma cells in bone marrow
  • abnormal monoclonal immunoglobulins in blood

  Prognosis worse if =

  • renal failure
  • hypercalcemia
  • several lytic lesions
  • high beta-2-microglobulin
  • high plasma cells
• Multiple myeloma symptoms

  • bone pain
  • fatigue
  • hypercalcaemia
  • weight loss
  • hyperviscosity
• Investigations into myeloma =

  Immunofixation of serum + urine = confirm paraprotein

  Bone marrow aspirate = confirm monoclonal plasma cells

  MRI (gold standard) = extent of myeloma bone disease
• Myeloma treatments =

  Bisphosphonates = reduced bone disease + pain

  Treat anaemia = EPO or blood transfusion

  Chemotehrapy

  Steroids

  Immunomodulatory drugs

  Stem cell transplant

  DVT prophylaxis
• CLL presentation =

  Mild + vague symptoms

  • lymphadenopathy
  • weight loss
  • persistent infections + anaemia (LATER)
  • Bleeding + bruising (LATER)
• Staging CLL =

  A = < 3 groups of lymph nodes + raised WCC

  B = > 3 groups of lymph nodes + raised WCC

  C = enlarged lymph nodes or spleen + raised WCC + low RCC/platelets
• Treatment for CLL =

  • chemotherapy
  • targeted cancer drugs
  • monoclonal antibodies