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Haematology > 1: Diagnostic approach to anaemia > Flashcards

1: Diagnostic approach to anaemia Flashcards

1
Q

What is anaemia

A

Deficiency in haemoglobin

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2
Q

How can anaemia be classified

A
  1. By aetiology

2. Morphology

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3
Q

What is required to classify anaemia by morphology

A

FBC: Hb, MCV, MCHC

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4
Q

What defines anaemia in males

A

Hb < 135

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5
Q

What defines anaemia in females

A

Hb <115

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6
Q

What defines anaemia in the first-trimester of pregnancy

A

Hb < 110

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7
Q

What defines anaemia in the second or third trimester of pregnancy

A

Hb <105

Remember 2 + 3 trimester = 5

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8
Q

What defines post-natal anaemia

A

Hb < 100

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9
Q

After investigating for anaemia, what is performed next

A

MCV

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10
Q

What MCV defines microcytic anaemia

A

Less-than 80

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11
Q

What is a mnemonic to remember causes of microcytic anaemia

A

TINS

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12
Q

What are the 4 causes of microcytic anaemia

A

Thalasemia
IDA
Normocytic anaemia/ anaemia chronic disease (initially)
Sideroblastic

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13
Q

What MCV defines normocytic anaemia

A

80-100

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14
Q

What is a mnemonic to remember causes of normocytic anaemia

A

HARP-B

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15
Q

What are the causes of normocytic anaemia

A 
Hypothyroidism (or microcytic) 
Haemolysis (or microcytic)
Anaemia of chronic disease 
Renal failure 
Pregnancy
Bone marrow failure
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16
Q

What MCV defines macrocytic anaemia

A

> 100

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17
Q

What is the mnemonic to remember macrocytic anaemia

A

MR.CRAB

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18
Q

What are the causes fo macrocytic anaemia

A 
MDS or myeloproliferative
Reticulocytosis 
Cytotoxic drugs (hydroxycarbamide)
Relatively low thyroid 
Anti-folate medications (methotrexate, phenytoin, trimethoprim) 
B12 or folate deficiency
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19
Q

If a person has microcytic anaemia, what should be looked at next

A

Ferritin

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20
Q

What does a microcytic anaemia, with low ferritin indicate

A

IDA

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21
Q

explain transferrin saturation in IDA

A

Transferrin saturation will be low. As low iron means less RBC and therefore less sites on transferrin occupied

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22
Q

explain TIBC in IDA

A

TIBC will be high. As less RBC, there will be more spaces on transferrin to be occupied by RBC

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23
Q

explain RDW in IDA

A

Wider - as more RBC produced

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24
Q

how will reticulocyte count present in IDA

A

Decreased - as insufficient iron to produce RBC

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25
Q

how will the following present in IDA:

a. Ferritin
b. TIBC
c. Transferrin saturation
d. RDW

A

a. Low
b. High
c. Low
d. High

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26
Q

If microcytic anaemia, ferritin is normal - what is looked at next

A

TIBC

27
Q

if TIBC is low in microcytic anaemia and ESR/ CRP is high, what does it likely indicate

A

Anaemia of chronic disease (early stages)

28
Q

If TIBC is low in microcytic anaemia and Hb electrophoresis is abnormal what does it likely indicate

A

Thalasemia

29
Q

What is a characteristic feature of sideroblastic anaemia

A

Basophilic stippling

30
Q

How will the following present in thalassemia

a. Ferritin
b. Transferrin saturation
c. TIBC
d. RDW

A

a. Normal
b. Normal
c. Low
d. Normal

31
Q

How will the following present in anaemia of chronic disease

a. Ferritin
b. Transferrin
c. TIBC
d. RBW

A

a. High
b. Low
c. Low
d. Normal

32
Q

How will the following present in sideroblastic anaemia

a. Ferritin
b. Transferrin saturation
c. TIBC
d. RDW

A

a. High
b. High
c. Low
d. High

33
Q

If an individual has normocytic anaemia what should be looked at next

A

reticulocytes

34
Q

If reticulocytes are high, what is looked at

A

EPO

35
Q

if reticulocytes are high, EPO low, what is the likely cause

A
  • CKD
36
Q

If reticulocytes are high, EPO high, what is the likely cause

A
  • Aplastic anaemia
37
Q

if reticulocytes are low what is looked at

A

Markers of haemolysis

38
Q

what are signs of haemolysis

A
  • Low haptoglobin

- High LDH

39
Q

what does no signs of haemolysis indicate

A

Blood loss

40
Q

what do signs of haemolysis indicate

A

Haemolytic anaemia

41
Q

what is performed if megaloblastic anaemia

A

Peripheral Blood Smear

42
Q

what causes a megaloblastic macrocytic anaemia

A
  • B12 Deficiency

- Folate Deficiency

43
Q

what causes a non-megaloblastic macrocytic anaemia

A
  • Reticulocytosis
  • Multiple myeloma
  • Alchoholism
  • MDS
  • Hypothyroidism
44
Q

what do symptoms of anaemia depend on

A
  • Fall in Hb

- Rate of fall in Hb

45
Q

what are symptoms of anaemia

A
  • Lethargy
  • Dizziness
  • Syncope
  • Dyspnoea
  • Pallour
  • Palpitations
  • Angina - if predisposing coronary artery disease
46
Q

what are 4 signs of anaemia

A
  • Conjunctival pallour
  • Kolonychia
  • Angular stomatitis
  • Glossitis
47
Q

how may a Hb below 80 present

A

Bounding pulse, Tachycardia, Postural Hypotension

48
Q

when are Howell-jolly bodies seen on peripheral blood film

A

Hyposplenism: Coeliac, Sickle Cell, Crohn’s

Post-Splenectomy

49
Q

what are pappenherimer bodies

A

granules of siderocytes containing iron

50
Q

when are pappenheimer bodies seen

A
  • Lead-poisoning

- Post-splenectomy

51
Q

what is poikilocytes

A

variation in RBC shape and size

52
Q

when are poikilocytes seen

A

IDA

53
Q

what is rouleaux formation

A

when RBC aggregate together

54
Q

when is rouleaux formation seen

A

multiple myeloma

55
Q

what are schistocytes

A

fragments RBC

56
Q

what causes schistocyte formations

A

intra-vascular haemolysis

57
Q

what are spherocytes

A

spherical shaped

58
Q

what causes spherocytosis

A

Hereditary spherocytosis

59
Q

what are target cells

A

RBC with central stain, ring of pallour and outer staining

60
Q

when are target cells seen

A
  • Liver disease
  • Hyposplenism
  • Thalasemia
  • IDA
61
Q

what are tear-drop RBC characteristic of

A

myelofibrosis

62
Q

what do Heinz bodies indicate

A

G6PD deficiency

Thalasemia

63
Q

what are hyperhsegmented neutrophils characteristic of

A

Megaloblastic anaemia

64
Q

if sideroblastic anaemia is suspected what is used to stain the bone marrow biopsy

A

prussian blue staining

Haematology (19 decks)

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