11 - Anaemia Flashcards by Mark Brown

What does haematocrit show?

(RBC x MCV) / total blood volume

increase = polycythemia

decreased = aneamia

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General signs of anaemia?

fatigue

weakness

pale/ yellow

irregular heart beats

SoB

Dizziness or light headedness

Chest pain

Cold hands and feet

headache

kolionychia - rare

Pica - craving for non food items

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What does MCV indicate?

Type of aneamia

increased - macrocytic

normal - normocytic

decreased - microcytic

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Causes of hypochromic microcytic aneamias?

Iron deficiency

Thalassaemias

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What is the cause if iron dificiency aneamia?

Diet - vegan

Malabsorption - IBD, milk, tea

Blood loss from chronic disease

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When to refer for endoscopic investigation with iron deficiency anaemia under the 2 week wait?

Dypsepsia

Unexplained

Women not menstruating

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What is the most common cause of iron deficiency anaemia in children?

Due to Cows milk

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Why might ferratin be derranged without pathology?

Rapid growth in infants and adolescents

inflammation - ferratin is an acute reaction protein

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Iron deficiency specific signs of aneamia?

Headache during activity

Pica - wallpaper

sore tooth or tongue

Brittle nails and hair loss

koilonychia

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Types of thalassaemia?

Alpha - controlled by 4 genes
Beta - controlled by 2 genes

Note: has aneamia, suffers from iron overload

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What is beta thalassaemia major?

No HbB only HbF (fetal)

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What are the causes of marcrocytic anaemia?

Alcohol

B12 deficiency

Folate deficiency

Malignancies

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Causes of vit. B12 deficiency anaemia?

Nutrition - vegan, poor diet, pregnancy

Malabsorption

Crohns

IBD

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What is perniscous anaemia?

Antibodies to parietal cells and intrinsic factor leading to B12 deficiency anaemia

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What features are specific for B12 deficiency anaemia?

insidious onsel

jaundice

glossitis

angular stomatitis

neuropahy - peripheral, optical and dementia

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What drugs can cause B12 deficiency anaemia?

Methotrexate

Anticonvulsants

Sodium valporate

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Milk from what animal can cause B12 deficiency?

Goats - unlike cows has iron

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What other causes of macrocytic aneamia other than megaloblastic?

Pregnancy

Chemotherpay

Hypothyroidism

Liver disease

Hypoxia

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What types of heamolytic anaemias?

Congenital

Aquired

What is the most common inhertied RBC disorder in northern europeans?

Heredity spherocytosis

How is hereditary sphenocytosis diagnosed?

Posotive family history and surgestive finding on blood film

Can use EMA binding test resulting in weaker flourescence

What is sickle cell aneamia?

Co-dominant ß thalassaemia

Results in loss of concave RBC to sickle cell

What complication can occur in sickle cell thalassaemia?

Autospleen infactation

Crisis Types:

Painful

Chest

Abdomen

Stroke

Management of sickle cell crisis?

Analgesia - IV opiates

Crossmatch blood

Rehydrate

Keep warm

Transfussion if decrease of RBC

Recommendation to patient with sickle cell anaemia

Keep warm Keep hydrated Keep regular hours Eat well Prophylaxis penecillin - spleen Hydroxyurea/ hydroxycarbamide

What does hydroxyurea/ hydroxycarbamide do?

incraeses fetal heamoglobin production therefore reducing the reliance on HbSS

What is sickle cell protective against?

Malaria - parasite is not viable inside the sickle cell RBC

Gucose-6-phosphate dehydrogenase deficiency

X linked Mediterianian, africa, middle east Attacks - fratigue, nack ache, jaundice and dark coloured urine Presipitated by henna, premaquine, asprin

What is coombs test?

Antihuman Antibodies introduced to blood sample, If agglutination occurs then +ve result + = most aquired heamolytic conditions

How is stroke risk managed in sickle cell disease?

Trancranial doppler indicates blood flow in circle of willis MRI reveals strokes = stem cell therapy or blood transfussion

How is Iron regulated?

Low transferretin saturation (indicates low iron) --\> decreases hepicidin activity --\> increases feroportin =\> release of iron from enterocytes and marrow marcrophages Therefore increasing Iron levels

Treatment of heredity spherocytosis?

B12 suppliment may need splenectomy

Recomendation to a patient taking iron tablets?

Take on empty stomach Don't take with tea, cofee and milk

What are the side effects of taking iron suplimment tablets?

GI problems Constipation Diarrhoea Stools may turn balck!

What drugs can effect iron uptake with supplment tablets?

TCA reduce Fe uptake Ca products Levothyroxine uptake is reduced with Fe suppliment

How is B12 suppliment given?

IV hydroxycoalbumin repeat every 2-3 months

When would you also use Folic aciud supplement?

When folate defiency is proven otherwise may exacerbate B12 deficiency. Usually given with B12 vit

What is a frequent complication of Hereditary Spherocytosis?

Gall stones

A female of 26 has hypochromic microcytic anaemia. What is the most likely cause? What additional investigations should be done?

Anaemia due to menorrhagia. vWD should be considered

How is beta thallasaemia trait diagnosed?

increased HbA2 (adult variant haemoglobin)

How many genes are involved in Alpha thalasaemia?

2 for each of HbA and HbA2

Is thalassaemia major present at birth?

No due to HbF, presents 6 months after birth

Which thalasaemia presents with hydrops fetalis?

Alpha not Beta, iron-deficiency anaemia can also cause hydrops fetalis

What is hydrops fetalis?

2 or more compartments have oedema. Caused from heart failure due to increased blood flow to deliver oygen to tissue.

What is fetal Rh incompatibilty?

Where the mother is Rh -ve and the fetus is Rh + and the mother's immune system causes heamolysis of HbF. Mother has to be previously sensatised by previous Rh+ pregnancy.

What does this head X ray indicate?

Thalasaemia major Sickle cell aneamia Heredity spherocytosis Iron deficiency anaemia