11 - Anaemia Flashcards
What does haematocrit show?
(RBC x MCV) / total blood volume
increase = polycythemia
decreased = aneamia
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
What does MCV indicate?
Type of aneamia
increased - macrocytic
normal - normocytic
decreased - microcytic
Causes of hypochromic microcytic aneamias?
Iron deficiency
Thalassaemias
What is the cause if iron dificiency aneamia?
Diet - vegan
Malabsorption - IBD, milk, tea
Blood loss from chronic disease
When to refer for endoscopic investigation with iron deficiency anaemia under the 2 week wait?
Dypsepsia
Unexplained
Women not menstruating
What is the most common cause of iron deficiency anaemia in children?
Due to Cows milk
Why might ferratin be derranged without pathology?
Rapid growth in infants and adolescents
inflammation - ferratin is an acute reaction protein
Iron deficiency specific signs of aneamia?
Headache during activity
Pica - wallpaper
sore tooth or tongue
Brittle nails and hair loss
koilonychia
Types of thalassaemia?
Alpha - controlled by 4 genes
Beta - controlled by 2 genes
Note: has aneamia, suffers from iron overload
What is beta thalassaemia major?
No HbB only HbF (fetal)
What are the causes of marcrocytic anaemia?
Alcohol
B12 deficiency
Folate deficiency
Malignancies
Causes of vit. B12 deficiency anaemia?
Nutrition - vegan, poor diet, pregnancy
Malabsorption
Crohns
IBD
What is perniscous anaemia?
Antibodies to parietal cells and intrinsic factor leading to B12 deficiency anaemia
What features are specific for B12 deficiency anaemia?
insidious onsel
jaundice
glossitis
angular stomatitis
neuropahy - peripheral, optical and dementia
What drugs can cause B12 deficiency anaemia?
Methotrexate
Anticonvulsants
Sodium valporate
Milk from what animal can cause B12 deficiency?
Goats - unlike cows has iron
What other causes of macrocytic aneamia other than megaloblastic?
Pregnancy
Chemotherpay
Hypothyroidism
Liver disease
Hypoxia
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
