22. Anaemia Flashcards
Signs of anaemia?
Pallor
Fatigue
Increased RR and HR
What might cause iron deficiency anaemia?
A microcytic
Malnutrition
Coeliacs
IBD
GI malignancy (if IDA, change in bowel habit and PR bleeding, it’s colon cancer)
Peptic ulcer
Menstruation
Pregnancy
Fever
What is anaemia of chronic disease?
Chronic disease produces cytokines that increase hepcidin.
Difference between IDA and ACD?
Ferritin is low in IDA but is high or normal in ACD.
Total iron binding capacity is high in IDA and low in ACD, ACD can often be normocytic too.
What is thalassaemia?
Autosomal recessive condition which can affect the alpha or beta chains.
How do we investigate thalassaemia?
Microcytic anaemia
Normal iron studies
Gel electrophoresis
How do we treat thalassaemia?
Regular red cell transfusions every 2-4 weeks with iron chelation
When do you produce your chains of globin?
Alpha is before birth
Beta is from early infancy
Gamma is present before birth but drops after born.
What is sickle cell disease?
Mutation on chromosome 11.
How does sickle cell present?
Often asymptomatic
Hypoxia
Dehydration
Pain in joints
What is a howell-jolly body?
Abnormal cell formed from left over DNA
What are the 5 main cornerstones of a sickle cell crisis?
Crisis Acute painful crisis Stroke Sequestration crisis Chronic cholecysitits
Managing a sickle cell crisis?
Sickle Acute Painful Crisis
Saturate (oxygen) Antibiotics Pain relief Cannula (fluids) Crizanlizumab
Blood transfusion, splenectomy and cholecystectomy
How do we diagnose sickle cell?
Hb electrophoresis and blood film
MOREHow do we manage day-to-day sickle cell anaemia?
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What causes megaloblastic anaemia and what do you see?
Folate or B12 deficiency
Hypersegmented neutrophils and macrocytes
How do differentiate between B12 and folate deficiency?
B12 - alcohol, IBD and coeliac, neurological signs, pernicious (stores last 3-4 years)
Folate - pregnancy, no neuro signs, anti-folate drugs (stores last 6 months)
What causes non-megaloblastic macrocytic?
Alcoholics May Have Life Failure
Alcohol
Myelodysplasia
Hypothyroidism
Liver failure
What do you see in haemolytic anaemia?
Scleral icterus Pallor Low Hb Low haptoglobin Raised unconj bilirubin High LDH
4 types of haemolytic anaemias?
Membrane - hereditary spherocytosis
Enzymes - G-6PD
Haemoglobin - sickle and thalassaemia
What is characteristic of G-6PD?
Bite cells
Heinz bodies
What is hereditary spherocytosis?
Lacking the centre of pallor, where you lack beta spectrin
How would you investigate hereditary spherocytosis?
Osmotic fragility test causes lysis
Negative coombs test
Aplastic crisis - when body doesn’t produce enough haemoglobin
What is microangiopathic haemolytic anaemia? (MAHA)
Shearing of red blood cells when microthrombi form which create nets that shear the cells.
