300. HEAM- Anaemia Flashcards
In the treatment of what two conditions is venesection indicated in
Polycythaemia rubra vera
Heamochormatosis
How does anaemia occur?
Low heamoglobin
Increased Red cells (e.g. pregnancy)
What are the symptoms of anaemia?
Fatigue, dyspnoea, faintness, palpitations, headache, tinnitus, anorexia, angina
What are the signs of anaemia?
Pallor tachycardia Flow murmurs- ejection systolic murmur Cardiac enlargement retinal hemorrhages (rare)
What are the causes of a microcytic anaemia?
Iron deficiency anaemia
Thalaessemia- mcv too low for red count
Sideroblastic anaemia- body cant put iron into heamoglobin
What are the causes of a normocytic anaemia?
Acute blood loss
Anaemia of chronic diseases
Bone marrow failure
Renal failure
Hypothyroidism
Heamolysis
Preganacy
What are the causes of a macrocytic anaemia?
B12 or folate deficiency
Alchohol excess
Reticulocytosis
Cytotoxics (hydrocarbamide)
Myelodysplastic syndromes (?myeloma)
Marrow infiltration
Hypothyroidism
Anti-folate drugs
What anaemias cause iron accumulation leading to increased iron and ferritin with a low TIBC
Thalaseammia and sideroblastic anaemia
How do you transfuse a severe aneamic with heart failure?
60-80g/L is the target to reach
give it slowly with 10-40mg furosemide
Check for warning signs of overdose e.g. rising JVP and basal crackles
What are the causes of iron deficiency anaemia?
Blood loss
Poor diet
malabsorbtion (coeliac)
Hookworm- most common cause outside UK
Signs of chronic IDA?
Koilonychia
Atrophic glossitis
Angular stomatitis
Post cricoid webs- plummer vinson syndrome (treat with iron and oesophageal widening therapy)
How do you treat those with iron deficiency anaemia?
Check ceoliac serology
Refer for colonoscopy and upper GI endoscopy. Unless menstruating and ? under 55’s?
Consider stool culture if travel history
How is iron deficiency anaemia treated?
Why might patients fail to respond to treatment?
Iron tablets
complaince, continued GI blood loss, anaemia of chronic diseases, thalaseammia
What three disruptions to biochemical processes cause anaemia of chronic diseases?
Poor use of iron in eryhthropoiesis
cytokine induced shortening of RBC survival
production of and response to EPO
What are the causes of anemia of chronic diseases?
Chronic infection, vasculitis, rhumatoid, malignancy, renal failure
How to treat anaemia of chronic diseases?
Treat underlying disease
EPO
IV iron
With regards to iron studies (Iron, TIBC and ferritin) what happens to iron in:
Iron deficiency
Anaemia of chronic disease
Chronic heamolysis
Heamochromatosis
Pregnancy
Sideroblastic anaemia
Iron deficiency and Anaemia of chronic disease- reduced iron
Chronic heamolysis, heamochromatosis, pregnancy, sideroblastic anaemia- Iron increased
What happens to TIBC in those conditions
IDA
CDA
Chronic heamlyosis
Heamochromatosis
Pregnancy
Sideroblastic anaemia
Iron deficiecny, pregnancy- TIBC increased
Anaemia of chronic diseases, chronic heamolysis- (reduced)
Heamochromatosis, sideroblastic anaemia- normal
How is ferritin affected in the following conditions
Iron deficiency, anaemia of chronic disease, chronic heamolysis, heamochromatosis, pregnancy, sideroblastic anaemia
IDA- reduced
Pregnancy- normal
All others- reduced
What are the two causes of macrocytic anaemia
Megaloblastic-b12, folate or cytotoxic
Non megablastic- alcohol XS, reticulocytosis, liver disease, hypothyroidism, pregnancy
How does a bone marrow biopsy help narrow down macrocytic anaemia
Will either show:
Megaloblastic marrow-
Normoblastic marrow
abnormal erythropoiesis
increased erythropoisis
How do you treat folate deficiency
replace with daily 400mcg folate and also give b12 unless b12 status is known.
Unopposed folate replacement causes increased subacute degeneration of the cord
What are the causes of vit b12 deficiency
Dietary
Malabsorbtion- pernicious anemia/ terminal ileum
what are the signs of b12 deficiency
Pallor, lemon tinge, glossitis
Irritability, depression, psychosis, dimentia
paraethesia, peripheral neuropathy, subacute degenration of the cord
What is subacute degeneration of the cord?
combination of peripheral sensory neuropathy with both upper and lower motor neuron signs.
Insidious onset, symmetrical, pain and temperature intact.
What is the classic triad of subacute degenration of the spinal cord
Absent knee jerks
Absent ankle jerks
Extensor plantars
What are the associations with pernicious anaemia?
Thyroid disease,
vitiligo,
addison’s,
hypoparathoidism,
carcinoma
A blood group
How do you identify a heamolytic jaundice
increased unconjugated bilirubin
increased urinary irobilinogen
increased serum LDH
Increased reticulocytes
What are the biochemical signs of heamolytic jaundice?
Increased free plasma heamoglobin
Methaemalbumineia (increased heam and albumin)
Decreased plasma haptoglobin
What examination signs might be seen in those with heamolytic anemia?
jaundice
hepatosplenomegaly
gallstones
leg ulcers
What tests should be done for heamolytic anemia
FBC, reticulocytes, bilirubin, LDH, haptoglobin, urinary urobillogen
Thick and thin blood films (malaria)
BLOOD FILMS
(Further tests)- osmotic fragility, coombs test, electropheresis
What are the heamolytic anaemias that are coombs positive?
Drug induced
Autoimmune heamolytic anaemia- split into warm and cold. Mostly idiopathic
Warm (extravascular)
Cold (Intravsacular)-
What is microangiopathic heamolytic anaemia?
Mechanical damage to RBC’s in circulatoin causing intravscular heamolysis and shischotcytes
What are the causes of microangiopathic heamolytic anaemia?
HUS, - e coli 0157 TTP, - anaemia, low platelets- ADAMTS13 antibodies DIC, pre-eclampsia and eclampsia, prosthetic heart valves
What can precipitate and GD6P crisis?
Henna Broad beans Aspirin primaquine sulfanamides
What happens in a gd6P crisis
What is done to relieve it?
Jaundice and anemia
Transfuse if severe
