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Clinical Pathology > 45 - Anaemia and Thrombocytopenia > Flashcards

45 - Anaemia and Thrombocytopenia Flashcards

1
Q

Causes of anaemia

A 
Haematinic deficiencies
2° to chronic disease
Haemolysis
Alcohol, drugs, toxins
Renal impairment - EPO
Primary haematological/marrow disease
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2
Q

Macrocytic anaemia causes

A

B12, folate, metabolic (liver, thyroid)
Marrow damage
Haemolysis

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3
Q

Normocytic anaemia causes

A

Anaemia of chronic disease/inflammatory

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4
Q

Microcytic anaemia causes

A

Iron deficiency

Hb disorders

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5
Q

Iron balance maintained by:

A 
No excretion but limited absorption 
Controlled at level of gut mucosa
Most iron is recycled
Absorbed in duodenum
Transported by transferrin
Stored in ferritin/haemosiderin
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6
Q

Lab tests for Fe deficiency

A 
FBC, indices and film
Ferritin
%hypochromic cells
Serum iron/TIBC
Marrow
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7
Q

Appearance of iron deficient cells

A

Small pale red cells (low MCV, low MCH)

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8
Q

Main causes of iron deficiency

A

Blood loss from anywhere
Increased demand i.e. pregnancy or growth
Reduced intake e.g. diet / malabsorption

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9
Q

Main causes of iron deficiency in children

A

Diet
Growth
Malabsorption

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10
Q

Main causes of iron deficiency in young women

A

Menstrual loss/problems
Pregnancy (can be v. long after pregnancy)
Diet

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11
Q

Main causes of iron deficiency in older people

A

Bleeding

GI problems

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12
Q

Iron therapy

A

Oral - unreliable
IM - painful, out-of-date
IV - increasingly used

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13
Q

Megaloblastic anaemia - why? in general

A

A characteristic cell morphology caused by impaired DNA synthesis

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14
Q

Causes of megaloblastic change

A

B12/folic acid deficiency
Alcohol
Drugs - cytotoxics, folate antagonists, N2O
Haematological malignancy
Congenital rarities - transcobalamin deficiency, orotic aciduria

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15
Q

How does B12 + folate cause anaemia?

A

DNA consists of purine/pyrimidine bases

Folates req. for synthesis

B12 essential for cell folate generation

Low folate therefore = B12 starves DNA of bases

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16
Q

Vit B12 in all diets in high numbers except…

A

Vegan

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17
Q

Where is vit B12 absorbed

A

Gastric parietal cells
Intrinsic factor
Receptors in terminal ileum

Stores sufficient for some years

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18
Q

B12 deficiency - effects

A 
Pernicious anaemia (autoimmune)
Gastrectomy

Small bowel problems (Crohn’s, jejunal diverticulosis, tapeworm)

19
Q

What foods are folic acid in

A 
Green veg
Beans
Peas
Nuts
Liver
20
Q

Folic acid is absorbed where and what food reqs.

A

Needs daily intake
Absorbed in upper small bowel
Body stores four months worth

21
Q

B12 or folate deficiency features

A 
Megaloblastic anaemia
Pancytopenia if more severe
Mild jaundice 
Glossitis/angular stomatitis
Anorexia / weight loss
Sterility
22
Q

Labs for B12 + folate deficiency

A 
Blood count + film (sometimes marrow)
Bilirubin + LDH
B12&folate
Antibodies
B12 absorption tests

GI investigations - Crohn’s, malabsorption, blind loop

23
Q

What is the classic cause of B12 deficiency

A

Pernicious anaemia

24
Q

What is pernicious anaemia

A

Igs to parietal cells/intrinsic factor
Autoimmune associations
Atrophic gastritis with achlorhydria
Incidence of Ca stomach

25
Q

What does SACDC stand for?

A

Subacute combined degeneration of the cord

26
Q

SACDC features

A

Any cause of severe B12 deficiency

Anaemia not absolute req.

Demyelination of dorsal + lateral columns

Peripheral nerve damage

27
Q

SACDC presentation

A

Peripheral neuropathy / paraesthesiae
Numbness and distal weakness
Unsteady walking
Dementia

28
Q

SACDC treatment

A

B12+folate until B12 excluded

B12 x 5 then 3 months for life

Folic acid 5mg daily to build stores

Need for K+ and Fe initially

29
Q

Haemolysis causes

A

Haemoglobinopathy
G6PD

Hereditary spherocytosis / elliptocytosis

Antibodies
Drugs, toxins
Heart valves
Vascular / vasculitis / microangiopathy

30
Q

Tests for haemolysis

A 
Anaemia
High MCV, macrocytic
High reticulocytes
Blood film (fragments/spherocytes)
Raised bilirubin, LDH
Low haptoglobins
Urinary haemosiderin
31
Q

Anaemia of chronic disease

A

Common
Normal MCV
Reduced RBC production due to: abnormal iron metabolism, poor EPO response and blunted marrow response

32
Q

Effects of ACD mediated by

A

Cytokine release - IL1,IL6, TNF-alpha

Hepcidin in particular -> regulator of iron absorption and release from macrophages

33
Q

Features of ACD

A

Usually normal MCV, ferritin, % saturation of transferrin

Low serum iron + raised inflammatory markers

34
Q

Treatment of ACD

A

Cause if possible
EPO/ IV Fe
Transfusion

All possible but need to check symptoms first

35
Q

Causes of thrombocytopenia

A 
Drugs, alcohol, toxins
ITP
Autoimmune diseases
Liver/hypersplenism
Pregnancy
Haematological / marrow issues
Infections
DIC
Congenital
36
Q

ITP stands for?

A

Immune thrombocytopenia purpura

37
Q

ITP features

A

Common - distinguishes kids + adults

Immune disorder

Can be acute/chronic/relapsing

38
Q

ITP - clinical presentation

A

Bruising or petechiae or bleeding

Platelet count can be anywhere

39
Q

ITP - therapy

A 
Steroids are first line
IV Ig
Immunosuppressives or splenectomy
Thrombo-mimetics
Thrombopoetin
40
Q

TTP stands for?

A

Thrombotic thrombocytopenia purpura

41
Q

TTP - features

A

rare but urgent diagnosis needed

Most are immune (ADAMTS-13 / VWD)

42
Q

TTP - clinical presentation

A

Fever
Neurological symptoms
Haemolysis (retics/LDH)

43
Q

TTP - tests

A

Microangiopathy

Blood film fragments

44
Q

TTP - therapy

A 
Plasma exchange with FFP/plasma
Steroids
Vincristine
Rituximab
Outcomes vary
Monitor ADAMTS-13

Clinical Pathology (65 decks)

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