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Clinical Pathology > 45 Anaemia + thrombocytopenia > Flashcards

45 Anaemia + thrombocytopenia Flashcards

1
Q

Simply, what are the causes of a macrocytic anaemia? (3).

A

B12/folate, metabolic.
Marrow damage.
Haemolysis (new RBC’s are larger).

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2
Q

What causes normocytic anaemia?

A

Anaemia of chronic disease/inflammation.

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3
Q

What causes a microcytic anaemia? (3).

A

Iron deficiency.
Haemoglobin disorders.
(Sometimes chronic disease).

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4
Q

Describe how iron is balanced in the body.

A

No excretion, limited absorption.

Controlled by gut mucosa, absorbed in duodenum.

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5
Q

What is iron transported by?

A

Transferritin.

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6
Q

What is iron stored in? (2)

A

Ferritin.

Haemosiderin.

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7
Q

Which lab tests are used to establish low iron? (3).

A

FBC, indices and film.
Ferritin.
% hypochromic cells.

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8
Q

What are the three main causes of low iron in children?

A

Diet.
Growth.
Malabsorption.

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9
Q

What are the three main causes of low iron in young women?

A

Menstrual loss/problems.
Pregnancy (body can’t increase uptake).
Diet.

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10
Q

What are the main causes of low iron in older people? (1,6)

A

Bleeding.

GI problems: ulcer, gastritis, malignancy, aspirin, diverticulitis, GI surgery.

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11
Q

How is low iron treated?

A 
Oral iron (if it doesn't work give IV).
Treat cause.
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12
Q

What do RBC’s look like in iron deficiency?

A

Microcytic.

Hypochromic.

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13
Q

What do RBCs look like in megaloblastic anaemia?

A

Macrocytic.

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14
Q

What are the causes of megaloblastic anaemia? (5).

A 
B12/folate deficiency.
Alcohol.
Drugs: cytotoxics, folate antagonists, NO2.
Haematological malignancies.
Congenital: transcobalamin deficiency,
orotic aciduria.
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15
Q

How does low B12/folate cause anaemia?

A

B12 needed to make folate. Folate needed to make purines. Purines needed for DNA synthesis.

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16
Q

Describe the sources of B12, its absorption and storage:

A

Animal sources only.
Gastric parietal cells, intrinsic factor and receptors in terminal ilium.
Stores sufficient for years.

17
Q

What can cause B12 deficiency? (1,2,5)

A

Veganism.
Gastric: pernicious anaemia, gastrectomy.
Small bowel problems: resection, corns, diverticulosis, fish tapeworm, tropical sprue.

18
Q

Describe the sources of folate:
Absorption site?
Storage:

A

Green vegetables, beans, peas, nuts, liver.
Absorbed in upper small bowel.
Body stores 4 months worth.

19
Q

What causes folate deficiency? (8)

A

Mainly dietary.
Malabsorption.
Increased usage: pregnancy, haemolysis, inflammation.
Drugs/alcohol/ITU.

20
Q

What are the features of B12/folate deficiency? (6).

A 
Megaloblastic anaemia.
If severe: pancytopenia.
Mild jaundice.
Glossitis.
Anorexia/weight loss.
Sterility.
21
Q

What is the cause of pernicious anaemia?

A

Autoimmune attack on parietal cells making intrinsic factor.

22
Q

What is SACDC?

A

Sub-acute combined degeneration of the cord.

Any cause of B12 deficiency will cause this.

23
Q

How is B12/folate deficiency treated?

A

B12 and folate until B12 excluded.
Folic acid daily to build stores.
Potassium + iron supplement needed initially.

24
Q

What are the common causes of haemolysis? (7).

A 
Haemoglobinopathy (sickle cell).
Enzyme defects (G6PD).
Hereditary sphero/eliptocytosis.
Antibodies.
Drugs/toxins.
Heart valves (fragmentation).
Vasculitis.
25
Q

How is autoimmune haemolytic anaemia managed?

A

Steroids/immunosuppression.

26
Q

What is anaemia of chronic disease due to? (3).

A

Abnormal iron metabolism.
Poor erythropoetin response.
Blunted bone marrow response.

27
Q

What is anaemia of chronic disease mediated by?

A

Release of Il-1, Il-6 and TNF-α.

Hepcidin (regulates iron release form macrophages).

28
Q

What are the features of anaemia of chronic disease? (4).

A

Mild anaemia, normal MCV.
Raised inflamm markers: CRP, ESR, PV.
Normal/high ferritin + low serum iron.
Normal % transferrin saturation.

29
Q

What are the two classical presentations of immune thrombocytopenia purpura?

A

Kids: acute, post viral, self limiting.
Adults: chronic, relapsing/remitting.

30
Q

How is immune thrombocytopenia purpura treated? (4)

A

Steroids.
IV immunoglobulin (to overload spleen).
Immunosuppressives/splenectomy.
Thrombo-mimetics: Eltrombopag, romiplostin.

31
Q

When should thrombotic thrombocytopenia purpura be suspected?

A

Thrombocytopenia with fever, neurological problems, haemolysis.

32
Q

What is the immune basis of TTP? (2).

A

ADAMTS-13.

VWD.

33
Q

How is TTP treated? (4).

A

Plasma exchange.
Steroids.
Vincristine.
Rituximab.

Clinical Pathology (66 decks)

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