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Integrative > 7) Anaemia > Flashcards

7) Anaemia Flashcards

1
Q

What can be the cause of reduced erythropoiesis?

A

Empty bone marrow - after chemo, toxic insult (parvovirus), aplastic anemia
Marrow infiltration by cancer cells of fibrous tissue
CKD

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2
Q

What are the features of myelodysplastic syndromes?

A

Production of abnormal clones of marrow stem cells

Macrocytic anaemia

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3
Q

How can myelodysplastic syndromes be diagnosed?

A

Microscopy of blood cells and bone marrow cells

Genetic testing on marrow cells

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4
Q

In which conditions can there be dyserythropoiesis?

A

Renal disease
RA
SLE
IBD

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5
Q

What are the features of dyserythropoiesis?

A

Iron is not released for use in bone marrow
Reduced RBC lifespan
Marrow shows lack of response to EPO

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6
Q

What haemoglobin abnormalities can lead to anaemia?

A

Lack of iron - IDA
Deficiency in building blocks for DNA synthesis - Vit B12/folate
Mutations in proteins encoding globin chains

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7
Q

Describe the features of red cells in iron deficient anaemia:

A

Microcytic anemia
Variation is size and shape of RBCs
Hypochromia

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8
Q

Why is there macrocytic anaemia in B12 and folate deficiency?

A

Deficiency causes DNA synthesis to be impaired so cell cycle can’t progress from G2 to M. Continuing growth without division

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9
Q

How is B12 delivered to bone marrow from oral intake?

A

Combined with intrinsic factor, and complex binds to ileum allowing absorption of B12
In blood B12 binds to transcobalamin which delivered it to bone marrow and other tissues

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10
Q

What can be the causes of vitamin B12 deficiency?

A

Dietary deficiency - vegan
Lack of intrinsic factor - pernicious anemia
Disease of ileum - Crohn’s
Lack of transcobalamin - congenital

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11
Q

Where is folate absorbed in the gut?

A

Duodenum and jejunum

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12
Q

What are dietary folates converted into once absorbed?

A

Methyltetrahydrofolate

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13
Q

What can be the causes of folate deficiency?

A

Dietary
Increased use: pregnancy, haemolytic anaemia
Disease of duodenum and jejunum - coeliac, Crohn’s
Methotrexate
Alcoholism

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14
Q

What other problems can occur as B12/folate deficiency progresses?

A

Neurological disease - focal demyelination

Depression and dementia

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15
Q

Describe the features of sickle cell disease:

A

Point mutation - substitution of valine for glutamate in beta chain of Hb
Sickle shape of RBCs when deoxygenated

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16
Q

How can sickle cell anaemia lead to sickle cell crisis?

A

Repeated cycles of deoxygenation cause irreversibly sickled RBCs which can cause obstruction in capillaries

17
Q

Which groups are thalassaemias particularly prevalent in?

A

South Asia, Mediterranean, Far East

18
Q

Describe the features of red cells in thalassaemia:

A

Hypochromic and microcytic

Anisopoikilocytosis, target cells, nucleated red cells

19
Q

Describe some of the systemic effects of thalassaemias:

A

Extramedullary haemopoiesis - splenomegaly, hepatomegaly
Stimulation of EPO
Iron overload

20
Q

What is the treatment for thalassaemias?

A

Transfusions
Iron chelation
Folic acid
Immunisation

21
Q

Describe beta-thalassaemia major:

A

Both beta genes abnormal
6-9 months after birth - switch from HbF to HbA
Transfusion dependent

22
Q

Describe beta-thalassaemia intermedia:

A

Severe anaemia - episodic blood transfusions

23
Q

Describe beta-thalassaemia minor/trait:

A

Usually asymptomatic with mild anaemia
One normal gene
Heterozygous

24
Q

Describe alpha thalassaemia trait:

A

Deletion of two alpha globin genes

Minimal or no anaemia

25
Q

Describe haemoglobin H disease:

A

Deletion of three alpha globin chains
Tetramers of beta globin (HbH) are formed
Moderately severe anemia

26
Q

Describe hydrops fetalis:

A

Deletion of all 4 alpha globin genes

Usually intrauterine death

27
Q

What inherited abnormalities in the red cell membrane can lead to anaemia?

A

Hereditary spherocytosis
Hereditary elliptocytosis
Hereditary pyropoikilocytosis
Hereditary stomatocytosis

28
Q

What can damage the red cell membrane and lead to anaemia?

A

Mechanical damage - valves, vasculitis, DIC
Heat damage - burns
Osmotic damage - drowning

29
Q

What red cell enzyme defects can lead to anaemia?

A

G6PD deficiency

Pyruvate kinase deficiency

30
Q

Where are common places to bleed causing unexplained microcyctic anaemia?

A 
Gastric ulcer
Gastric cancer
Colon cancer
Excessive menstruation
Bladder cancer
31
Q

Describe autoimmune haemolytic anaemia:

A

Autoantibodies bind to red cell membrane proteins and remove them from circulation
Can be warm or cold

32
Q

What are some key laboratory features of autoimmune haemolytic anaemia?

A

Increased reticulocytes
Raised bilirubin
Raised LDH

33
Q

How should we classify anaemia to allow us to identify the cause?

A

Mechanism
Size - micro, normo and macrocytic
Presence or absence of reticulocytosis

Integrative (9 decks)

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