Acquired anaemia Flashcards
What is the normal haemoglobin for males?
12-70= 140-180 >70= 116-156
What is the normal haemoglobin for females?
12-70= 120-160 >70= 108-143
What factors influence normal haemoglobin levels?
Age Sex Ethnicity Time of day Time to analysis
What controls iron absorption?
Hepcidin
What is the role of hepcidin?
Internalise iron transporters to prevent absorption
When and where is hepcidin produced?
In the liver, when liver storage of iron if full
What are the general features of anaemia?
Tiredness Pallor Breathlessness Swelling of ankles Dizziness Chest pain
What signs can be present in anaemia related to the cause?
Evidence of bleeding- menorrhagia, blood in stool Malabsorption- weight loss, diarrhoea Jaundice Splenomegaly Lymphadenopathy
What ar the 3 categories of causes of acquired anaemia?
Hypochromic microcytic
Normochromic normocytic
Macrocytic
What are the hypo chromic microcytic causes of anaemia?
Iron deficiency
Thalassaemia
Secondary anaemia
How can causes of hypo chromic microcytic anaemia be differentiated?
Ferritin
Low ferritin= iron deficiency
Normal or high= thalassaemia, secondary anaemia
What are the causes of iron deficiency anaemia?
Bleeding- most common
Diet- malabsorption
Increased requirement- pregnancy
What is the treatment of iron deficiency anaemia?
Oral iron- IV if intolerant
Blood transfusion rarely
Correct cause
What are the causes of normochromic normocytic anaemia?
Bone marrow problem
Acute blood loss
Haemolysis
How can the causes of normochromic normocytic anaemia be differentiated?
Reticulocyte count
Low= bone marrow
High= acute blood loss, haemolysis
What is haemolytic anaemia?
Accelerated re cell destruction
Compensated by bone marrow
What are the causes of haemolytic anaemia?
Congenital Acquired -extravascular ---Autoimmune haemolytic anaemia -intravascular ---Severe infection/DIC ---Pre-eclampsia
What investigations are done for haemolytic anaemia?
Direct antiglobulin test
Detects antibody or complement on red cell membrane
What does the result of a direct anti globulin test tell us?
\+= immune mediated -= non immune
What s the treatment of haemolytic anaemia?
Folic acid Treat cause -immune- steroids, trigger -remove site of red cell destruction Consider transfusion
What are the causes of macrocytic anaemia?
B12 deficiency Folate deficiency Myelodysplasia Marrow infiltration Drugs and alcohol
How can the causes of macrocytic anaemia be differentiated?
B12/folate assay
Megaloblastic= B12/folate
Non megaloblastic= myelodysplasia, marrow infiltration, drugs and alcohol
What ar the causes of B12 deficiency?
Pernicious anaemia- most common cause, autoimmune
Gastric/ileal disease
What are the causes of folate deficiency?
Dietary
Increased requirement- e.g. haemolysis
GI pathology
What are the clinical features of megaloblastic anaemia?
Lemon yellow tinge
What is the treatment of megaloblastic anaemia?
B12 IM injection every 3 months
Oral folate
