Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Haematology > Acquired Anaemia > Flashcards

Acquired Anaemia Flashcards

1
Q

Define anaemia

A

Hb below normal for age and sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is normal Hb level worked out?

A

It is +/- 2 SDs from the mean (this includes 95% of the population)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What factors influence normal Hb levels?

A 
Age 
Sex (higher in men due to testosterone) 
Time sample taken (e.g. if fasting sample Hb will be higher, than if diluted) 
Time to analyse
Ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the normal Hb level for woman?

A

12-70: 120-160

>70: 108-143

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the normal Hb level for men?

A

12-70: 140-180

>70: 116-156

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some general features of anaemia/

A 
Due to reduced O2 delivery to tissues:
Tiredness
Pallor
Dizziness (reduced O2 to brain) 
Breathlessness
Chest pain (myocardial ischaemia) 
Swelling of ankles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What clues in history may help you identify a cause for anaemia?

A 
Menorrhagia
Dyspepsia, PR bleeding
Malabsorption (diarrhoea, weight loss) 
Jaundice (haemolysing --> increased bilirubin) 
Splenomegaly/lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main red cell indices to be aware of?

A 
MCV = mean cell volume (size) 
MCH = mean cell haemoglobin (pigmentation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are the red cell indices measured?

A

Automatic machine that uses a laser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the three main types of acquired anaemia?

A 
Hypochromic microcytic (small, pale cells) 
Normochromic normocytic (normal looking cells, reduced in number) 
Macrocytic (large cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What further tests should you do if you find hypochromic microcytic cells?

A

Serum ferritin

Most common reason for HM cells = Fe deficient anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What further tests should you do if you find normochromic normocytic cells?

A

Reticulocyte count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What further tests should you do if you find macrocytic cells?

A

B12/Folate
Bone marrow

Commonest cause of macrocytic cells = B12/folate deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypochromic microcytic cells + low serum ferritin =?

A

Fe deficient anosmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypochromic microcytic cells + normal/high serum ferritin =?

A

Thalassaemia
Secondary anaemia (although more commonly get normocytic normochromic cells with this)
A lot more rarely: sideroblastic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How much iron is in the body?

A

4g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the pathway to get rid of excess iron?

A

No pathway for this exists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two things that can happen to iron in the gut?

A

Bound to mucosal ferritin and sloughed off

Transported across basement membrane by ferroportin then bound to transferrin in plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which Fe ion is absorbed more readily in the gut?

A

Fe2+ (from animals haem form) > Fe3+ (non-haem form)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What form is iron stored as in the body?

A

Ferritin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the role of hepcidin in controlling iron levels in the body?

A

Hepcidin synthesised by hepatocytes in response to too much iron, liver failure, inflammatory markers (esp. IL6)

Hepcidin blocks ferroportin –> reduced Fe absorption in the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What must you do after you get a diagnosis of iron deficient anaemia?

A

Find a cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What must you check for in the history?

A 
Dyspepsia, GI bleeding
Menorrhagia 
Diet (e.g. vegan?)
Increased requirements? - e.g. pregnant 
Malabsorption - gastrectomy, coeliac disease, diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are signs of Fe deficient anaemia?

A

Sore, atrophic tongue
Kolionychia
Angular cheilitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Management of Fe deficiency
Correct cause (diet, ulcer therapy, gynae interventions, surgery) Oral iron (IV if intolerant)
26
Normochromic normocytic anaemia + increased reticulocyte count = ?
Haemolysis Acute blood loss (bone marrow working and compensating for loss of blood cells)
27
Normochromic normocytic anaemia + decreased/normal reticulocyte count = ?
Secondary anaemia Hypoplasia Marrow infiltration
28
what is haemolytic anaemia?
Accelerated RBC destruction --> decreased Hb With compensation of bone marrow (hence increased retic count)
29
What are the two types of haemolysis?
Intravascular - RBC destruction in circulation | Extravascular - RBC breakdown in spleen etc.
30
Where are RBCs normally broken down?
RES (mostly spleen)
31
What are types of haemolytic anaemia?
Congenital - hereditary spherocytosis, enzyme deficiency, haemoglobinopathy (HbSS) Extravascular - Auto-immune haemolytic anaemia Intravascular - mechanical (e.g. heart valve), infection/DIC, PET/HUS/TTP
32
What is HUS?
Thrombotic microangiopathy in which microthrombi occlude arterioles and capillaries --> thrombocytopenia, haemolytic anaemia, AKI
33
Acquired haemolytic anaemia is broadly split into two categories - what are these?
Immune - mostly extravascular | Non-immune - mostly intravascular
34
How do you distinguish between immune and non-immune haemolytic anaemia?
DAT (direct coombs test) | Mix red cells with anti-human globulin, agglutination = positive test (presence of autoantibodies on surface of RBCs)
35
Normochromic, normocytic cells, high reticulocyte count, positive DAT test, presence of spherocytes on blood film is most likely to indicate what?
Autoimmune haemolytic anaemia
36
Warm autoantibody is most likely to indicate what?
Autoimmune Drugs CLL
37
Cold autoantibody is most likely to indicate what?
CHAD Infections Lymphoma
38
Alloautoantibody is most likely to indicate what?
Transfusion reactions
39
Why might you see spherocytes on film in an autoimmune haemolytic anaemia?
Bits of membrane of RBCs tagged with autoantibodies are broken down leading to spherocytes
40
What kind of cells may you see in intravascular haemolysis?
Schistocytes | smashed up cells
41
How can you work out if a patient is haemolysing?
``` FBC, high retic count, blood film (spherocytes/schistocytes) High bilirubin Low serum haptoglobin DAT Urine for haemosiderin/urobilinogen ```
42
What is haptoglobin?
Mops up free Hb (so levels of empty haptoglobin are low in haemolytic anaemia)
43
How do you manage patients with haemolytic anaemia?
Folic acid to support marrow Correct cause - immunosuppression (steroids) Treat CLL, lymphoma, stop causative meds Splenectomy (removing site of RBC destruction) Consider transfusion if struggling
44
Normochromic, normocytic anaemia + normal/low reticulocyte count mostly commonly = ?
Secondary anaemia
45
What is the pathophysiology behind secondary anaemia?
Inflammatory markers/renal failure --> increased hepicidin --> blocks ferroportin so there is defective iron absorption
46
Why do you need to be careful when diagnosing secondary anaemia?
May be initial increase in ferritin
47
What may cause a secondary anaemia?
Infection, inflammation, malignancy
48
What are the two types macrocytic anaemia?
Megaloblastic | Non-megaloblastic
49
What is the cause of megaloblastic anaemia?
B12 and folate deficiency
50
Aside from anaemia what else is associated with B12/folate deficiency?
Neurological symptoms (due to degeneration of the cord (B12))
51
What are the two causes of B12 deficiency?
Pernicious anaemia | Gastric/ileal disease
52
What are the causes of folate deficiency?
Dietary Increased requirements (e.g. pregnancy, haemolysis) GI pathology, e.g. coeliac
53
Why do you get a lemon yellow tinge in megaloblastic anaemia?
Abnormal cells --> increased haemolysis --> increased bilirubin
54
How is B12 absorbed from the gut?
Binds intrinsic factor (made by parietal cells) Absorbed in distal ileum Bound to transcobalamin II in portal circulation for transport to marrow/other tissues
55
What is the most common cause of B12 deficiency in western world?
Pernicious anaemia
56
What is the pathophysiology of pernicious anaemia?
Autoantibody against intrinsic factor/parietal cells
57
Why do the signs/symptoms of B12 deficiency take years to come on after development of IF antibody?
As stores of B12 are so goog
58
How do you treat megaloblastic anaemia?
``` B12 replacement (3monthy IM injection) Oral folate ```
59
What are other common causes of macrocytosis?
``` Alcohol Drugs (methotrexate, antiretrovirals, hydroxycarbamide) Disordered liver function Hypothyroidism Myelodysplasia ```
60
Macrocytic anaemia that is non-megaloblastic may indicate what?
Myelodysplasia Marrow infiltration Drugs

Haematology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions