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Y3 Haematology > Acquired Anaemias > Flashcards

Acquired Anaemias Flashcards

1
Q

do males or females have a higher Hb?

A

males have higher due to androgens

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2
Q

state some clinical features of anaemia ?

A 
tiredness
pallor
SOB
swelling of ankles 
dizziness
chest pain
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3
Q

state three things that can cause acquired anaemia?

A

bleeding
malabsorption
splenomegaly

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4
Q

what does MCV stand for?

A

mean cell volume

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5
Q

what does MCH stand for?

A

mean cell haemoglobin

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6
Q

what are the three morphological types of anaemia?

A

hypo chromic microcytic
normochromic normocytic
macrocytic

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7
Q

what test should be used for hypo chromic microcytic to determine the cause?

A

serum ferritin

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8
Q

what test should be used for normochromic normocytic to determine the cause?

A

reticulocyte count

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9
Q

what test should be used for macrocytic to determine the cause?

A

B12/folate

Bone marrow

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10
Q

what is the commonest cause of anaemia?

A

iron deficiency

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11
Q

state some signs of hypo chromic microcytic anaemia?

A

atrophic tongue
koilonychias
angular cheilitis

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12
Q

state some causes of hypo chromic microcytic anaemia/

A

GI bleed
menorrhagia
gastrectomy
coeliac disease

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13
Q

what would low serum ferritin suggest for microcytic anaemia?

A

iron deficiency

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14
Q

what would a normal or increased serum ferritin with microcytic anaemia suggest?

A

thalassaemia or secondary anaemia

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15
Q

what causes secondary anaemia ?

A

chronic inflammation

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16
Q

what does a high reticulocyte count suggest?

A

high reticulocyte count suggests good production of RBCs

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17
Q

what is the commonest cause of macrocytic anaemia?

A

B12/folate deficiency

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18
Q

state some causes of macrocytic anaemia?

A 
B12/folate deficiency 
alcohol
drugs (methotrexate, anti-retrovirals)
hypothyroidism 
disordered liver function
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19
Q

what are the two types of macrocytic anaemia?

A

megaloblastic

non-megaloblastic

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20
Q

what type of macrocytic anaemia is caused by B12/folate deficiency ?

A

megaloblastic

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21
Q

state two symptoms of megaloblastic anaemia?

A

lemon yellow tinge

neuropathy

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22
Q

what is the treatment for megaloblastic anaemia?

A

replace the deficiency

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23
Q

state some causes of non-megaloblastic anaemia?

A

bone marrow infiltration

myelodysplasia

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24
Q

what characteristic of the red cell does the MCV determine ?

A

size of the cell

25
Q

what characteristic of the red cell does the MCH determine ?

A

the colour of the cell

- pale or dark

26
Q

what protein is responsible for transporting iron out of duodenal cells into circulation and moving iron from the circulation into hepatocytes?

A

feroportin

27
Q

what enzyme controls the actions of feroportin?

A

hepcidin

28
Q

when is hepcidin made?

A

hepcidin is produced in response to inflammation

29
Q

what affect does hepcidin have on iron levels in duodenal cells and hepatocyte cells?

A

reduces duodenal iron absorption

mobilise iron from reticuloendothelial cells

30
Q

does increase of hepcidin increase or decrease RBC production?

A

high hepcidin reduces RBC production since less iron is available

31
Q

what is iron transported as in plasma?

A

transferrin

32
Q

what is iron stored in cells as?

A

ferritin

33
Q

what affect on ferroportin does hepcidin have?

A

hepcidin decreases the actions of ferroportin

34
Q

what is the name of the reaction which break down red cells?

A

haemolysis

35
Q

what is the management of iron deficient anaemia?

A

correct diet
ulcer therapy
surgery if bleeding
replace iron

36
Q

what would an increased reticulocyte count suggest

A

suggest there is a greater RBC production and hence may suggest there is acute blood loss or increased haemolysi and the body is trying to compensate

37
Q

state two places where haemolysis can occur?

A

intravascular

extravascular

38
Q

what is intravascular anaemia?

A

RBCs lyse in the circulation releasing hemoglobin into the plasma

39
Q

what is extravascular anaemia?

A

RBCs are phagocytized by macrophages in the spleen and liver.
Extravascular hemolysis is characterized by spherocytes.

40
Q

what does haptoglobin bind to?

A

free Hb

41
Q

what are the levels of haptoglobin like for intravascular haemolytic anaemia?

A

low because a lot of it has bound to free Hb

42
Q

what type of condition causes extravascular haemolytic anaemia?

A

autoimmune

43
Q

what test should be done for extravascular haemolytic anaemia?

A

direct anti globulin test (DAGT)

44
Q

what does the DAGT test detect?

A

DAGT binds to antibodies on the red cells which suggests autoimmune disease since the body is making antibodies to their own cells

45
Q

what question should be asked to the patient with a positive DAGT ?

A

have they had a blood transfusion recently?

any other autoimmune diseases?

46
Q

what does the histology of autoimmune (extravascular) haemolytic anaemia look like?

A

spherocytes

agglutination in cold AIHA

47
Q

why does the red cells clump (agglutinate) together in extravascular haemolytic anemia

A

IgM antibody causes the cells to clump together since it has receptors on its surface for the cells
- only clump in the cold

48
Q

state some causes of intravascular haemolytic anaemia?

A

injury
severe infection
drugs

49
Q

what are fragments of RBCs called?

A

schistocytes

50
Q

what tests should be done for intravascular haemolytic anaemia ?

A

bilirubin (high)
LDH (high)
serum haptoglobin (low)
check urine for haemosiderin/urobilinogen

51
Q

what is the management of intravascular haemolytic anaemia?

A

support marrow function with folic acid
remove site of red cell destruction (splenectomy)
treat underlying cause
consider transfusion

52
Q

state some causes of B12 deficiency ?

A

pernicious anaemia

gastric/ileal disease

53
Q

what causes pernicious anaemia?

A

autoimmune disease against intrinsic factor

54
Q

state some causes of folate deficiency ?

A

dietary
increased requirements (haemolysis)
coeliac disease

55
Q

what is another name for DAGT test? (direct anti globulin test)

A

coombs test

56
Q

secondary anaemia is caused mostly by what type of anaemia?

A

normochromic normocytic

57
Q

where is B12 absorbed in the body?

A

distal ilium

58
Q

how is pernicious anaemia diagnosed?

A

presence of antibodies against intrinsic factor

Y3 Haematology (14 decks)

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