Acquired Anaemias Flashcards
Firstly define Anaemia [4]
Ranges for male 12-70 yo and >70 yo [2]
Ranges for female 12-70 yo and >70 yo [2]
A haemoglobin below the normal range for Age/Sex/Ethnicity
Male 12-70: 140-180
Male >70: 116-156
Female 12-70: 120-160
Female >70: 108-143
What are the clinical features of anaemia [5] related to reduced oxygen delivery to tissues
What other symptoms can present in which are related to underlying cause [5]
- Fatigue
- SOB
- Ankle Swelling
- Dizziness
- Chest Pain
Symptoms of the cause:
- menorrhagia
- dyspepsia, PR bleeding
- diarrhea, weight loss
- jaundice
- splenomegaly, lymphadenopathy
First investigation for anemia - what can it tell you? [3]
A FBC
Tells you the haemoglobin and the MCV/MCH
How do we describe anaemias using red cell indices and blood film? [3]
Morphologically based on MCH & MCV
1) Hypochromic, Microcytic
2) Normochromic, Normocytic
3) Macrocytic
FBC shows hypochromic, microcytic anaemia, what is the likely cause? [2] How to check and make sure
Most likely Fe-deficiency Anaemia, if you’re in any doubt do a serum Ferritin to check (should be low)
Fe-deficiency anaemia is not a diagnosis but must have a cause, what could cause it? [3]
Malabsorption e.g. poor diet, gastrectomy
Blood loss e.g. GI or menorrhagia
Increased requirement in pregnancy
What elements of an exam of hands and head could suggest iron deficiency anaemia? [3]
Koilonychia, atrophic tongue & angular stomatitis
What tests can we do if we get a case of Fe-deficiency anaemia? [2]
Endoscopy & barium study can be done if there’s evidence of GI blood loss
How do you treat Fe-deficiency anaemia? [4]
Oral FERROUS SULPHATE 200mg/8h
Treat the cause: diet changes, ulcer therapy, surgery if bleeding
Patient presents with a Normochromic, normocytic anaemia, what can the reticulocyte count tell us if:
Elevated? [2]
Normal or low? [3]
If it’s increased it means you’re losing RBCs and the marrow is compensating –> Blood loss, hemolysis
If its normal or low –> anemia secondary to infection, inflammation, malignancy (bone marrow infiltration)
Normochromic, normocytic + elevated reticulocyte count
So you suspect a haemolytic anaemia as no evidence of acute blood loss
Define hemolytic anemia [2]
3 congenital causes of hemolytic anemia
5 acquired hemolytic anemias - these can be further classified according to intra/extravascular hemolysis
Accelerated red cell destruction compensated by bone marrow
Congenital causes:
- G6PD deficiency
- Hereditary Spherocytosis
- Haemoglobinopathies e.g. Sickle cell
Acquired hemolytic anemias:
- Autoimmune HA (extravascular haemolysis)
- Mechanical e.g. artificial valve leaking (intravascular)
- Severe infection (intravascular)
- Pre-eclampsia, HUS or DIC (intravascular)
- Drugs (intravascular)
Normochromic + normocytic, high reticulocyte count
What is evidence on blood film that shows its immune hemolysis of the extravascular [2] and intravascular variety [1] ?
What 5 other investigative modalities would be used to test if the patient is hemolysin and what are the expected results?
Blood film:
Extravascular - spherocytes, agglutination in cold
Intravascular - schistocytes
Other investigations indicating hemolysis:
Serum Bilirubin = High
LDH = High
Serum Haptoglobin = low (eats up free haemoglobin)
Urine for hemosiderin and urobilinogen
Coomb’s test or DAT
Two tests are useful in differentiating intravascular and extravascular hemolysis [2]
Coomb’s Test:
Detects Ab/complement on the red cell membrane so if +Ve suggests an immune cause for hemolysis
Urine test:
- Haemosiderinuria in intravascular haemolysis
- Extravascular haemolysis increases serum bilirubin –> high Urobilinogen
Immune mediated haemolysis - 3 ways
Alloantibody causing transfusion reactions
Autoimmune haemolysis
* Can be due to CLL and other lymphoproliferative disorders, both result in reduced lifespan of RBC.
* Warm AIHA: IgG (antibodies react at body temp), spherocytes + polychromasia on film, organomegaly.
* Cold AIHA: IgM (antibodies react optimally at 4), MCV raised factitiously
How would we manage a haemolytic anaemia? 3 modalities/approaches 1. Support marrow function [1] 2. Correct cause [4] 3. Consider transfusion
Support the marrow with Folic Acid
Correct cause:
- Immunosuppression & treat trigger if immune
- IV Abx if septic
- Prosthetic valve replacement if leaky
- Remove the site of haemolysis i.e. spleen
