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4th Year Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Describe the structure of haemoglobin

A
  • 4 polypeptide globin chains
  • Each chain is complexed to a haem molecule
  • Haem is an iron containing compound
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2
Q

What is anaemia?

A

A reduction of haem and/or globin

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3
Q

What haemoglobin level is seen in anaemia?

How is anaemia classified?

A

Men: Hb <130g/L

Women: <120g/L

Anaemia is classified based on mean corpuscular volume (MCV)

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4
Q

Classifications of anaemia

A
  • Microcytic (MCV <80fL)
  • Normocytic (MCV 80-95fL)
  • Macrocytic (MCV >95fL)
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5
Q

Causes of microcytic anaemia

A
  • Iron deficiency anaemia
  • Thalassaemia
  • Anaemia of chronic disease
  • Sideroblastic anaemia
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6
Q

Symptoms of anaemia

A
  • Fatigue
  • SOB exertion
  • Chest pain
  • Palpitations
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7
Q

Signs of anaemia

A
  • Tachycardia
  • Tachypnoea
  • Hypotension
  • Pallor
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8
Q

History taking in anaemia

A
  • History of presenting complaint
    • Symptoms of anaemia (fatigue, SOB, palpitations, chest pain)
    • Screen for areas of blood loss: GI, respiratory, urinary tract, menstrual
    • Alarm symptoms: weight loss, loss of appetite, night sweats, lymphadenopathy
    • Dietry history
  • Past medical history
    • Chronic disease
    • Trauma
  • Family history
    • Inherited disorders eg haemaglobinopathies
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9
Q

General principles of investigations in anaemia

A

Bloods:

  • FBC: reduced Hb, assess MCV
  • Blood film
  • Iron studies
  • B12 and folate levels
  • Haemolysis screen: bilirubin, haptoglobin, COombs test
  • U&Es: CKD
  • TFTs: hypothyroidism
  • LFTs: chronic liver disease

Imaing:

  • Assess for sight of blood loss

Special tests

  • Bone marrow biopsy
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10
Q

Definition of iron deficiency anaemia

A

Reduced intake, increased requirement, or increased loss of iron, leading to anaemia.

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11
Q

Iron is absorbed in the duodenum and is transported in the blood bound to X. It is stored intracellularly bound to Y.

A

X = Transferrin

Y = Ferritin

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12
Q

Causes of iron deficiency anaemia in infants

A
  • Malnutrition
  • Breast feeding
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13
Q

Causes of iron deficiency anaemia in children

A
  • Malnutrition
  • Malabsorption eg coeliac disease
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14
Q

Causes of iron deficiency anaemia in adults

A
  • Peptic ulcer disease
  • Menorrhagia
  • Malabsorption eg coeliac disease
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15
Q

Causes of iron deficiency anaemia in the elderly

A
  • Colon cancer
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16
Q

Clinical features of iron deficiency anaemia

A
  • Glossitis (tongue red and stolen)
  • Angular stomatitis/chelitis
  • Koilonychia
  • Pica
17
Q

Which patients with iron deficiency anaemia would require an urgent colonoscopy?

A

Over the age of 60

18
Q

Investigations for iron deficiency anaemia

A

Bloods

  • FBC: microcytic anaemia (MCV <80fL)
  • Blood film: hypochromic red cells, target cells
  • Iron studies:
    • Ferrtitin: reduced
    • Serum iron: reduced
    • TIBC: increased
    • Transferrin saturation: decreased

Imaging

  • Endocopy if:
    • Suspecting upper GI bleed or
    • ≥ 60 years old with iron deficiency anaemia

Special test

  • Coeliac serology (if suspecting coeliac disease)
19
Q

Managment of iron deficiency anaemia

A
  • Address the underlying cause
  • Oral iron replacement
    • Ferrous sulphate or ferrous fumarate
    • Monitor Hb 2-4 weeks after staring and then at 2-4 months
    • Treatment should continue for 3 months after anaemia corrected
  • Intravenous iron replacement
  • Blood transfusion
20
Q

Which patients with iron deficiency anaemia should receive intravenous iron replacement?

A
  • Not responding or intolerant to oral therapy
  • Malabsorption
  • Renal failure
21
Q

Which patients with iron deficiency anaemia should receive a blood transfusion?

A
  • Hb <70g/L or
  • Hb <80g/L and cardiac co-morbidity
22
Q

Side effects of oral iron

A
  • Constipation
  • Black stools / malaena
23
Q

Definition of thalassaemia

A

Autosomal recessive haemoglobinopathy. There is impaired globin chain synthesis.

24
Q

Epidemiology of thalassaemia

A
  • Prevelent in areas of malaria
  • Alpha thalassaemia: Asian and African
  • Beta thalassaemia: Asian, Mediteranean and Middle Eastern
25
Q

What are the types of normal haemoglobin? Show their structure and proportion in adults.

A
  • HbA α2β2 90%
  • HbA2 α2δ2 <2%
  • HbF α2γ2 <2-5%
26
Q

HbA, HbA2 and HbF in alpha thalassaemia and beta thalassaemia

A
  • Alpha thalassaemia
    • HbA = reduced
    • HbA2 = reduced
    • HbF = reduced
  • Beta thalassaemia
    • HbA = reduced
    • HbA2 = increased
    • HbF = increased
27
Q

Alpha thalassaemia types of disease. Number of gene deletions. Effect on haemoglobin. Features of disease.

A
  • Silent carrier:
    • 1 deletion
    • Normal haemoglobin
    • Asymptomatic
  • Trait:
    • 2 deletions
    • Reduced haemoglobin
    • Mild anaemia
  • HbH
    • 3 deletions
    • Greatly reduced haemaglbin
    • Marked anaemia; beta chains form tetramers
  • Hb Barts
    • 4 deletions
    • Absent haemoglobin
    • Hydrops fetalis; death in utero; gamma chains from tetramers
28
Q

Pathophysiology of beta thalassaemia

A
  • 2 alleles code for beta globin production
  • Gene mutations
    • Raised production (β+)
    • Absent production (β0)

Trait; β/β+; reduced HbA, increased HbA2 and HbF; asymptomatic or mild symptoms

Major; β0β0; absent HbA, increased HbA2 and HbF; marked anaemia

29
Q

Signs of thalassaemia

A
  • Neonatal jaundice
  • Hepatosplenomeglay
  • Failure to thrive
  • Chipmunk facies
30
Q

Investigations for thalassaemia

A
  • Bloods:
    • FBC: microcytic anaemia (MCV <80fL)
    • Blood film: hypochromic red cells, target cells, Howell Jolly bodies
    • Hb electrophoresis
  • Imaging
    • Skull x-ray: hair on end appearance
31
Q

Managment of alpha or beta thalassaemia trait

A
  • No intervention required
32
Q

Managment of HbH and beta thalassaemia major

A
  • Regular blood transfusions
  • Folate supplementation: haemolysis leads to folate deficiency
  • Iron chelation: desferrioxamine reduces the risk of iron overload
  • Splenectomy
    • ​For patients with massive splenomeglay due to extramedullary haematopoiesis
    • Resuting hypersplenism leads to increased haemolysis
  • Stem cell transplant: ​Only curative option
33
Q

Definition of anaemia of chronic disease

A

Anaemia due to inflammation mediated reduction in RBC production.

Can be microcytic or normocytic. Often starts as normocytic and becomes microcytic.

34
Q

Epidemiology of anaemia of chronic disease

A
  • Second most common anaemia worldwide
  • Multiple causes
35
Q

Causes of anaemia of chronic disease

A
  • Autoimmune disorders eg rheumatoid arthritis
  • Chronic infection
  • Chronic disease eg CKD, heart failure
  • Malignancy
  • Major trauma
36
Q

Investigations for anaemia of chronic disease

A
  • Bloods
    • Iron studies
      • Ferritin: raised
      • Serum iron: reduced
      • Transferrin saturation: reduced
      • TIBC: reduced
    • Inflammatory markers: raised
37
Q

Definition of sideroblastic anaemia

A

Anaemia due to defective haem synthesis within the mitochondria

38
Q

Causes of sideroblastic anaemia

A
  • Congenital: X-linked recessive enzyme deficiency
  • Vitamin B6 deficiency
  • Lead poisoning
  • Chronic alcoholism
39
Q

Investigations in Sideroblastic anaemia

A
  • FBC: microcytic anaemia
  • Blood film: ringed sideroblasts
  • Iron studies
    • Ferritin: increased
    • Serum iron: increased
    • Transferrin saturation: increased
    • TIBC: reduced

4th Year Haematology (7 decks)

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