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Anaemia Flashcards

1
Q

What is anaemia?

A

Reduced haemoglobin concentration in relation to age, gender, ethnicity, physiological state (pregnancy), geography/altitude.

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2
Q

What are the reference ranges for male and female respectively?

A

Female: 115g/L to 155 g/L
Male: 130 - 175 g/L

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3
Q

State the severity intervals for anaemia.

A

Mild > = 100g/L
Moderate 70-100g/L
Severe < 70g/L

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4
Q

List the symptoms of anaemia.

A

Weak/fatigue
Heart pounding/palpitations (increased SV)
Headaches/head throbbing
Pallor of mucous membranes
Feel cold
If vascular disease is present –> angina, claudication
*** Mild anaemia = often no symptoms

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5
Q

What are the clinical signs of anaemia?

A

Pallor of mucus membranes

Increase in pulse rate

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6
Q

What are the signs of severe anaemia?

A

Increase in pulse rate
Retinal haemorrhage
Heart failure

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7
Q

What are the signs of severe anaemia with a co-existing vascular disease?

A

Myocardial ischaemia in ECG/exercise test

Confusion: brain failure due to inadequate oxygen delivery

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8
Q

What do you call Hb that is raised?

A

Polycythaemia

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9
Q

What categories do you look at on the blood screen?

A

Hb - normal/anaemia/polycythaemia
Cell size - microcytic/normocytic/macrocytic
Hb content of cells - hypochromic/normochromic

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10
Q

What are the most common forms of anaemia?

A

Normocytic normochromic
Microcytic hypochromic
Macrocytic normochromic

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11
Q

What are less common forms of anaemia?

A

Microcytic normochromic

Normocytic hypochromic

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12
Q

Name the three causes of anaemia (aetiology)

A

Blood loss - followed by haemodilution
Impaired red cell production
Haemolysis - increased rate of RBC breakdown

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13
Q

What happens in erythroid hypoplasia?

A

Marrow failure, reduced erythropoietin, reticulocytes low

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14
Q

What happens in haemolytic anaemia?

A

Shorted cell survival with secondary erythroid hyperplasia, reticulocytes increased

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15
Q

What happens in ineffective erythropoiesis?

A

Reticulocytes usually normal or mildly increased; many erythroblasts destroyed in the marrow due to metabolic abnormalities arising in erythropoiesis

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16
Q

Name the main causes of microcytic hypochromic anaemia.

A

Iron deficiency - unable to make normal amounts of Hb.
Thalassemias - decreased production of alpha or beta globin peptides
Other rare causes

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17
Q

What happens in microcytic hypochromic anaemias?

A

Reduced concentration of Hb in red cells

Small, red cells

18
Q

What are features of iron defiency?

A

Pencil and target cells

Erythroblasts show reduced Hb - no stainable iron marrow

19
Q

What are the main causes for macrocytic anaemias?

A

Megaloblastic anaemia
Non-megaloblastic causes - liver disease, increase in red cell production (haemolytic anaemias)
Others - myelodysplasia = common in elderly

20
Q

What is megaloblastic anaemia?

A

Delayed and abnormal maturation of all cells in bone marrow and other tissues.

21
Q

What causes megaloblastic anaemia?

A

Deficiencies in folate/folic acid and vit B12

22
Q

What are folate and vit B12 needed for?

A

Thymidine synthesis - build part of nucleotides

23
Q

How does liver disease cause macrocytic anaemia?

A

Increased cholesterol in red cell membrane - cells become larger

24
Q

How do haemolytic anaemias cause macrocytic anaemia?

A

Younger red cells are larger, as red cells age, they lose cell membrane and become smaller. Average cell size increases.

25
What mainly causes normocytic normochromic anaemias?
Blood loss followed by haemodilution | Anaemia of chronic disease (ACD)
26
Describe how blood loss causes normochromic normocytic anaemias.
Blood pressure in veins (and capillaries) falls. Net movement of fluid from tissues into vessels IV infusion of fluids - kidneys retain salt and water over several days. Replaces fluid loss from tissues.
27
Name the main cause for ACD>.
Changes in iron availability - low serum iron | Caused by liver release of a peptide = hepcidin
28
How do you treat ACD?
Anaemia resolves if the underlying condition sttles
29
Describe the mechanisms causing ACD.
1 - Release of iron stores from macrophages (main site of iron stores) to transferrin is reduced. Less iron for transport. Reduced availability to erythroblasts. 2 - changes in serum iron and transferrin e.g. surgery - cholecysectomy. Any inflammation will reduce serum iron levels and reduce iron supply to erythroblasts.
30
List some examples of ACD with inflammation and infection.
RA TB and other opportunistic infections in HIV/Aids. Some cancers Response to chronic inflammation
31
Name some mixed causes of anaemia which often co-exist in ACD.
Bleeding | Shortened red cell survival
32
What is the ESR?
Red cells are normally negatively charged, settle slowly. When plasma proteins increase (positive) they neutralize the red cells. Red cells become stacked called a rouleaux which settles rapidly. ESR increases slowly (days) in inflammation.
33
What are the main globulin proteins causing an increase in ESR.
Fibrinogen | Immunoglobulins (antibodies)
34
What is the importance of CRP?
Shows the levels of acute/chronic inflammation in the body. Protein produced by the liver.
35
How do different infections cause a change in CRP?
High levels indicate bacterial infection Mild increase in viral infections Mild to moderate increase in injury e.g. trauma, infarction
36
Do we measure the CRP and ESR together?
No, rarely done, often refused by labs.
37
Why does anaemia occur in renal disease?
Often due to low erythropoietin - reduced erythropoiesis or absence of kidneys. Some waste products shorten red cell survival. Responds to subcutaneous injection of erythropoietin.
38
What is the issue with blood doping by athletes?
Increase in levels of Hb and viscosity of blood results in risk for thromboses.
39
What is haemolytic anaemia?
Shortened red cell survival in the circulation Marrow responds by increased RBC production Reticulocytosis - increase in red cells leading to polychromasia (blue staining) MCV is increased in severe haemolysis (reticulocytes larger than mature cells)
40
Name examples of acquired haemolytic anaemias.
Malaria, burns, autoantibody
41
Name the main tests for haemolysis.
Clinical history FBC Reticulocyte count Bilirubin - raised

Blood (8 decks)

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