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Blood > Anaemia > Flashcards

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
Q

What mainly causes normocytic normochromic anaemias?

A

Blood loss followed by haemodilution

Anaemia of chronic disease (ACD)

26
Q

Describe how blood loss causes normochromic normocytic anaemias.

A

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
Q

Name the main cause for ACD>.

A

Changes in iron availability - low serum iron

Caused by liver release of a peptide = hepcidin

28
Q

How do you treat ACD?

A

Anaemia resolves if the underlying condition sttles

29
Q

Describe the mechanisms causing ACD.

A

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
Q

List some examples of ACD with inflammation and infection.

A

RA
TB and other opportunistic infections in HIV/Aids.
Some cancers
Response to chronic inflammation

31
Q

Name some mixed causes of anaemia which often co-exist in ACD.

A

Bleeding

Shortened red cell survival

32
Q

What is the ESR?

A

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
Q

What are the main globulin proteins causing an increase in ESR.

A

Fibrinogen

Immunoglobulins (antibodies)

34
Q

What is the importance of CRP?

A

Shows the levels of acute/chronic inflammation in the body. Protein produced by the liver.

35
Q

How do different infections cause a change in CRP?

A

High levels indicate bacterial infection
Mild increase in viral infections
Mild to moderate increase in injury e.g. trauma, infarction

36
Q

Do we measure the CRP and ESR together?

A

No, rarely done, often refused by labs.

37
Q

Why does anaemia occur in renal disease?

A

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
Q

What is the issue with blood doping by athletes?

A

Increase in levels of Hb and viscosity of blood results in risk for thromboses.

39
Q

What is haemolytic anaemia?

A

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
Q

Name examples of acquired haemolytic anaemias.

A

Malaria, burns, autoantibody

41
Q

Name the main tests for haemolysis.

A

Clinical history
FBC
Reticulocyte count
Bilirubin - raised

Blood (8 decks)

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