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Year 3 Haem > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Define Anaemia

A

Low Hb concentration

Due to low red cell mass or increased plasma volume

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2
Q

What are low values in males and females?

A

Low Hb in males: <135g/L

Low Hb in females: <115g/L

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3
Q

What are some general symptoms of anaemia?

A

Fatigue

Dyspnoea

Faintness

Palpitations

Headache

Tinnitus

Anorexia

Angina if pre-existing CAD

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4
Q

What are some general signs of anaemia?

A

May be absent

Pallor e.g. conjunctival

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5
Q

What are signs of severe anaemia?

A

Signs of hyper-dynamic circulation

  • Tachycardia
  • Flow murmurs
  • Cardiomegaly
  • Retinal haemorrhages

Later heart failure may occur

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6
Q

What is a normal MCV?

A

Normal: 76-96fL

First thing that should be checked

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7
Q

Define microcytic anaemia?

A

Anaemia associated with a low MCV (< 80 fl)

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8
Q

What is the aetiology of microcytic anaemia?

A

Defects of haem synthseis:
Iron deficiency
Anaemia of Chronic disease
Sideroblastic anaemia

Defects in globin synthesis:
Thalasaemia
Sickle cell (haemolytic)

Lead poisoning

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9
Q

What causes iron deficiency?

A 
blood loss (e.g. GI – in 
Tropics, hookworm is the most common cause of GI blood loss, menorrhea)

Reduced absorption (e.g. small bowel disease, coeliac, cystic fibrosis, gastectomy)

Increased demands (e.g. growth/pregnancy)

Reduced intakes (e.g. vegans)

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10
Q

What causes anaemia of chronic disease?

A

Due to poor use of iron in erythropoiesis, cytokine-induced shortening of RBC survival, and reduced production of and response to erythropoietin

Hepcidin plays a key role - hormone that regulates iron metabolism

Can occur in many chronic diseases e.g. chronic infection, vasculitis, rheumatoid arthritis, malignancy, renal failure

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11
Q

What is sideroblastic anaemia?

A

Abnormality of haem synthesis

Can be inherited or secondary (e.g. to alcohol/drugs)

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12
Q

Epidemiology of microcytic anaemia?

A

Iron deficiency anaemia is the MOST COMMON form of anaemia worldwide

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13
Q

Presenting symptoms of microcytic anaemia?

A
  • Tiredness

o Lethargy

o Malaise

o Dyspnoea

o Pallor

o Palpitations

o Exacerbation of ischaemic conditions

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14
Q

What can lead poisoning cause?

A

Microcytic anaemia

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15
Q

What are the symptoms of lead posioning?

A
  • Anorexia

o Nausea/Vomiting

o Abdominal pain

o Constipation

o Peripheral nerve lesions

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16
Q

What are the signs of microcytic anaemia on examination?

A
  • Pallor

o Brittle nails and hair

o Koilonychia (if severe)

Glossitis

· Angular stomatitis

· Signs of thalassemia

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17
Q

What are the signs of lead poisoning?

A
  • Blue gumline

o Peripheral nerve lesions (causing wrist or foot drop)

o Encephalopathy

o Convulsions

o Reduced consciousness

*basophilic stippling on blood film

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18
Q

What are the appropriate investigations for microcytic anaemia?

A 
FBC
Serum iron
Total iron binding capacity
Serum ferritin (high in ACD)
Serum lead
CRP/ESR for ACD
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19
Q

What is seen on a blood film in microcytic anaemia?

A

Microcytic
Hypochromic
Anisocytosis
Poikilocytosis

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20
Q

What is seen on a blood film in sideroblastic anaemia?

A

Dimorphic blood flim

Hypochromic microcytic celles

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21
Q

What is the treatment for iron deficiency anaemia?

A

Oral iron supplements

OCP for menorrhagia

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22
Q

What is the treatment for sideroblastic anaemia?

A

o Treat the cause

o Pyridoxine used in inherited forms

o Blood transfusion and iron chelation can be considered if there is no response to other treatments

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23
Q

What is the treatment for lead poisoning?

A

o Remove the source

o Dimercaprol

o D-penicillinamine

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24
Q

Define normocytic anaemia?

A

Anaemia with a normal MCV (80-100).

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25
Q

Aetiology of normocytic anaemia?

A 
Acute blood loss
Failure of RBC production
Haemolysis
Uncompensated increase in plasma volume 
Pooling of red cells in spleen
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26
Q

What can cause failure in RBC production?

A

Bone marrow failure or suppression e.g. aplastic anaemia, chemotherapy

Bone marrow infiltration e.g. malignancy

Renal failure – abnormal erythropoietic drive

Early stages of iron deficiency or anaemia of chronic disease

Hypothyroidism (can be macrocytic)

Vitamin B2 deficiency

Vitamin B6 deficiency

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27
Q

What can cause an increase in plasma?

A

Pregnancy

Fluid overload

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28
Q

Presenting symptoms of normocytic anaemia?

A

Breathlessness
Fatigue
Conjunctival pallor

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29
Q

Investigations for normocytic anaemia?

A

FBC - check Hb and MCV

Check history for haemorrhage

If WCC low or platelets low, suspect marrow failure

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30
Q

Define macrocytic anaemia?

A

Anaemia associated with a high MCV of erythrocytes (>100 fl in adults)

Usually results from abnormal haemopoiesis so that red cell precursors continue to synthesis haemoglobin and other cellular proteins but fail to divide normally.

31
Q

What is megaloblastic anaemia?

A

specifically refers to a delay in maturation of the nucleus

while the cytoplasm continues to mature and the cell continues to grow -

unusually large, structurally abnormal, immature red cell

32
Q

What are the main features of megaloblastic anaemia?

A

Oval macrocyctes

o Caused by deficiency of B12 or folate required for the conversion of deoxyuridate to thymidylate, DNA synthesis and nuclear maturation

33
Q

What are the causes of B12 deficiency?

A

Reduced absorption (e.g. post-gastrectomy, pernicious anaemia – autoimmune condition causing severe lack of IF, terminal ileal/small bowel resection or disease)

· Reduced intake (vegans)

· Abnormal metabolism (congenital transcobalamin II deficiency)

34
Q

What are causes of folate deficency?

A
  • Reduced intake (alcoholics, elderly, anorexia)

· Increased demand (pregnancy, lactation, malignancy, chronic inflammation)

· Reduced absorption (coeliac, tropical sprue)

· Jejunal disease (e.g. coeliac disease)

· Drugs (e.g. phenytoin)

35
Q

What can cause non-megaloblastic macrocytic anaemia?

A

Alcohol excess or Liver disease – ROUND macrocytes

o Myelodysplasia

o Multiple myeloma

o Hypothyroidism

o Aplastic anaemia

o Haemolysis (shift to immature red cell form - reticulocytosis)

o Drugs (e.g. tyrosine kinase inhibitor)

o Pregnancy

36
Q

Summarise the epidemiology of macrocytic anaemia

A

More common in ELDERLY FEMALES

· Pernicious anaemia is the MOST COMMON cause of B12 deficiency in the West

37
Q

Recognise the presenting symptoms of macrocytic anaemia

A

Tiredness

o Lethargy

o Dyspnoea

· Family history of autoimmune disease

· Previous GI surgery

· Symptoms of the CAUSE (e.g. weight loss, diarrhoea)

38
Q

Signs of Pernicious Anaemia

A
  • Mild jaundice

o Glossitis

o Angular stomatitis

o Weight loss

39
Q

Signs of B12 Deficiency

A
  • Peripheral neuropathy

o Ataxia

o Subacute combined degeneration of the spinal cord

o Optic atrophy

o Dementia

o Positive Babinski’s, absent ankle reflex, increase knee reflex

40
Q

Bloods for macrocytic anaemia?

A

FBC

· High MCV

· Pancytopaenia in megaloblastic anaemia

· Different degrees of cytopaenia in myelodysplasia

· Exclude reticulocytosis

o LFT

· High bilirubin (due to ineffective erythropoiesis or haemolysis)

o ESR

o TFT

o Serum vitamin B12

o Red cell folate

o Anti-parietal cell (90%) and anti-intrinsic factor antibodies (40-60%)

o Serum protein electrophoresis - looking for a dense band in myeloma

41
Q

What does megaloblastic anaemia look like on a blood film?

A

Megaloblasts

· Hypersegmented neutrophil nuclei

· Target cells if liver disease

42
Q

How can you test for pernicious anaemia?

A

schilling Test

o Method of testing for pernicious anaemia

o B12 will only be absorbed when given with intrinsic factor

43
Q

What is treatment for pernicious anaemia?

A

IM hydroxycobalamin for life

o If no neurological defect

IM hydroxycobalamin 1mg 3x/week for 2 weeks then 1mg/3 months

o If neurological defect present

1mg every other day until no further improvement then 1mg/2 month

44
Q

What is treatment for folate deficiency?

A

Oral folic acid

o If B12 deficiency is present, it must be treated before the folic acid deficiency as B12 is needed for folate to enter cells

· In pregnancy, prophylactic folate is given from conception until 12 weeks to prevent spina bifida

45
Q

What are some complications of macrocytic anaemia?

A

Pernicious anaemia –> increased risk of gastric cancer

· Pregnancy - folate deficiency increases the risk of neural tube defects

46
Q

Define haemolytic anaemia?

A

Premature erythrocyte breakdown causing shortened erythrocyte life span (< 120 days) with anaemia

47
Q

What are some presenting symptoms of haemolytic anaemia?

A
  • Jaundice

· Haematuria

· Dark urine

· Anaemia

· Can often be asymptomatic

· Family history

· Race

· Recent travel

48
Q

What are the signs of haemolytic anaemia on examination?

A
  • Pallor

· Jaundice

· Hepatosplenomegaly

· Leg ulcers, due to poor blood flow

  • Pigementuria
49
Q

What is seen on a FBC in haemolytic anaemia?

A
  • Low Hb

· High reticulocytes (polychromasia)

· High MCV

· High unconjugated bilirubin

· Low haptoglobin (a protein that binds to free Hb released by red blood cells)

o U&Es

o Folate

50
Q

What is seen on a blood film in haemolytic anaemia?

A
  • Leucoerythroblastic picture

o Macrocytosis

o Nucleated erythrocytes or

reticulocytes

o Polychromasia

51
Q

How can you test for auto-immune haemolytic anaemia?

A

Coomb’s test positive (direct antiglobulin test)

Antibody to RBC antibody leads to clumping of RBC

52
Q

What are the acute complications of sick cell disease?

A 
Vaso-occlusive crisis
Acute chest syndrome
Stroke
Infection
Fat embolism
Splenic sequestration
53
Q

What is Sickle cell disease?

A 
disease of red blood cells
Caused by an autosomal recessive single gene defect in the beta chain of haemoglobin
Sickle cell Hb production
fragile and haemolyse
occlude small vessles
54
Q

What are presenting features of sickle cell disease?

A

FH
Persistent pain in skeleton, chest, abdomen
Dactylitis

Pallor
Jaundice
Febrile illness
Tachycardia/Tachypnoea

55
Q

How would you investigate cause of iron deficiency anaemia?

A

History and exam

e.g. menhorragia in pre-menopausal woman

56
Q

What are causes of iron deficiency anaemia?

A

Decreased intake

  • dietary
  • malabsorption

Increased blood loss

  • GI bleed
  • GI cancer
  • Menorrhagia

Increased requirements

  • Pregnancy
  • CKD
57
Q

What would iron studies show in anaemia of chronic disease?

A

Ferritin high

Transferrin low

58
Q

What investigation is done for sickle cell anaemia?

A

Haemoglobin electrophoresis

59
Q

What is the treatment for a vaso-oclusive sickle cell crisis?

A

Analgesia
Supportive care
+/- blood transfusion

60
Q

What preventive measures are taken in sickle cell?

A

Reduce infection risk

  • Pneumococcal immunisation
  • AB prophylaxis
  • Good nutrition
61
Q

What are causes of megaloblastic anaemia?

A

B12/Folate deficency

62
Q

What are features of megaloblastic anaemia on blood film?

A

Hypersegmented neutrophils

Impaired DNA synthesis produces abnormal cell production

63
Q

What are signs OE for iron deficency anaemia?

A

Angular stomitis
Atrophic glossitis
Koilonychia

64
Q

What are some metabolic causes of haemolytic anaemia?

A

Pyruvate kinase deficiency

G6PD deficiency

65
Q

What is MAHA? What causes it?

A

Microangiopathic haemolytic anaemia

Causes: haemolytic-uraemic syndrome, TTP, DIC, pre-eclampsia

66
Q

How might MAHA, G6PD and AI Haemolytic anaemia’s present on blood film?

A

Schistocytes - MAHA
Heinz bodies - G6PD
Spherocytes - autoimmune haemolytic

67
Q

What can cause intravascular haemolytic anaemia?

A

Malaria
G6PD Deficency
Mismatched blood transfusions (ABO)
Cold antibody haemolytic syndromes
Drugs
MAHA (e.g. HUS, TTP)
Paroxysmal nocturnal haemoglobinuria

68
Q

How can we classify hereditary haemolytic anaemia’s?

A

Membrane
Red cell Metabolism
Hb

69
Q

What are the consequences of haemolysis?

A

Anaemia (not always, there is compensation with increased erythropoiesis)
Increased reticulocytes
Increased folate demand for production of RBCs

Increases susceptibility to parvovirus B19

70
Q

What are the clinical effects of G6PD deficiency?

A

Neonatal jaundice
Acute Haemolysis
Rarely chronic haemolytic anaemia
X-linked
Positively selected for in areas with endemic malaria

71
Q

What can precipitate acute haemolysis in G6PD deficiency?

A

Drugs
Infection
Fava Beans

72
Q

What are the principles of management for haemolytic anaemia?

A

Folic acid suppplementation
Avoidance of precipiating factors
Red cell transfusion
Immunisation against blood born virus
Splenectomy

73
Q

What are indications for splenectomy in haemolytic anaemia?

A

PK deficiency
Hereditary spherocytosis
Severe elliptocytosis/pyropoilikocytosis
Thalassaemia syndromes
Immune haemolytic anaemia

74
Q

What are the risks with splenectomy?

A

Risk of sepsis
Esp capsulated bacteria e.g. pneumoccocus

Year 3 Haem (7 decks)

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