Anaemia Flashcards
What do we mean by the term Haemolysis and Haemolytic anaemia?
Blood cells destroyed faster than they can be made,
when r.b.c number decreases = anaemia
What does this patient have?
- yellow tinge in eyes
- LFT and bloods normal
- bilirubin 30
- unconjugated
- Hb 98
- Spherocytes
- polychromatic macrocytes
- high reticulocytes
- reticulocyte increase = bone marrow compensating for bleeding (or haemolysis)
- jaundice due to bilirubin from haemolysis and not other cause as it is unconjugated
- Low Hb
Haemolytic anaemia
How is haemolytic anaemia treated?
Folic acid - required to make red blood cells due to increased need
Splenectomy - if severe to increase red cell life span
upper right abdo pain and tenderness
Bilirubin 60
Largely conjugated?
18 years old
Anaemia
gallstones at a very young age due to increased breakdown of haemoglobin into bilirubin
Stone has caused obstructive jaundice
Liver is able to conjugate bilirubin but it is not passing from the bile ducts and gall bladder into duodenum
What type of gallstones can one get due to anaemia?
Pigmented - due to bilirubin from r.b.c breakdown in haemolytic anaemia
What type of anaemia is the following:
Low Hb high MCV high ferritin normal B12 and folate high bilirubin high creatinine high LDH
Macrocytic anaemia
Bilirubin and LDH shows haemolysis based macrocytic anaemia
What does LDH signify?
Marker of cell breakdown, it is an intracellular enzyme so levels should not be high
What is Auto Immune haemolytic anaemia DAT positive?
Can be seen with other disorders of the immune system and autoimmune disorders
direct antiglobulin test (DAT) shows antibodies bound to RBC
What inherited defects of red blood cells can cause haemolysis?
abnormal membrane
abnormal Hb
Defect in glycolytic pathway
defect in enzymes of pentose shunt
What is an example of abnormal r.b.c membrane?
hereditary spherocytosis
What is an example of abnormal Hb?
sickle cells anaemia
What is an example of defect in glycolytic pathway?
pyruvate kinase deficiency - provides energy for the cell
What is an example of defect in enzyme of pentose shunt?
G6PD Deficiency * key enzyme in pentose shunt which protects from oxidant damage
Blood film with Ghost cells, Heinz Bodies, Hemighosts, irregularly contracted cells
G6PD deficiency
What cells on a blood film show oxidant damage?
Irregularly contracted cells and heinz bodies
The Heinz bodies are precipitated oxidised haemoglobin
What do Ghost cells show?
There has been intravascular haemolysis
What advise is given to patients with G6PD deficiency?
Avoid oxidant drugs
Don’t eat broad beans
avoid nephthalene
- be aware that haemolysis can result from something like infection which can generate oxidants
58 year old presents:
- tired
- lethargy
- breathlessness at rest
- worsens at exertion
- ankle swelling end of day
blood test:
Low Hb Low MCV Low ferritin Low serum Iron High transferrin
Iron deficiency anaemia
But why?
What further questions should be asked if someone has iron deficiency anaemia?
- Are you veggie
- GI symptoms
- Changes in bowel habit
- Menstrual history
- weight loss
- Medication e.g. NSAIDs
What clinical signs are there of iron deficiency anaemia?
Koilonychia
Glossitis
Angular stomatitis
What investigations for an elderly post menopausal women, with anaemia?
FIT test (Faecal Immunochemical Test) to detect faecal occult blood
Imaging
biopsy
colonoscopy
coeliac antibody testing
What can cause increased blood loss for iron deficiency anaemia?
Hookworm
Menstrual
Gastrointestinal
What can cause insufficient iron intake for iron deficiency anaemia?
Dietary - vegetarians
Malabsorption : coeliac disease, H.Pylori gastritis
What can cause increased iron requirements not being fulfilled for iron deficiency anaemia?
Pregnancy
Infancy
