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CardioRespiratory 2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What do we mean by the term Haemolysis and Haemolytic anaemia?

A

Blood cells destroyed faster than they can be made,

when r.b.c number decreases = anaemia

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2
Q

What does this patient have?

  • yellow tinge in eyes
  • LFT and bloods normal
  • bilirubin 30
  • unconjugated
  • Hb 98
  • Spherocytes
  • polychromatic macrocytes
  • high reticulocytes
A
  • 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

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3
Q

How is haemolytic anaemia treated?

A

Folic acid - required to make red blood cells due to increased need

Splenectomy - if severe to increase red cell life span

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4
Q

upper right abdo pain and tenderness

Bilirubin 60

Largely conjugated?

18 years old

Anaemia

A

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

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5
Q

What type of gallstones can one get due to anaemia?

A

Pigmented - due to bilirubin from r.b.c breakdown in haemolytic anaemia

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6
Q

What type of anaemia is the following:

Low Hb
high MCV
high ferritin
normal B12 and folate
high bilirubin
high creatinine
high LDH
A

Macrocytic anaemia

Bilirubin and LDH shows haemolysis based macrocytic anaemia

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7
Q

What does LDH signify?

A

Marker of cell breakdown, it is an intracellular enzyme so levels should not be high

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8
Q

What is Auto Immune haemolytic anaemia DAT positive?

A

Can be seen with other disorders of the immune system and autoimmune disorders

direct antiglobulin test (DAT) shows antibodies bound to RBC

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9
Q

What inherited defects of red blood cells can cause haemolysis?

A

abnormal membrane

abnormal Hb

Defect in glycolytic pathway

defect in enzymes of pentose shunt

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10
Q

What is an example of abnormal r.b.c membrane?

A

hereditary spherocytosis

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11
Q

What is an example of abnormal Hb?

A

sickle cells anaemia

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12
Q

What is an example of defect in glycolytic pathway?

A

pyruvate kinase deficiency - provides energy for the cell

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13
Q

What is an example of defect in enzyme of pentose shunt?

A

G6PD Deficiency * key enzyme in pentose shunt which protects from oxidant damage

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14
Q

Blood film with Ghost cells, Heinz Bodies, Hemighosts, irregularly contracted cells

A

G6PD deficiency

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15
Q

What cells on a blood film show oxidant damage?

A

Irregularly contracted cells and heinz bodies

The Heinz bodies are precipitated oxidised haemoglobin

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16
Q

What do Ghost cells show?

A

There has been intravascular haemolysis

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17
Q

What advise is given to patients with G6PD deficiency?

A

Avoid oxidant drugs

Don’t eat broad beans

avoid nephthalene

  • be aware that haemolysis can result from something like infection which can generate oxidants
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18
Q

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
A

Iron deficiency anaemia

But why?

19
Q

What further questions should be asked if someone has iron deficiency anaemia?

A
  • Are you veggie
  • GI symptoms
  • Changes in bowel habit
  • Menstrual history
  • weight loss
  • Medication e.g. NSAIDs
20
Q

What clinical signs are there of iron deficiency anaemia?

A

Koilonychia

Glossitis
Angular stomatitis

21
Q

What investigations for an elderly post menopausal women, with anaemia?

A 
FIT test (Faecal Immunochemical Test) 
to detect faecal occult blood

Imaging

biopsy

colonoscopy

coeliac antibody testing

22
Q

What can cause increased blood loss for iron deficiency anaemia?

A

Hookworm

Menstrual

Gastrointestinal

23
Q

What can cause insufficient iron intake for iron deficiency anaemia?

A

Dietary - vegetarians

Malabsorption : coeliac disease, H.Pylori gastritis

24
Q

What can cause increased iron requirements not being fulfilled for iron deficiency anaemia?

A

Pregnancy

Infancy

25
Q

Iron deficiency anaemia blood film?

A

Low MCV
Pale, hypochromia cells
target cells
Pencil cells

26
Q

45 year old male presents:

Anaemia Hb 85, previous was normal

Has RA

Takes NSAIDS + corticosteroids

Normal reticulocytes
Low MCV 
High ferritin
Low transferrin
High ESR

Blood film: hypochromic, microcytic, rouleaux

A

His Anaemia is due to RBC production not destruction * due to normal reticulocytes

ESR shows inflammation

could be iron deficiency and anaemia of chronic disease

Hepcidin increases in inflammatory states so iron absorption is not regulated

27
Q

Describe the pathophysiology of chronic disease?

A

Pro inflammatory cytokines IL-1 TNFa IL-6

–> Decreased Erythropoietin production

and

–> Hepcidin increase –> Iron absorption, transport, availability decreases

28
Q

What are some common causes of anaemia of chronic disease?

A

Infection:
TB, HIV

RA / autoimmune

Malignancy

29
Q

62 year old women presents:

Tiredness
Decrease exercise capacity
‘Walking on cotton wool’
Jaundice / depigmentation on face

Low Hb
High MCV
High LDH
High bilirubin

film : poikilocytosis, megloblastic anaemia , neutrophil hypersegmentation

A

B12 deficiency signs on blood film

B12 needed for DNA synthesis, without is severe anaemia

  • megaloblastic changes can also be due to DNA synthesis impairments from drugs, Folate antagonists, BM cancers
30
Q

Which drugs can cause DNA impairment in megaloblastic anaemia?

A

Azathioprine cytotoxic chemo

31
Q

Which folate antagonists can cause DNA impairment in megaloblastic anaemia?

A

methotrexate

32
Q

Which cancers can cause DNA impairment in megaloblastic anaemia?

A

myelodysplastic syndrome

33
Q

What is folic acid required for?

A

Homocysteine metabolism

34
Q

Examples of neurological disorders due to B12 deficiency?

A

Dementia

SACD - sub acute combined degeneration - of spinal cord

35
Q

What defects can folic acid deficiency cause?

A

Developmental neural tube defects during pregnancy

36
Q

What are the causes of reduced red cell survival?

A

Hereditary spherocytes

Autoimmune haemolytic anaemia

G6PD

37
Q

What are the cases of reduced red cell production?

A

Iron deficiency anaemia

Anaemia of chronic disease

Megaloblastic anaemia / Vit B12 lack

38
Q

Which rbc are hypochromic?

A

microcytic

39
Q

Which rbc are normocytic?

A

normocytic

macrocytic

40
Q

What is thalassaemia?

A

defect in globin synthesis, can be alpha or beta chain defect

causes microcytic anaemia

41
Q

What can case pooling of red cells in spleen?

A

hypersplenism e.g. liver cirrhosis, splenic sequestrations in sickle cell

42
Q

What gastric based issues can cause vit b12 deficiency?

A

Gastrectomy or autoimmune pernicious anaemia:

Intrinsic factors not available for vit b12 absorption

43
Q

What does pernicious anaemia do?

A

Anti gastric parietal cell antibodies - that are supposed to secrete IF

44
Q

What bowel based issues can cause vitamin B12 deficiency?

A

Crohns disease

ileal resection

CardioRespiratory 2 (12 decks)

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