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Z Year3 Haem Conditions > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is different classifcations for anaemia?

A

Hb<13g/dL men and <12 in women over 15 years

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2
Q

What are RF for anaemia?

A
  1. Extremes of age
  2. Female sex
  3. Lactation
  4. Pregnancy
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3
Q

What causes microcytic anaemia?

A
  1. Iron deficiency anaemia
  2. Thalassaemia
  3. Sideroblastic anaemia
  4. Anaemia of chronic disease
  5. Sickle cell anaemia
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4
Q

What causes normocytic anaemia?

A
  1. Acute blood loss
  2. Anaemia of chronic disease
  3. Bone marrow failure
  4. Renal failure
  5. Hypothyroidism
  6. Haemolysis
  7. Pregnancy
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5
Q

What causes macrocytic anaemia?

A
  1. B12 or folate deficiency
  2. Alcohol excess
  3. Reticulocytosis
  4. Cyotixc
  5. Myelodysplastic syndromes
  6. Marrow infiltration
  7. Hypothyroidism
  8. Antifolate drugs
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6
Q

What are the signs of haemolytic anaemia?

A
  • mildly jaundice
  • normally normocytic
  • splenomegaly
  • Anaemia
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7
Q

What would blood results for haemolytic anaemia show?

A
  1. Increased LDH
  2. Haemoglobinuria
  3. Haemosiderinaemia
  4. Decreased haptoglobins
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8
Q

What are hereditary causes of haemolytic anaemia?

A
  • membrane (hereditary spherocytosis)
  • haem (thalassaemias, sickle cell)
  • enzymes (G6PD defici)
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9
Q

What are acquired causes of haemolytic anaemia?

A
  • autoimmune
  • drugs
  • MAHA (fibrin strands in circulation and when RBCs pass through they get damaged)
  • Infection (malaria)
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10
Q

What are symptoms and signs of anaemia?

A

Depends on cause:

  1. Fatigue
  2. Dyspnoea
  3. Headache
  4. Faintness
  5. Palpitations
  6. Pallor
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11
Q

What are signs and symptoms of anaemia if severe?

A
  1. tachycardia
  2. ejection systolic murmur
  3. cardiac enlargement
  4. later heart failure
  5. increased resp rate
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12
Q

What are investigations for anaemia?

A
  1. Blood film

2. Ferritin

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13
Q

What is the management plan for anaemia?

A
  • Blood transfusion is Hb<70g/L and acute
  • Chronic: iron supplements (ferrous sulfate 200mg/8h)
  • Give BT very slowly in heart failure
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14
Q

What are causes of reduced uptake IDA?

A
  1. IBD
  2. Malnutirtion
  3. Coeliac
  4. Achlrohydria
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15
Q

What are the causes of increased loss IDA?

A
  1. GI malignancy
  2. IBD
  3. menstruation
  4. Peptic ulcer
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16
Q

What are causes of increased demand IDA?

A
  1. Pregnancy

2. Breastfeeding

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17
Q

In anaemia of chronic disease what are levels of ferritin and TIBC?

A
  1. high/normal ferritin
  2. low TIBC
    (acute phase protein so high during infections)
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18
Q

In IDA what are levels of ferritin and TIBC?

A
  1. low ferritin

2. high TIBC

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19
Q

What would you see on a blood film for IDA?

A
  1. Ansio-Poikilocytosis
  2. Pencil cells
  3. Hypochromic and microcytic
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20
Q

What is TIBC?

A

Transferrin/Total Iron binding capacity it means the same as Transferrin level

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21
Q

What are symptoms of IDA?

A
  1. Angular cheilitis
  2. Koilonychia
  3. Pale
  4. Weight loss
  5. Stomach issues
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22
Q

What are causes of IDA?

A
  1. Reduced uptake
  2. Increased loss
  3. Increased requirement
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23
Q

What is the triad for colon cancer?

A
  1. Unexplained IDA
  2. Change in bowel habit
  3. PR bleeding
    (+FLAWS)
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24
Q

What type of anemia is aneamia of chronic disease?

A

usually a normocytic anaemia but can present as microcytic

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25
Q

What is the path of anemia of chronic disease?

A

chronic disease e.g. IBD leads to increase of cytokines and increased in hepicidin release

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26
Q

What does the increase of hepicidin release lead to in anaemia of chronic disease?

A
  1. Decreases uptake of iron
  2. Decreases transport of iron
  3. Increases storage of iron
  4. Therefore a lot of ferritin (iron store)
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27
Q

What happens to iron in infection?

A
  1. Infective organism wants to utilize the body’s iron
  2. In response to this, cytokines switch off iron transport via hepcidin
  3. This increases its storage and decreases its presence in serum.
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28
Q

What is a common type of macrocytic anemia?

A

megaloblastic anaemia

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29
Q

What are causes of megaloblastic anaemia?

A

folate or B12 deficiency

30
Q

What do you see on a blood film for megaloblastic anaemia?

A
  1. Hyper segmented neutrophils

2. Macrocytic cells

31
Q

What are causes of VitB12 def?

A
  1. Alcohol
  2. IBD and Coeliac
  3. Malnutrition
  4. Pernicious anaemia
32
Q

What are causes of folate deficiency?

A
  1. Alcohol
  2. IBS and coeliac
  3. Anti-folate drugs
  4. Pregnancy
33
Q

How long does B12 deficiency last for?

A

reserves last 3-4 years

34
Q

Why can you get folate def in pregger not vitb12?

A
  • Pregnancy is only 9 months – your B12 stores are long enough to last. (3-4 years)
  • Folate stores run out after ~6 months
35
Q

What is B12 needed for?

A

RBC maturtiation

36
Q

What symptoms do you get with B12 def?

A

megaloblastic anemia and neuro signs (no nuero signs in folate)

37
Q

What are the neuro signs in B12 def?

A
  1. Glove and stocking parathesiae
  2. Hyporeflexia
  3. Romberg’s +ve
  4. Subacute combined degeneration of the cord
38
Q

What else is present in B12 def?

A 
Pernicious  anaemia 
(anti parietal cells and anti-intrinsic factor)
39
Q

What are other causes of megaloblastic macrocytic anaemia?

A
  1. MYELODYSPLASIA
  2. HYPOTHYROIDISM
  3. LIVER DISEASSE
  4. ALCOHOL
40
Q

What are different types of normocytic anaemia?

A
  1. haemolytic anaemia

2. hereditary haemolytic anaemias

41
Q

What are features of haemolytic anaemias?

A
  1. Scleral icterus

2. Pale and conjunctivae and skin

42
Q

What are blood test results in haemolytic anaemia?

A
  1. Hb low
  2. Haptoglobin low*
  3. Unconjugated bilirubin raised
  4. LDH raised
43
Q

What are hereditary haemolytic anaemias?

A

disorders of RBC itself

44
Q

What does a disorder of RBC membrane lead to?

A

hereditary spherocytosis

45
Q

What does disorder of RBC enzymes lead to?

A

G-6-PD def

46
Q

What does disorders in the haemoglobin in the rbc lead to?

A

sickle cell and thalassaemia

47
Q

What sort of inheritence is glucuose-6-phophate def?

A

x linked recessive

48
Q

What must be avoided in G6PD def?

A

Vulnerable to oxidative stress - AVOID BROAD BEANS

49
Q

What would be seen on G6PD def blood film and when?

A
  1. Heinz bodies: active haemolysis

2. Bite cells: previous haemolysis

50
Q

What is the inheritence of hereditary spherocytosis?

A

Autosomal dominant (75%)

51
Q

What does G6PD enzyme do?

A
  • Helps to increase NADP+

- So when decreased prone to oxidative stress/deprivation

52
Q

What is seen on blood film for herditary spherocytosis?

A

spherocytes (lack central whiteness)

53
Q

What is the patho for herditary spherocytosis?

A

lacks beta spectrin or ankyrin (so problem with cytoskleteon so becomes a blob)

54
Q

What are investigations for hereditary spherocytsois?

A
  1. Osmotoic fragility test: break apart if placed in very concentrated water)
  2. Coombs test negative
55
Q

What is a complication of HS?

A

aplastic crisis

56
Q

What is aplastic crisis?

A

when you fail to produce red cells (just red cells)

57
Q

Why are you more likely to get aplastic crisis in HS?

A

due to Parvovirus B19 infection

58
Q

What are different types aquired of haemolytic anaemias?

A
  1. MAHA: HUS, TTP, DIC
  2. Autoimmune
  3. Drugs
  4. Infection
59
Q

What drugs can cause haemolytic anaemia?

A

e.g. Dapsone

Anti-leprosy ABx

60
Q

What infections can cause haemolytic anaemia?

A

Plasmodium falciparum malaria (Blackwater fever)

61
Q

What are autoimmune haemolytic anaemia?

A
  1. Anti-RBC antigen antibodies

2. DAT/Coombs +ve

62
Q

What is autoimmune haemolytic anaemia like when warm >37 degrees?

A

IgG antibodies

  1. Idiopathic
  2. SLE
  3. CLL
63
Q

What is autoimmune haemolytic anaemia like when cold <37 degrees?

A

IgM Antibodies

  1. Idiopathic
  2. Mycoplasma
  3. Mononucleosis
64
Q

What can cause normocytic anaemia?

A
  1. Myelofibrosis
  2. Aplastic
  3. Acute blood loss
  4. Haemolytic anaemia
65
Q

What is primary myelofibrosis?

A

Fibrosis in response to a Bone Marrow malignancy

66
Q

What is the epid of primary myelofibrosis?

A
  1. > 65

2. Radiation

67
Q

What does BM aspirate show in primary myelofibrosis?

A

‘dry tap’ fibrosis

68
Q

What does blood film show in primary myelofibrosis?

A

tear drop cells

69
Q

What are examples of microcytic anaemia?

A
  1. IDA
  2. ACD
  3. Thalasseamia
  4. Sickle cell
70
Q

What are examples of macrocytic aneamia?

A
  1. Alcohol
  2. Vit B12
  3. Folate
  4. Myelodysplasia
  5. Liver disease
  6. Hypothryoidism
71
Q

What are Sx of myelofibrosis?

A
  1. Cachetic

2. Splenomegaly

Z Year3 Haem Conditions (18 decks)

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