Anaemia Flashcards
What is different classifcations for anaemia?
Hb<13g/dL men and <12 in women over 15 years
What are RF for anaemia?
- Extremes of age
- Female sex
- Lactation
- Pregnancy
What causes microcytic anaemia?
- Iron deficiency anaemia
- Thalassaemia
- Sideroblastic anaemia
- Anaemia of chronic disease
- Sickle cell anaemia
What causes normocytic anaemia?
- Acute blood loss
- Anaemia of chronic disease
- Bone marrow failure
- Renal failure
- Hypothyroidism
- Haemolysis
- Pregnancy
What causes macrocytic anaemia?
- B12 or folate deficiency
- Alcohol excess
- Reticulocytosis
- Cyotixc
- Myelodysplastic syndromes
- Marrow infiltration
- Hypothyroidism
- Antifolate drugs
What are the signs of haemolytic anaemia?
- mildly jaundice
- normally normocytic
- splenomegaly
- Anaemia
What would blood results for haemolytic anaemia show?
- Increased LDH
- Haemoglobinuria
- Haemosiderinaemia
- Decreased haptoglobins
What are hereditary causes of haemolytic anaemia?
- membrane (hereditary spherocytosis)
- haem (thalassaemias, sickle cell)
- enzymes (G6PD defici)
What are acquired causes of haemolytic anaemia?
- autoimmune
- drugs
- MAHA (fibrin strands in circulation and when RBCs pass through they get damaged)
- Infection (malaria)
What are symptoms and signs of anaemia?
Depends on cause:
- Fatigue
- Dyspnoea
- Headache
- Faintness
- Palpitations
- Pallor
What are signs and symptoms of anaemia if severe?
- tachycardia
- ejection systolic murmur
- cardiac enlargement
- later heart failure
- increased resp rate
What are investigations for anaemia?
- Blood film
2. Ferritin
What is the management plan for anaemia?
- Blood transfusion is Hb<70g/L and acute
- Chronic: iron supplements (ferrous sulfate 200mg/8h)
- Give BT very slowly in heart failure
What are causes of reduced uptake IDA?
- IBD
- Malnutirtion
- Coeliac
- Achlrohydria
What are the causes of increased loss IDA?
- GI malignancy
- IBD
- menstruation
- Peptic ulcer
What are causes of increased demand IDA?
- Pregnancy
2. Breastfeeding
In anaemia of chronic disease what are levels of ferritin and TIBC?
- high/normal ferritin
- low TIBC
(acute phase protein so high during infections)
In IDA what are levels of ferritin and TIBC?
- low ferritin
2. high TIBC
What would you see on a blood film for IDA?
- Ansio-Poikilocytosis
- Pencil cells
- Hypochromic and microcytic
What is TIBC?
Transferrin/Total Iron binding capacity it means the same as Transferrin level
What are symptoms of IDA?
- Angular cheilitis
- Koilonychia
- Pale
- Weight loss
- Stomach issues
What are causes of IDA?
- Reduced uptake
- Increased loss
- Increased requirement
What is the triad for colon cancer?
- Unexplained IDA
- Change in bowel habit
- PR bleeding
(+FLAWS)
What type of anemia is aneamia of chronic disease?
usually a normocytic anaemia but can present as microcytic
What is the path of anemia of chronic disease?
chronic disease e.g. IBD leads to increase of cytokines and increased in hepicidin release
What does the increase of hepicidin release lead to in anaemia of chronic disease?
- Decreases uptake of iron
- Decreases transport of iron
- Increases storage of iron
- Therefore a lot of ferritin (iron store)
What happens to iron in infection?
- Infective organism wants to utilize the body’s iron
- In response to this, cytokines switch off iron transport via hepcidin
- This increases its storage and decreases its presence in serum.
What is a common type of macrocytic anemia?
megaloblastic anaemia
What are causes of megaloblastic anaemia?
folate or B12 deficiency
What do you see on a blood film for megaloblastic anaemia?
- Hyper segmented neutrophils
2. Macrocytic cells
What are causes of VitB12 def?
- Alcohol
- IBD and Coeliac
- Malnutrition
- Pernicious anaemia
What are causes of folate deficiency?
- Alcohol
- IBS and coeliac
- Anti-folate drugs
- Pregnancy
How long does B12 deficiency last for?
reserves last 3-4 years
Why can you get folate def in pregger not vitb12?
- Pregnancy is only 9 months – your B12 stores are long enough to last. (3-4 years)
- Folate stores run out after ~6 months
What is B12 needed for?
RBC maturtiation
What symptoms do you get with B12 def?
megaloblastic anemia and neuro signs (no nuero signs in folate)
What are the neuro signs in B12 def?
- Glove and stocking parathesiae
- Hyporeflexia
- Romberg’s +ve
- Subacute combined degeneration of the cord
What else is present in B12 def?
Pernicious anaemia (anti parietal cells and anti-intrinsic factor)
What are other causes of megaloblastic macrocytic anaemia?
- MYELODYSPLASIA
- HYPOTHYROIDISM
- LIVER DISEASSE
- ALCOHOL
What are different types of normocytic anaemia?
- haemolytic anaemia
2. hereditary haemolytic anaemias
What are features of haemolytic anaemias?
- Scleral icterus
2. Pale and conjunctivae and skin
What are blood test results in haemolytic anaemia?
- Hb low
- Haptoglobin low*
- Unconjugated bilirubin raised
- LDH raised
What are hereditary haemolytic anaemias?
disorders of RBC itself
What does a disorder of RBC membrane lead to?
hereditary spherocytosis
What does disorder of RBC enzymes lead to?
G-6-PD def
What does disorders in the haemoglobin in the rbc lead to?
sickle cell and thalassaemia
What sort of inheritence is glucuose-6-phophate def?
x linked recessive
What must be avoided in G6PD def?
Vulnerable to oxidative stress - AVOID BROAD BEANS
What would be seen on G6PD def blood film and when?
- Heinz bodies: active haemolysis
2. Bite cells: previous haemolysis
What is the inheritence of hereditary spherocytosis?
Autosomal dominant (75%)
What does G6PD enzyme do?
- Helps to increase NADP+
- So when decreased prone to oxidative stress/deprivation
What is seen on blood film for herditary spherocytosis?
spherocytes (lack central whiteness)
What is the patho for herditary spherocytosis?
lacks beta spectrin or ankyrin (so problem with cytoskleteon so becomes a blob)
What are investigations for hereditary spherocytsois?
- Osmotoic fragility test: break apart if placed in very concentrated water)
- Coombs test negative
What is a complication of HS?
aplastic crisis
What is aplastic crisis?
when you fail to produce red cells (just red cells)
Why are you more likely to get aplastic crisis in HS?
due to Parvovirus B19 infection
What are different types aquired of haemolytic anaemias?
- MAHA: HUS, TTP, DIC
- Autoimmune
- Drugs
- Infection
What drugs can cause haemolytic anaemia?
e.g. Dapsone
Anti-leprosy ABx
What infections can cause haemolytic anaemia?
Plasmodium falciparum malaria (Blackwater fever)
What are autoimmune haemolytic anaemia?
- Anti-RBC antigen antibodies
2. DAT/Coombs +ve
What is autoimmune haemolytic anaemia like when warm >37 degrees?
IgG antibodies
- Idiopathic
- SLE
- CLL
What is autoimmune haemolytic anaemia like when cold <37 degrees?
IgM Antibodies
- Idiopathic
- Mycoplasma
- Mononucleosis
What can cause normocytic anaemia?
- Myelofibrosis
- Aplastic
- Acute blood loss
- Haemolytic anaemia
What is primary myelofibrosis?
Fibrosis in response to a Bone Marrow malignancy
What is the epid of primary myelofibrosis?
- > 65
2. Radiation
What does BM aspirate show in primary myelofibrosis?
‘dry tap’ fibrosis
What does blood film show in primary myelofibrosis?
tear drop cells
What are examples of microcytic anaemia?
- IDA
- ACD
- Thalasseamia
- Sickle cell
What are examples of macrocytic aneamia?
- Alcohol
- Vit B12
- Folate
- Myelodysplasia
- Liver disease
- Hypothryoidism
What are Sx of myelofibrosis?
- Cachetic
2. Splenomegaly
