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BRS YR2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What causes hereditary spherocytosis?

A

an inherited defect in the red cell membrane

- disruption of vertical linkages in the membrane, usually ankyrin/spectrin

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2
Q

What is haemolytic anaemia?

A

increased destruction with shortened RBC survival and resultant anaemia

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3
Q

How would you treat haemolytic anaemia?

A
  • folic acid (increased need)

- splenectomy (if severe, it increase RBC life span)

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4
Q

What can haemolytic anaemia cause?

A

gallstones, due to increased breakdown of haemoglobin into bilirubin

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5
Q

What is AutoImmune Haemolytic anaemia (DAT positive)?

A
  • Idiopathic
  • associated with disorders of the immune system: systemic autoimmune disease (SLE), and underlying lymphoid cancers (lymphoma)
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6
Q

What in bloods can prove haemolysis?

A
  • raised LDH
  • unconjugated hyperbilirubinaemia
  • reduced haptoglobins
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7
Q

What is the bone marrow response to haemolysis?

A
  • reticulocytosis
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8
Q

When should haemolysis be considered?

A
  • anaemia with raised bilirubin
  • elevated reticulocytes, LDH and unconjugated bilirubin
  • blood film
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9
Q

What are the possible impacts of inherited RBC defects?

A
  • abnormal RBC membrane
  • abnormal haemoglobin
  • defect in glycolic pathway
  • defect in the enzymes of pentose shunt
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10
Q

What does the pentose shunt do?

A

protects from oxidant damage

key enzyme: G6PD

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11
Q

What in a blood film suggests oxidant damage?

A
  • irregularly contracted cells

- Hienz bodies

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12
Q

What are Hienz bodies?

A

precipitated oxidised haemoglobin

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13
Q

What does the presence of ghost cells on a blood film suggest?

A

intravascular haemolysis

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14
Q

What should be advised during a G6PD deficiency?

A
  • avoid oxidant drugs
  • don’t eat broad beans
  • avoid naphthalene
  • awareness that haemolysis can result from infection
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15
Q

What can be seen on a blood film with a G6PD deficiency?

A
  • irregularly contracted cells
  • Hienz bodies
  • ghost cells
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16
Q

What can be a symptom of G6PD deficiency?

A

jaundice

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17
Q

What questions should be asked if iron deficiency anaemia is suspected?

A
  • diet
  • GI symptoms (dysphagia, dyspepsia, abdominal pain, change in bowel habits, rectal bleeding)
  • menstrual history/post-menopausal bleeding
  • weight loss
  • medications (NSAIDs)
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18
Q

What are the clinical signs of iron deficiency anaemia?

A
  • Koilonychia

- Glossitis Angular stomatitis

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19
Q

What investigations should be done for suspected iron deficiency anaemia?

A
  • Faecal Immunochemical Test (blood in stool)
  • Upper GI endoscopy (oesophagus, stomach and duodenum)
  • Duodenal biopsy
  • Colonoscopy
  • Coeliac antibody testing
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20
Q

What are the possible causes of iron deficiency?

A 
Increased blood loss
- hookworm
- menstrual (menorrhagia)
- GI (occult)
Insufficient iron intake
- dietary 
- malabsorption (coeliac, H. pylori)
Increased iron requirements
- physiological
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21
Q

How is iron deficiency anaemia seen on a blood film?

A
  • microcytosis (low MCV)
  • hypochromia (low MCHC)
  • occasional target cells
  • ellipocytes
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22
Q

How much iron is absorbed daily?

A

1-2mg per day

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23
Q

What controls iron absorption?

A

Hepcidin (absorption and release of stores)

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24
Q

What increases hepcidin production?

A

inflammatory state

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25
Q

What is Koilonychia?

A

soft nails that looks scooped out (can hold a drop of liquid)

26
Q

What is Glossitis Angular Stomatitis?

A

inflamed tongue and sides of mouth

27
Q

Does a normal ferritin always exclude iron deficiency?

A

NO - ferritin can be normal with iron deficiency/anaemia of chronic disease

28
Q

What does hepcidin do?

A

blocks the absorption and release of storage iron

29
Q

What are the common causes of anaemia of chronic disease?

A
  • infections (TB, HIV)
  • Rheumatoid arthritis and autoimmune disorders
  • Malignancy
30
Q

What is the pathophysiology of anaemia of chronic disease?

A
  • IL-1, TNFa, IL-6 inhibit iron release from macrocytes to erythroids, reducing EPO production
  • Hepcidin (triggered by inflammatory proteins) reduced the transport, availability and absorption of iron.
31
Q

What is megaloblastic anaemia?

A

anaemia associated with megaloblastic morphological changes in bone marrow due to asynchronous nucleocytoplasmic maturation.

32
Q

What causes megaloblastic anaemia?

A
  • Vitamin B12 deficiency

- Folic acid deficiency

33
Q

What can cause a Vitamin B12 deficiency?

A
  • diet
  • gastric: structural (gastrectomy) or autoimmune (pernicious anaemia)
  • terminal ileum: structural (resection) or inflammation (Crohn’s disease)
34
Q

What can cause a Folic acid deficiency?

A
  • diet
  • proximal jejenum (coeliac disease)
  • excess demand
  • haemolysis
  • pregnancy
35
Q

How does megaloblastic anaemia present on a blood film?

A
  • macrocytic RBC
  • very high MCV
  • Impaired DNA synthesis, nuclear maturation and cell division
36
Q

What are the neurological impacts of a Vitamin B12 deficiency?

A
  • dementia

- SACD (sub-acute combined degeneration) of the spinal cord

37
Q

What are the neurological impacts of a Folic acid deficiency?

A
  • affects the development of neural tube defects
38
Q

Where is folic acid absorbed?

A
  • duodenum

- jejunum

39
Q

Where is Vitamin B12 absorbed?

A
  • ileum
40
Q

What is microcytic anaemia?

A

average cell size is decreased

41
Q

What are the common causes of microcytic anaemia?

A
  • defect in haem synthesis

- defect in globin synthesis

42
Q

What are the 2 disorders due to defects in globin synthesis?

A
  • alpha thalassaemia: defect in the alpha chain

- beta thalassaemia: defect in the beta chain

43
Q

What are the 2 difference types of microcytic anaemia?

A
  • anaemia of chronic disease

- iron deficiency anaemia

44
Q

What are the blood features of anaemia of chronic disease?

A 
Hb - Low
MCV - Low/Normal
Ferritin - High
Serum Iron - Low
Transferrin - Low/Normal
Transferrin saturation - Normal
ESR - High
45
Q

What are the blood features of iron deficiency anaemia?

A 
Hb - Low
MCV - Low
Ferritin - Low
Serum Iron - Low
Transferrin - High
Transferrin saturation - Low
ESR - High
46
Q

What is the difference in Hb electrophoresis between iron deficiency anaemia and B thalassaemia trait?

A

Hb A2 raised in B-thalassaemia trait

47
Q

What are the mechanisms of normocytic anaemia?

A
  • recent blood loss
  • failure of RBC production
  • pooling of RBCs in the spleen
48
Q

What are some causes of normocytic anaemia?

A
  • GI haemorrhage
  • trauma
  • early stage iron deficiency
  • bone marrow failure/supression (chemotherapy)
  • bone marrow infiltration (leukaemia)
  • hypersplenism (liver cirrhosis)
  • splenic sequestration in sickle cell
49
Q

What are the common causes of macrocytic anaemia?

A
  • lack of VItamin B12 or Folic acid
  • drugs that interfere with drug synthesis
  • liver disease and ethanol toxicity
  • haemolytic anaemia (increased reticulocytes)
50
Q

What are the causes of haemolytic anaemia?

A

A defect in:

  • integrity of the membrane
  • haemoglobin structure and function
  • cellular metabolism
51
Q

What haemolytic anaemias are cause by a defect in the integrity of the membrane?

A
  • hereditary spherocytosis

- autoimmune haemolytic anaemia

52
Q

What haemolytic anaemias are cause by a defect in the cellular metabolism?

A

G6PD deficiency

53
Q

What are the non-immune environmental factors that can damage RBCs?

A
  • Microangiopathic
  • Haemolytic uraemic syndrome
  • Malaria
  • Snake venom
  • Drugs
54
Q

What are the immune mediated (DAT+ive) environmental factors that can damage RBCs?

A
  • autoimmune

- allo-immune (post blood transfusion)

55
Q

Which two blood disorders both have spherocytes?

A
  • Hereditary spherocytosis

- Acquired auto immune haemolytic anaemia

56
Q

What test distinguishes between hereditary spherocytosis and acquired autoimmune haemolytic anaemia?

A

Direct Antiglobulin test (DAT)

57
Q

What does the Direct Antiglobulin test detect?

A

whether self-antibodies have formed

58
Q

What is the treatment for when a gastrectomy or antoimmune pernicious anaemia cause Vitamin B12 deficiency?

A

Hydroxocobalamin injections (IM)

59
Q

What is the treatment for Vitamin B12 deficiency caused by Chron’s disease or an Ileal resection?

A

Hydroxocobalamin injections (IM)

60
Q

What is the treatment for VItamin B12 deficiency caused by an inadequate diet?

A

Oral supplementation

61
Q

How does autoimmune pernicious anaemia cause Vitamin B12 deficiency?

A

produces anti GPC and IF antibodies

- IF is necessary for Vitamin B12 absorption

62
Q

What is used to treat folic acid deficiency irrelevant of the cause?

A

Oral supplementation

BRS YR2 (70 decks)

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