Anaemia

Question 1

Anaemia General Definition

Answer 1

Reduced HB concentration in blood

Question 2

Anaemia Symptoms

Answer 2

Shortness of breath
Weakness
Pallor (Paleness)
Lethargy
Palpitations
Headaches
Heart failure + confusion in older patients

Question 3

Clinical signs

Answer 3

Pallor of mucous membranes + nail beds in most patients

Depending on anaemia type:
Concave nails (koilonychia)
Jaundice
Leg ulcers 
Bone deformities
Recurrent infections + bruising if due to bone marrow failure or leukaemia

Question 4

Parameters of Anaemias

Answer 4

Mean Cell Volume (MCV)
Mean Cell Hb (MCH) (Hb/RBC)
Mean Corpuscular Hb Concentration (MCHC) (Hb/Hematocrit)

Question 5

Anaemia classifications

Answer 5

Size:
+ Microcytic
+ Normocytic
+ Macrocytic

Colour (according to Hb Concentration)
+ Hypochromic (Reduced Hb)
+ Normochromic (Normal Hb)
+ Hyperchromic (High Hb) (Restricted to spherocytosis)

Can also be classified by impaired function or increased RBC loss/destruction

Question 6

Common types of Anaemia

Answer 6

+ Normocytic, normochromic (NN)
+ Microcytic, hypochromic (MH)
+ Macrocytic, normochromic (MN)

Question 7

Clinical causes of anaemia

Answer 7

+ Acute/Chronic bleeding
+ Fe/B12/Folate deficiency
+ RBC Cytoskeletal disorders - mostly congenital haemolytic disorders
+ Acquired/Inherited impairment of erythropoiesis
+ Acquired hemolytic anaemia ie autoimmune or mechanical causes
+ RBC enzymopathies - mostly congenital haemolytic anaemia
+ Haemoglobinopathy ie structural Hb variant, Globin chain synthesis impairments (thalassemia)

Question 8

Pancytopenia

Answer 8

Deficiency in RBC, WBC, platelets in all blood

Question 9

Acute Blood Loss Anaemia

Answer 9

+ Normocytic + Normochromic
+ Young + Healthy can tolerate 500-1000ml loss with little to no effect
+ 1000-1500ml loss is fine if sitting or lying?
+ 1500-2000ml loss = Variable loss of consciousness, shortness of breath, sweating
+ >2000ml loss = Shock, possibly irreversible + death
+ For up to 2-3 days post bleed, hypovolaemia (state of low extracellular fluid volume), but not anaemic
+ 3-5 days post bleed, reticulocyte response increases, causing formation of more reticulocytes in response to a bone marrow stimulus

Question 10

Fe Deficient Anaemia (IDA)

Answer 10

+ Microcytic, hypochromic anaemia
+ Caused by bad diet, malabsorption or chronic blood loss
+ Treatment: Fe Replenishment ie oral administration or injected

Question 11

Vitamin B12/Folate deficiency

Answer 11

+ Macrocytic + Normochromic

+ Similar treatment to IDA