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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Define anaemia

A
  • reduced total red cell mass
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2
Q

What markers can be used in anaemia?

A
  • haemoglobin concentration

- haematocrit

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3
Q

Normal haemoglobin and hamatocrit concentrations in males and females

A
  • males (>130, Hct> 0.38)

- females (>120, hct>0.37)

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4
Q

How is haemoglobin concentration measured in the lab?

A
  • burst red cell
  • stabilise Hb with cyan-metHb
  • measure optical density
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5
Q

What law describes the OD proportion to the concentration

A
  • Beer’s law
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6
Q

When might haemoglobin concentration not be accurate?

A
  • immediately after trauma event with blood loss

- haemodilution with fluids

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7
Q

What triggers reticulocytosis?

A
  • hypoxia
  • sensed by the kidneys
  • erythropoietin released
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8
Q

Explain reticulocytes?

A
  • just left bone marrow
  • young and larger
  • stain purple/deep red
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9
Q

What levels can be measured from a blood sample

A
  • haemoglobin concentrations
  • number of red cells
  • size of red cells (MCV)
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10
Q

What levels can be calculated from blood samples?

A
  • haematocrit
  • mean cell haemoglobin
  • mean cell haemoglobin concentration
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11
Q

2 main pathophysiologies of anaemia?

A
  • decreased production (hypo-proliferation, maturation abnormality)
  • increased loss or destruction (bleeding, haemolysis)
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12
Q

Where is Hb synthesised?

A
  • in the cytoplasm
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13
Q

Explain microcytic anaemia?

A
  • low mcv, low red cell numbers
  • small and hypochromic
  • deficient haemoglobin synthesis
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14
Q

Causes of microcytic anaemia?

A
  • TAILS
  • Thalassaemia (globin deficiency)
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead posing
  • Sideroblastic anaemias
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15
Q

Where is iron absorbed

A
  • proximal duodenum
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16
Q

How is iron transported?

A
  • transferrin
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17
Q

How is iron stored

A
  • ferritin
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18
Q

Explain transferrin

A
  • 2 binders for iron
  • transfers from tissue to cells
  • % saturation measured
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19
Q

When might percentage saturation of transferrin be reduced?

A
  • iron deficiency

- chronic disease

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20
Q

When might transferrin saturation be increased?

A
  • genetic haemachromatosis
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21
Q

What is ferritin?

A
  • storage form of iron

- may be high in infection or inflammation

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22
Q

Blood results in iron deficiency

A
  • low serum iron
  • low hb
  • low ferritin
  • low MCV
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23
Q

Iron deficiency may cause what type of anaemia?

A
  • microcytic anaemia
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24
Q

Epithelial changes in iron deficiency?

A
  • dry skin
  • koilonychia
  • angular chelitis
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25
Q

causes of iron deficiency

A
  • reduced dietary
  • losing iron
  • malabsorption
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26
Q

How can iron loss be estimated during blood loss?

A
  • volume of blood loss/ 2 = iron loss
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27
Q

Treatment of iron deficiency?

A
  • treat underlying cause

- iron supplements

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28
Q

Complication of oral iron supplementation

A
  • gut irritant
  • dark stools and constipation
  • may lead to poor compliance
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29
Q

Describe macrocytosis

A
  • big increase in red cell size
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30
Q

Define macrocytic anaemia

A
  • reduction in red blood cells

- increase in volume

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31
Q

Normal MCV values

A
  • microcytic < 80
  • normocytic 80-100fl
  • macrocytic > 100fl
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32
Q

How is MCV measured?

A
  • light scatter beam
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33
Q

True macrocytosis may be ___ or ___

A
  • megaloblastic

- non-megaloblastic

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34
Q

Explain normoblast development

A
  • pronomoblast
  • early normoblast
  • intermediate normoblast
  • late normoblast
  • reticulocyte
  • erythrocyte
35
Q

Describe megaloblast

A
  • abnormally large
  • immature nucleus
  • reside in bone marrow
36
Q

Descrive megaloblastic anaemia?

A
  • lack or RBC
  • Larger MCV
  • megaloblasts in bone marrow
  • reduced cell division
  • increased apoptosis
  • bone marrow hypercellular
37
Q

Causes of megaloblastic anaemia?

A
  • B12 deficiency
  • folate deficiency
  • anti-convulasants
38
Q

Role of B12 and folate

A
  • co factors
  • nuclear maturity
  • reduced = impairment to nervous system
39
Q

Where is vit B12 found

A
  • meat and egg
40
Q

What binds to B12 for absorption

A
  • intrinsic factor
41
Q

What secretes intrinsic factor

A
  • parietal cells
42
Q

Where is vit b12 absorbed

A
  • ileum
43
Q

Causes of a vit b12 deficiency

A
  • dietary

- pernicious anaemia

44
Q

What is pernicious anaemia

A
  • autoimmune destruction of gastric parietal cells
  • ass. with other autoimmune conditions
  • less intrinsic factor = vit b 12 deficiency
  • vit b12 IM
45
Q

What is the body storage timeline of vit b12?

A
  • 2-4yrs
46
Q

Where is folate found?

A
  • plant substances
47
Q

Where is folate absorbed?

A
  • proximal small bowel
48
Q

Causes of a folate deficiency?

A
  • dietary
  • coeliac or chrons
  • haemolysis
  • pregnancy
  • malignancy
49
Q

Folate deficiency may cause what type of anaemia?

A
  • macrocytic anaemia
50
Q

Typical storage timeline of folate in the body

A
  • 3 months
51
Q

Symptoms of a vit b12 deficeincy

A
  • anaemic
  • weight loss
  • diarrhoea
  • pre hepatic jaundice
  • neurological symptoms
52
Q

In macrocytic anaemia blood film what else may be visible

A
  • macrovalocytes

- hyper-segmented neutrophils

53
Q

Anti-gastric parietal antibody

A
  • sensitive
  • not specific
  • pernicious anaemia
54
Q

Anti-intrinsic factor

A
  • specific
  • not sensitive
  • pernicious anaemia
55
Q

Treatment of a folate deficiency

A
  • folic acid
56
Q

Non-megaloblastic macrocytosis causes?

A
  • liver disease
  • alcohol
  • hypothyroidism
  • marrow failure
57
Q

Why might spurious macrocytosis occur?

A
  • wrongly picked up as macrocytic anaemia
  • reticulocytosis
  • cold-agglutinin
58
Q

Iron + porphyrin =

A
  • haem
59
Q

How might you biochemically distinguish between continued blood loss and poor compliance of iron tablets?

A
  • reticulocyte count
60
Q

Define haemolysis

A
  • premature red cell destruction
61
Q

Why are red cells specifically susceptible to damage?

A
  • biconcave structure
  • no mitochondria = limited metabolic reserve
  • no nucleus = cannot generate new proteins
62
Q

Describe compensated haemolysis?

A
  • increased red cell production to even out destruction

- normal Hb

63
Q

Define decompensated haemolysis?

A
  • destruction > production

- low Hb

64
Q

What are the consequences of haemolysis?

A
  • erythroid hyperplasia

- excess red cell breakdown products

65
Q

What stains reticulocytes blue and why?

A
  • new methylene blue stain

- due to the presence of RNA

66
Q

What are the consequences to the bone marrow of haemolysis?

A
  • reticulocytosis

- erythroid hyperplasia

67
Q

Explain extravascular haemolysis?

A
  • taken up by the spleen and liver
  • commoner
  • hyperplasia at site of destruction
68
Q

Blood results in extravascular haemolysis?

A
  • protoporphyrin

- urobilinogenuria

69
Q

Describe intravascular haemolysis?

A
  • RBC destroyed within circulation
70
Q

Causes of extravascular haemolysis

A
  • haemolytic disease of the newborn
  • delayed transfusion reaction
  • hereditary spehrocytosis
  • sickle cell
  • thalasseamia
71
Q

Intravascular haemolysis causes?

A
  • ABO incompatible blood (acute)
  • G6PD deficiency
  • malaria
72
Q

Blood results in intravascular haemolysis?

A
  • haemoglobuminaemia
  • methaemalbuminaemia
  • haemosiderinuria
73
Q

Investigations into haemolysis?

A
  • FBC
  • Reticulocyte count
  • serum unconjugated bilirubin
  • serum haemoglobin
  • urinary urobilinogen
74
Q

What is warm haemolysis mediated by?

A
  • IgG
75
Q

What is cold haemolysis mediated by?

A
  • IgM
76
Q

Causes of warm haemolysis

A
  • idiopathic
  • autoimmune (SLE)
  • Drugs (penicillins)
  • infection
77
Q

Causes of cold haemolysis?

A
  • idiopathic

- infection (EBV)

78
Q

What is Direct Coombs test?

A
  • identifies antibody bound to own red cell
79
Q

Immediate vs delayed autoimmune transfusion reaction?

A
  • immediate (IgM)

- delayed (IgG)

80
Q

Examples of alloimmune haemolysis?

A
  • haemolytic transfusion reaction

- haemolytic disease of the newborn

81
Q

What mechanical reasons may cause haemolytic anaemia?

A
  • mechanical valve

- burns related

82
Q

Blood film in a severe burns patient?

A
  • microspherocyte
83
Q

Describe hereditary spherocytosis?

A
  • defects in the proteins that aid red cell membrane flexibility
  • splenomegaly and gallstones
  • autosomal dominatn
84
Q

Effect of a G6PD disease

A
  • more suceptible to oxidative damage

- problems with ATP generation

Haematology (14 decks)

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