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Y3 Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

what is anaemia?

A

reduced total red cell mass

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2
Q

what is the diagnostic criteria for anaemia in adult males?

A

Hb <130g/L
or
Hct <0.38

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3
Q

what is the diagnostic criteria for anaemia in adult females?

A

Hb <120 g/L
or
Hct <0.37

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4
Q

where does RBC production take place?

A

in the bone marrow

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5
Q

what effect does acute blood loss have on Hb concentration?

A

no change

Hb is a poor marker of acute blood loss

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6
Q

what effect can giving IV fluids have on Hb concentration?

A

can cause reduced Hb due to haemodilution

even though the number of red cells hasnt changed

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7
Q

what is the normal response to anaemia?

A

produce more red cells

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8
Q

what is reticulocytosis?

A

the increased production of red cells

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9
Q

what are reticulocytes?

A

red cells that have just left the bone marrow

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10
Q

what size are reticulocytes and what effect does this have on MCV?

A

larger than red cells

increase MCV

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11
Q

describe the appearance of reticulocytes on blood film

A

stain darker red due to containing remnants of RNA

creates a polychromic picture

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12
Q

how long does it take for up regulation of reticulocytes in response to anaemia to occur?

A

usually around a week

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13
Q

what is anaemia with low MCV called?

A

microcytic anaemia

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14
Q

what is anaemia with high MCV called?

A

macrocytic anaemia

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15
Q

what causes microcytic anaemias?

A

defects in Hb synthesis combined with intact nuclear machinery allowing division into small cells

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16
Q

what are the building blocks of Hb?

A 
haem = iron + porphyrin 
globin = proteins
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17
Q

are the cells in microcytic anaemia hypochromic or hyperchromic

A

hypochromic

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18
Q

what are the five causes of microcytic anaemias?

A 
thalassaemia 
anaemia of chronic disease 
iron deficiency 
lead poisoning 
sideroblastic anaemia
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19
Q

what are the two causes of a haem deficiency?

A

lack of iron

problems with porphyrin synthesis

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20
Q

what is the most common cause of microcytic anaemia?

A

iron deficiency

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21
Q

what two things can rarely cause anaemia by causing problems with porphyrin synthesis?

A

lead poisoning

congenital sideroblastic anaemias

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22
Q

what disease can result in a microcytic anaemia by causing a globin deficiency?

A

thalassaemia

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23
Q

what are the two states in which iron can exist?

A 
Fe2+ = ferrous 
Fe3+ = ferric
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24
Q

what type of iron is required for oxygen transportation?

A

ferrous (Fe2+)

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25
Q

how can iron be toxic to the body?

A

generates free radicals if going from Fe2+ to Fe3+

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26
Q

around how much iron is absorbed per day?

A

1mg/day

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27
Q

where is most iron in the body found?

A

in Hb

28
Q

how can you roughly calculate the mg of iron present in the body at any time?

A

blood volume divided by two

29
Q

what transfers iron from the iron stores to the Hb?

A

transferrin

30
Q

how is iron taken up into the erythroid cells?

A

via transferrin receptors

31
Q

where is the major site of iron storage in the body?

A

the liver

32
Q

how is iron stored?

A

in ferritin molecules

33
Q

what test can be done to assess functional iron status?

A

Hb concentration

34
Q

what can be measured to assess transported iron status?

A

serum iron
transferrin
transferrin saturation

35
Q

what can be measured to assess storage iron status?

A

serum ferritin

reflects intracellular ferritin levels

36
Q

what happens to saturation of transferrin in iron deficiency?

A

reduces

37
Q

what happens to saturation of transferrin in anaemia of chronic disease?

A

reduced

38
Q

what happens to saturation of transferrin in genetic haemochromatosis?

A

increased

39
Q

what do low ferritin levels suggest?

A

an iron deficiency

40
Q

what is the first change seen in iron deficiency?

A

ferritin falls as iron stores are exhausted

41
Q

what change can be seen when iron deficient erythropoeisis begins occurring?

A

fall in MCV - cells become microcytic

42
Q

what epithelial changes can be seen in patients with chronic iron deficiency?

A

dry skin
koilonychia
angular chelitis

43
Q

what are the three possible causes of iron deficiency?

A

lack of dietary intake
losing iron due to blood loss
malabsorptio n

44
Q

where is iron absorbed?

A

proximal small bowel

45
Q

what are the two conservative measures that should be taken for patients with iron deficiency?

A

review their diet
improve their gastric acidity
review other medications

46
Q

why is improving gastric acidity beneficial for iron deficiency?

A

gastric acid is needed for the absorption of non-haem iron

47
Q

which type of iron is absorbed more easily?

A

haem iron

48
Q

what is the aim of treatment in ID anaemia?

A

normalise Hb

restore iron stores

49
Q

when will ferritin rise in ID anaemia?

A

when Hb returns to normla

50
Q

what increase in Hb is possible by health marrow if well supplied with iron?

A

7-10g/L per week

51
Q

what two methods of administration can be used for iron?

A

oral

IV

52
Q

name an oral iron preparation

A

ferrous fumarate

53
Q

what dose of oral iron is usually given?

A

100-200mg daily

54
Q

what oral iron is used in paeds?

A

sodium feredetate (sytron)

has a lower iron concentration

55
Q

what are the possible side effects of oral iron?

A

GI symptoms such as constipation, N+V, abdo pain and dark stools

56
Q

how long does iron therapy need to be given for to replenish stores?

A

2-3 months

57
Q

what should be monitored to assess the response to iron?

A

rise in Hb, MCV and reticulocytes

58
Q

what is normal haemoglobin for children aged 6 months to 6 years?

A

above 110

59
Q

what is normal haemoglobin for children 6-14?

A

above 120

60
Q

what is normal haemoglobin for adult males?

A

above 130

61
Q

what is normal haemoglobin for adult females?

A

above 120

62
Q

what is normal haemoglobin for pregnant females?

A

above 110

63
Q

what should you look for if you suspect haemolytic anaemia?

A

evidence of RBC breakdown products

reticulocytosis

64
Q

what are possible causes of macrocytosis without a significant anaemia?

A

hypothyroidism
alcohol
liver disease

65
Q

what is renal anaemia?

A

an anaemia of chronic disease due to failure of erythropoietin production

Y3 Haematology (23 decks)

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