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Anaemia Flashcards

1
Q

Anaemia definition in men

A

Hb <135g/L (13.5g/dL)

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2
Q

Anaemia definition in women

A

Hb <115g/L (11.5g/dL)

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3
Q

3 causes of anaemia

A

Reduced production of RBCs
Increased loss of RBCs (haemolytic anaemias)
Increased plasma volume (pregnancy)

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4
Q

Microcytic anaemias

A

IDA
Anaemia of chronic disease
Sideroblastic anaemia
Thalassaemia

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5
Q

Normocytic anaemias

A 
Acute blood loss
Anaemia of chronic disease
Bone marrow failure
Renal failure
Hypothyroidism
Haemolysis
Pregnancy
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6
Q

Macrocytic anaemias

A 
Fetus (pregnancy)
Antifolates (e.g. phenytoin)
Hypothyroidism
Reticulocytosis (release of larger immature cells e.g. haemolysis)
B12/folate deficiency
Cirrhosis (EtOH excess/liver disease)
Myelodysplastic syndromes
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7
Q

Symptoms of anaemia

A

Tiredness, shortness of breath, palpitations, headache, tinnitus, anorexia

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8
Q

Signs of anaemia

A

Pallor, in severe hyperdynamic circulation (tachycardia + flow murmurs (ejection-systolic loudest over apex), heart failure)

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9
Q 
Koilonychia
Brittle hair and nails
Atrophic glossitis
Angular cheilosis
Post-cricoid webs (Plummer-Vinson syndrome)
=?
A

IDA

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10
Q

IDA blood film

A

Microcytic, hypochromic
Anisocytosis (varying size)
Poikilocytosis (varying shape)
Pencil cells

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11
Q

Clinically considered cause of IDA

A

Bleeding until proven otherwise, menorrhagia in young women

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12
Q

5 classifications of IDA

A 
Blood loss
Increased utilisation
Decreased intake
Decreased absorption
Intravascular haemolysis
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13
Q

Blood loss-related causes of IDA

A

Gastrointestinal loss of blood

  • peptic ulcers/gastritis
  • polypa/colorectal cancer (>50)
  • menorrhagia (W <50)
  • Meckel’s diverticulum (children)
  • hookworm infestation (developing countries)
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14
Q

Increased utilisation-related causes of IDA

A

Pregnancy/lactation

Growth - infants/children

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15
Q

Decreased intake-related causes of IDA

A

Prematurity - loss of iron each day foetus isn’t in utero

Infants/children/elderly - suboptimal diet

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16
Q

Decreased absorption-related causes of IDA

A

Coeliac disease - absence of villi in duodenum

Post-gastric surgery - rapid transit so less acid to aid iron absorption

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17
Q

Intravascular haemolysis-related causes of IDA

A

Microangiopathic Haemolytic anaemia

PNH (paroxysmal nocturnal haemoglobinuria)

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18
Q

Investigations for IDA

A

Identify cause

If no obvious cause then OGD + colonoscopy, urine dip, coeliac Ix

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19
Q

IDA treatment

A

Treat the cause
Oral iron (ferrous sulphate)
IV iron if severe + symptomatic
If septic then blood transfusion instead of iron (fuels infection)

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20
Q

Anaemia of chronic disease causes

A

Chronic infection (e.g. TB, osteomyelitis)
Vasculitis
Rheumatoid arthritis
Malignancy etc (long-standing illness)

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21
Q

Mechanism of cause for anaemia of chronic disease

A

Cytokine-driven inhibition of RBC production
1 - Inflammatory markers reduce EPO receptor production (and thus EPO synthesis) by kidneys
2 - Iron metabolism dysregulated, IL6/LPS stimulate production of hepcidin by liver decreasing iron absorption by inhibiting transferrin and causing iron accumulation in macrophages

OR renal failure (EPO deficiency)

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22
Q

Ferritin (intracellular protein indicating iron store) status in ACD

A

Raised due to iron storage in macrophages

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23
Q

Aetiology of sideroblastic anaemia

A

Ineffective erythropoiesis - iron loading (accumulation of iron in body) causing haemosiderosis (endocrine, liver, cardiac damage due to iron deposition)

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24
Q

Diagnostic feature for sideroblastic anaemia

A

Ring sideroblasts seen in marrow

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25
Ring sideroblast description
Erythroid precursors with iron deposited in mitochondria in a ring around nucleus
26
Sideroblastic anaemia causes
``` Myelodysplastic disorders Post-chemo Irradiation !!Alcohol excess Lead excess Anti-TB drugs Myeloproliferative disease ```
27
Sideroblastic anaemia treatment + drug
Remove cause | Pyroxidine (vit B6 to promote RBC production)
28
Plasma iron study categories (3)
Serum iron TIBC (total iron binding capacity) Ferritin
29
Iron study results - Dx? Serum iron - lowered TIBC - raised Ferritin - lowered
IDA
30
Plasma iron study results - Dx? Serum iron - lowered TIBC - lowered Ferritin - raised
Anaemia of chronic disease
31
Iron study results - Dx? Serum iron - raised TIBC - lowered Ferritin - raised
Chronic haemolytic anaemia
32
Iron study results - Dx? Serum iron - raised TIBC - lowered or normal Ferritin - raised
Haemochromatosis
33
Iron study results - Dx? Serum iron - raised TIBC - raised Ferritin - normal
Pregnancy
34
Sideroblastic anaemia iron study results
Serum iron - raised TIBC - normal Ferritin - raised
35
Transferrin saturation calculation + iron deficiency threshold
serum iron/TIBC | <20% = Fe deficiency
36
Adjustment to iron study necessary if patient in inflammatory state (e.g. infection/malignancy)
Ferritin is raised so check CRP with each ferritin sent and transferrin saturation will be more useful
37
Investigations for pancytopenia
B12/folate/iron Abdo exam to assess spleen (myelofibrosis = splenomegaly) Reticulocyte count (aplastic anaemia or bone marrow failure syndromes if low) Blood film (hairy cell leukaemia, dysplasia = myelodysplasia, blasts = acute leukaemia) Myeloma screen Parvovirus (can cause this in immunosuppressed) Some medications may cause this Bone marrow biopsy
38
Macrocytic anaemia types (3)
Megaloblastic Non-megaloblastic Other haematological disease
39
Megaloblastic macrocytic anaemia causes
B12 deficiency Folate deficiency Cytotoxic drugs
40
Non-megaloblastic macrocytic anaemia causes
``` Alcohol excess (commonest cause of macrocytosis without anaemia as well) Reticulocytosis Liver disease Hypothyroidism Pregnancy ```
41
Other haematological diseases that cause macrocytic anaemia (neither megaloblastic/non-megaloblastic)
Myelodysplasia Myeloma Myeloproliferative disorders Aplastic anaemia
42
Megaloblastic macrocytic anaemia blood film description
``` Hypersegmented polymorphs Leucopenia Macrocytosis Anaemia Thrombocytopenia with megaloblasts ```
43
Main sources of vitamin B12
Meat and dairy | Large body stores
44
Causes of vitamin B12 deficiency
Dietary | Malabsorption
45
Causes of vitamin B12 malabsorption
Stomach - lack of intrinsic factor produced by gastric parietal cells - pernicious anaemia or post-gastrectomy Terminal ileum - ileal resection, Crohn's, bacterial overgrowth, tropical sprue, tapeworms
46
Clinical features of B12 deficiency
Mouth - glossitis, angular cheilosis (swelling, fissuring of lips) Psych - irritability, depression, psychosis, dementia Neuro - parasthesiae, peripheral neuropathy (loss of vibration/proprioception, absent ankle reflex, spastic paraperesis, subacute combined degeneration of spinal cord)
47
Pernicious anaemia aetiology and physiological consequences
Autoimmune atrophic gastritis - achlorydia and lack of gastric intrinsic factor COMMONEST cause of macrocytic anaemia in Western countries (>40yrs)
48
!!TESTS for pernicious anaemia
!!Parietal cell antibodies (90%) !!Intrinsic factor antibodies (50%) Schilling test (outdated)
49
Treatment for vit B12 deficiency
Replenish stores with !!IM hydroxycobalamin
50
Main sources of folate
DIET - green veg, nuts, yeast & liver, synthesised by gut bacteria (low body stores, can't produce de novo)
51
Causes of folate deficiency
Poor diet Increased demand - pregnancy or increased cell turnover (haemolysis, malignancy, inflammatory disease, renal dialysis) Malabsorption - coeliac, tropical sprue Drugs - alcohol, anti-epileptics (phenytoin), methotrexate, trimethoprim
52
Treatment for folate deficiency
Oral folic acid (don't give if cause of anaemia is unknown as may exacerbate)
53
Definition of haemolytic anaemias
Breakdown of RBCs before their normal life span of around 120 days
54
Features present in all haemolytic anaemias
``` Raised bilirubin (unconjugated) Raised urobilinogen Raised LDH (lactate dehydrogenase) Reticulocytosis (raised MCV and polychromasia) ``` May have pigmented gallstones
55
Features present in intravascular haemolytic anaemias
Raised free plasma Hb Lowered haptoglobin (binds free Hb) Haemoglobinuria (dark red urine) Methaemalbuminaemia (haem + albumin in blood)
56
Main feature of extravascular haemolytic anaemias
Splenomegaly
57
Issues patients in erythroid hyperplasia state are susceptible to
Parvovirus B19 (aplastic crisis) Iron overload Osteoporosis
58
Expected outcome of reticulocyte count if patient is acutely anaemic
High reticulocyte count - bone marrow responding appropriately to produce more RBCs
59
Classifications of causes of haemolytic anaemias
Inherited - membrane defect - enzyme defect - haemoglobinopathies Acquired - immune - non-immune
60
Inherited causes of haemolytic anaemias
Membrane defect - hereditary spherocytosis/elliptocytosis Enzyme defect - G6PD deficiency, pyruvate kinase deficiency Haemoglobinopathies - sickle cell disease, thalassaemias
61
Acquired causes of haemolytic anaemias
Immune - autoimmune (warm or cold), alloimmune (haemolytic reactions to transfusions) Non-immune - mechanical (e.g. metal valves, trauma), PNH, MAHA, infections (e.g. malaria), drugs
62
Hereditary spherocytosis + elliptocytosis inheritance pattern
Autosomal dominant
63
Aetiology of hereditary spherocytosis and susceptibilities
Spectrin or ankyrin deficiency (membrane proteins) Susceptible to parvovirus B19 and gallstones
64
Site of haemolysis in hereditary spherocytosis + clinical sign
Extravascular | Splenomegaly
65
Diagnosis method for hereditary spherocytosis
Spherocytes on blood film Increased osmotic fragility (lysis in hypotonic solution) Negative DAT/Coombs test (not autoimmune Ab mediated) Flow cytometry
66
Treatment of hereditary spherocytosis
Splenectomy | Folic acid
67
Only form of hereditary elliptocytosis that ISN'T autosomal dominant
Hereditary pyropoikilocytosis (overly sensitive to heat) - autosomal recessive
68
Severity range of outcomes for hereditary elliptocytosis
Hydrops foetalis to asymptomatic
69
Hereditary elliptocytosis appearance on blood film
RBCs are elliptical in shape
70
South East Asian Ovalocytosis inheritance pattern + clinical relevance
Recessive - heterozygous +/- malaria protection
71
Inheritance pattern for commonest RBC enzyme defect (G6PD def)
X-linked
72
Prevalent areas of G6PD def
Malarial endemicity (i.e. Africa, mediterranean, middle eastern populations)
73
G6PD def attack clinical features + blood film description
``` Rapid anaemia + jaundice + dark urine Bite cells (RBCs with small semicircular part cut out, like a bite) + !!Heinz bodies (blue deposits, oxidised Hb) ```
74
Causes of G6PD def attacks
Oxidants (G6PD usually helps RBCs make glutathione = antioxidant) - drugs (2-3 days after starting) - broad beans - acute stressors - moth balls - acute infection
75
Diagnosis method for G6PD def
Classical signs of anaemia on basic Ix G6PD def spot test - NON-FLUORESCENT as no NADPH Enzyme assay 2-3 months after crisis - young RBCs may have sufficient enzyme so appear normal
76
Treatment for G6PD def
Supportive + folic acid, avoid precipitants Blood transfusion if severe attack Genetic screening can be useful
77
Inheritance pattern for pyruvate kinase def
Autosomal recessive
78
Clinical features of pyruvate kinase def
Severe neonatal jaundice Splenomegaly Haemolytic anaemia
79
Management of pyruvate kinase def
Most don't require treatment but can do blood transfusion or splenectomy

Y5 Pathology (4 decks)

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