Anaemia Flashcards
What are 4 common clinical laboratory tests used in anaemia?
FBC
Iron profile
Folate
Vitamin B12
What things can be found out using a FBC blood test?
Haemoglobin (Hb)
Red blood cells (RBCs)
White blood cells (WBCs)
Platelets (Plts)
Haematocrit (HCT)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Haemoglobin (MCH)
Mean Corpuscular Haemoglobin Conc (MCHC)
What things can be found using an iron profile test?
Iron
Ferritin
Transferrin
Iron Saturation
What is Haemoglobin (Hb)?
These are iron containing oxygen binding protein complexes found in RBCs which carries oxygen around the body.
What are red blood cells?
These are blood cells that carry oxygen.
What is the haematocrit (HCT) measurement?
Volume of red blood cells in blood - expressed as a percentage.
What is mean corpuscular volume (MCV)?
Average volume of a single red blood cell.
What is mean corpuscular haemoglobin?
Average weight of haemoglobin in red blood cells.
What is mean corpuscular haemoglobin concentration?
Average concentration of haemoglobin in a given volume of red blood cells.
What are reticulocytes?
Concentration of immature red blood cells.
What is ferritin?
Ferritin is an iron storage protein. Measuring this will indicate the amount of iron stored in the body.
What is transferrin?
Plasma iron binding protein for transport around the body.
What is meant by iron saturation?
Ratio of serum iron to iron binding capacity.
What are platelets?
Platelets are cell fragments that function in the clotting system.
Name a few platelet disorders?
Thrombocythaemia
Thrombocytosis
Thrombocytopenia
What does thrombocytosis and thrombocythaemia mean?
What can this be caused by?
Body produces too many platelets resulting in an abnormal increase in platelet count.
Caused by malignancy, inflammatory disease, response to blood loss.
What does thrombocytopenia mean? What can this be cause by?
Decrease in platelet count.
Can be drug induced e.g. heparin, LMW heparin.
What is the FBC Hb reference ranges for male and female?
Male: 130-180 g/L
Female: 120-150 g/L
What is the FBC RBC reference ranges for male and female?
Male: 4.5-5.5 x 10^12 /L
Female: 3.8-4.8 x 10^12 /L
What is the FBC HCT reference ranges for male and female?
Male: 40-50 %
Female: 36-46 %
What is the FBC Ferritin reference ranges for male and female?
Both: 13-300 micrograms/L
What is the FBC MCV reference ranges for male and female?
Male: 80-104 fl
Female: 74-104 fl
What is the FBC MCH reference ranges for male and female?
All: 27-32 pg
What is the FBC MCHC reference ranges for male and female?
All: 315-350 g/L
What is the FBC platelets reference ranges for male and female?
All: 150-410 x 10^9 /L
What is the FBC reticulocytes reference ranges for male and female?
All: 0-2%
What is anaemia?
Anaemia is a condition in which you do not have enough RBCs or the Hb concentration contained within RBCs is no enough to meet your body’s requirements.
What causes increase in haemoglobin loss?
Haemorrhage
Haemolysis
What causes reduction in haemoglobin synthesis?
Lack of nutrients
Bone marrow failure
List the mild anaemia symptoms.
Fatigue
Lethargy
Pallor
Exercise intolerance
List moderate anaemia symptoms.
Light headedness
Confusion
Headaches
List severe anaemia symptoms.
Shortness of breath
Palpitations
Tachycardia
Angina
Heart failure
Anaemia is diagnoses depending on Hb level. Why are there 3 different Hb classification to confirm anaemia?
For men, women, pregnant women
State the Hb level for men, non-pregnant women and pregnant women.
Men >15 years old = <130g/L
Women >15 years old = <120g/L
Pregnant women = <110g/L
In what 3 ways is anaemia classifed?
Microcytic, normocytic, macrocytic.
What is microcytic anaemia and state the MCV level?
Microcytic anaemia occurs when your red blood cells are smaller than usual because they don’t have enough oxygen.
MCV <80 fl
What causes microcytic anaemia?
Iron deficiency
Thalassemia (inherited blood disorder that causes body to have less haemoglobin than normal)
What is normocytic anaemia and state the MCV level?
Normocytic anaemia occurs when there are fewer red blood cells than normal and those RBCs don’t have enough Hb.
MCV 80-100 fl
What causes normocytic anaemia?
Acute blood loss
Chronic disease
Haemolytic anaemia
Aplastic anaemia
What is macrocytic anaemia and state the MCV level?
Macrocytic anaemia occurs when bone marrow produces abnormally large red blood cells.
MCV >100 fl
What causes macrocytic anaemia?
Vitamin B12 deficiency
Folate deficiency
Hypothyroidism
Drug induced
Alcohol abuse
What group can anemia be diagnosed in?
Children <5 years old and women of childbearing age
List the causes of iron deficiency anaemia.
Increased blood loss, increase in requirements of iron, decrease absorption, decreased intake
Describe how increase in blood loss can cause iron deficiency anaemia.
- can be caused by bleeding such as due to haemorrhage, haematemesis, GI bleeding.
- can be caused by menstruation such as menstrual blood loss.
Describe how increase in requirements can cause iron deficiency anaemia.
- due to pregnancy, breastfeeding or children can have high demand for iron. Body requires additional iron due to demands of pregnancy.
Describe how decreased absorption can cause iron deficiency anaemia.
- due to malabsorption such as in coeliac disease, IBD, short bowel syndrome.
Describe how decreased in take of iron causes iron deficiency anaemia.
- due to poor nutrition as reduced amount of dietary iron intake over a significant time period.
What are some iron deficiency symptoms?
Headache, fatigue, hair loss, paleness, brittle nails, shortness of breath, cold intolerance, restless leg syndrome, cognitive dysfunction.
What is haematemesis?
Vomiting blood - caused by bleeding in the upper part of the GI tract
What is short bowel syndrome?
Body unable to absorb enough nutrients from foods due a loss in the portion of small intestine.
What 4 factors must be assessed to diagnose iron deficiency anaemia?
Symptoms, diet, medications, social history
How can travelling abroad cause iron deficiency anaemia?
Infection or parasites can cause blood loss - iron deficiency anaemia.
Go through the process for diagnosing iron deficiency anaemia.
- Full blood count is taken.
- Hb levels are investigated (Men, women, pregnant = 130, 120, 110 g/L).
- If Hb levels are low, investigate MCV. If lower than 80 fl, check Ferritin levels.
- Ferritin is the level of iron stores in the body (in anaemia this will be low). <30 micrograms/L.
- Iron deficiency anaemia can be confirmed.
What component of FBC doesn’t confirm iron deficiency anaemia?
Platelet levels.
Describe the management for iron defiency anaemia.
- Address underlying cause.
- Coeliac screen.
- Urinalysis.
- Start iron replacement therapy.
What are some underlying causes for iron deficiency anaemia?
- regular NSAID use
- diet related - lack of iron
- heavy periods
- pregnancy
List some iron rich foods
Brown rice, tofu, dark green leafy vegetables, red meat, nuts/seeds, eggs, dried fruits, fish, iron-fortified cereals/bread.
How is iron deficiency anemia managed medically?
By use of iron supplements.
- once daily dose of 50-100mg of elemental iron e.g. 200mg ferrous sulfate tablet once daily (can be given 3-4 times a day but reduced to once daily)
- continue supplement for 3-4 months after iron deficiency is corrected to replenish iron stores
-
Dose related side effects can occur. What can be done if the supplement is not tolerated well?
- lower dose
- take supplement on alternative days
- consider parenteral iron
- take supplements with food (better tolerated)
What are the 3 iron salts commonly used as an iron supplement? What content of ferrous iron is found in these 3 formulations?
Ferrous Sulphate
- dose = 200mg
- content = 65mg
Ferrous Fumarate
- dose = 200mg
- content = 65mg
Ferrous Gluconate
- dose = 300mg
- content = 35mg
What 3 points must be mentioned when counselling a patient about taking iron supplements?
How to take it
Side effects
Monitoring
Interactions
When counselling a patient on how to take the iron supplements, what points must be mentioned?
- take before/after food on an empty stomach to get the most absorption
- if not tolerated well, take with food
- dose and frequency must be highlighted
- duration of at least 4 months
When counselling a patient on the side effects of the iron supplements, what points must be mentioned?
- side effects are dose related and will settle over time
- GI side effects are common - N&V, heartburn
- diarrhoea, constipation
- black stools - this is an indication of blood in stools but can be seen in those on iron supplements
How is the patient monitored after being prescribed iron tablets?
- check Hb 4 weeks after initiation of treatment to assess the response to treatment
- once Hb is in range, continue for another 3 months to replenish iron stores
Describe two interactions which can occur when taking iron supplements.
Reduced iron absorption
e.g. antacids e.g. Peptac, PPIs and calcium supplements
- iron will bind to calcium
Absorption reduced by iron
e.g. levothyroxine, antibiotics e.g. doxycycline and ciprofloxacin and biphosphonates
- these can bind to iron
What can be done to avoid interactions?
Administer at separate times
Who is parenteral iron used for?
- for patients who are severely anaemic
- for patients who do not tolerate oral preparations
- peri-operative
- haemodialysis
List some IV iron preparations.
- iron dextran (Cosmofer)
- iron sucrose (Venofer)
- ferric derisomaltose (Monofer)
- ferric carboxymaltose (Ferinject)
Describe how parenteral iron is given.
- dose based on weight and Hb levels
- must be administered under close medical supervision due to possible hypersensitivity reactions
What are the consequences if iron deficiency anemia is left untreated?
- Increased risk of infection because lack of iron affects the immune system.
- Symptoms can progress resulting in Restless Legs Syndrome and angina/heart failure.
- Pregnant women have a higher risk of complications before and after birth.
Describe haemochromatosis (iron overload)
- hereditary condition in which excessive amounts of iron are absorbed from their food.
- early diagnosis is essential
- without treatment, it can lead to severe organ damage and premature death due to iron being deposited into organs
- symptoms are non-specific e.g. fatigue, weakness, aching joints
- ferritin is measured to establish the degree of iron overload
- iron profile must be checked
What is macrocytic anaemia caused by?
MCV level is higher
- caused by Vit B12 deficiency and folate deficiency
Describe the body stores in Vit B12 deficiency.
2-3 mg of stores of Vit B12.
Vit B12 body stores may take 2-3 years to present as a deficiency.
Describe the body stores in Folate deficiency.
10-12 mg stores of folate.
Folate body stores can become deplete in 4 months.
What causes Vitamin B12 deficiency?
- pernicious anaemia (autoimmune disorder that affects the stomach)
- malnutrition
- vegan diet
- inadequate intake of Vit B12
- intestinal disease (e.g. Crohn’s disease)
What causes Folate deficiency?
- alcohol consumption
- malnutrition
- increased requirements e.g. pregnancy, malignancy, inflammatory disease (Crohn’s disease)
What medications can cause Vit B12 deficiency?
Colchicine
Metformin
PPIs
What medications can cause folate deficiency?
Folate antagonists e.g. methotrexate
Trimethoprim
Describe the signs and symptoms of macrocytic anaemia.
Symptoms similar to other types of anaemia e.g. fatigue which progresses into shortness of breath and palpitations.
Onset is subtle with gradually progressive signs and symptoms which may develop over the years.
Other symptoms - glossitis, anorexia, mild jaundice, GI symptoms.
What symptoms can be seen in Vitamin B12 deficiency?
- Neurological - visual disturbances, cognitive changes (confusion, memory loss), unexplained paraesthesia.
- Psychological - mood swings, depression, psychosis, dementia.
- Progressive neuropathy affecting legs.
- Muscle weakness - increased risk of falls.
