Anaemia Flashcards
Define anaemia
Anaemia is a lower than normal concentration of haemoglobin or red blood cells (Hb <130 in men, <120 women)
name the 5 different types of anaemia
Haemolytic: increased breakdown of RBC’s
Aplastic: decreased RBC, WC, platelets
Microcytic: reduced MCV
Macrocytic: raised MCV
Normocytic: normal MCV
most common cause of anaemia
Fe deficiency
symptoms of anaemia
Symptoms: fatigue, headache, dizziness, dyspnoea (especially on exertion)
signs of anaemia
Signs: tachycardia, pale skin , conjunctiva painless , intermittent claudication
presentation of anaemia
tired
cold
palpitations
What may specifically indicate haemolytic anaemia
jaundice or dark urine
what may specifically indicate b12 deficiency
lemon- yellow skin
angular stomatis - skin condition
what causes b12 deficiency
pernicious anaemia
loss of intrinsic factor production
what may specifically indicate iron deficiney
angular stomatis or koilonychia - spoon shaped nails
What is mcv
mean corpuscular volume
5 causes of microcytic anaemia
T- Thalassaemia
A- Anaemia of chronic disease
I-Iron deficiency
L-Lead poisoning
S-Sideroblastic Anaemia
what is thalassaema
defect in the production of alpha or beta chains in hb
What would a full blood count for Microcytic anaemia show
low hb
mcv <80
what would a blood film show for microcytic anaemia
small hypochromic cells
In iron deficiency microcytic anaemia what would iron studies show
Low ferratin (unless active inflammation)
Low serum iron
Low transferrin saturation
Raised transferrin
what is the role of ferratin
Ferratin = main protein that stores iron intracellularly. Predominantly in the liver. Ferratin is an acute phase reactant so will rise in acute inflammation.
why would transferrin be raised in anaemia
body tries to compensate for reduced iron levels by producing more transferrin.
what is the role of transferrin
protein mediating iron transport in the blood
most common cause of FE deficiency anaemia
- blood loss as most common
-malnutrition - kids - poor iron absorption
elderly 60+ RARE RED FLGAG, colon cancer or bleeding
treatment for fe deficiency anaemia
oral iron - ferrous sulfate
SE of ferrous sulfate
nausea, abdo discomfort, diarrhoea, constipation
causes of chronic microcytic anaemia
Chronic infection
Chronic inflammation (connective tissue diseases)
Neoplasia
pathogenesis of microcytic chronic anaemia
- inflammatory cytokines lead to reduced sensitivity of the marrow to epo and failure to incorporate iron into developing cells
what is sideroblastic anaemia
iron levels are normal but the body cant insert this into hb
what type of anaemia are alpha and beta thalassaemia
microcytic
what causes alpha thalassaemia
due to insufficient synthesis of alpha-hemoglobin chains and an excess of beta chains.
- 4 genes on alpha chain, 2 from each parent
symptoms of b thalassaemia
CHIPMUNK FACE
hepatospenomegaly
massively enlarged forehead + cheekbones due to decrease in RBC
DIAGNOSIS for b thalassaemia
FBC+ blood film- hypochromic RBC
HB electrophoresis
pathophysiology of b thalassaemia
- decreased or no b chain production
- excess a chain
Treatment of B thalassaemia
- regular transfusion, iron chelation
mcv value for normocytic anaemia
80-95mcv
causes of normocytic anaemia
anaemia of chronic disease
chronic kidney disease
aplastic anaemia
haemolytic anaemia
acute blood loss
normoblastic causes of macrocytic anaemia
alcohol
liver disease
hypothyroidism
pregnancy
reticulocytosis
myelodysplasia
drugs
megaloblastic causes of macrocytic anaemia
b12 deficiency
folate deficiency
what is sickle cell anaemia
a genetic condition that causes sickle shapes red blood cells - normocytic
pathophysiology of sickle cell anaemia
Hbf is usually replaced with Hba around 6 weeks after birth in SCA it is replaced with an abnormal variant HbS
main issue with sickle cell anaemia
hbS polymerises when deoxygenated
CAUSE of sickle cell
single point mutation in b globin gene - HbS
Describe the genetic background of SCA
AUTOSOMAL RECESSIVE
abnormal gene for beta-globin on chromosome 11
one copy results in the trait.
Link between malaria and SCA
SCA more prevalent in areas where malaria is also common,
having one copy reduces the severity of malaria
acute presentation of SCA
MSK: Bone pain, joint pain
Infection
Resp: dyspnoea, cough, hypoxia
CNS: stroke
GI: sequestration crisis
WHAT IS SEQUESTRATION CRISIS
blood outflow from the spleen is blocked. Blood accumulates - splenomegaly
diagnosis of SCA ?
- newborn screening - heel prick test
-sickle solubility
-blood film + fbc, normocytic normochromic with increased reticulocytes and howell jolly bodies
-HB electrophoresis
MANAGEMENT OF SCA
- avoid dehydration and other triggers
-ensure vaccines are up to date
-antibiotic prophylaxis
-blood transfusion for severe anaemia
treatment for acute complicated attacks of SCA
iv fluids
ANALGESIA
o2
what is G6PDH DEFIEICNY
condition where there is a defect in the red blood cell enzyme G6PD
what is the presentation of g6pd deficiency
jaundice- in neonates
gall stones
anaemia
Heinz bodies on blood film
what does g6pd cause
crises that are triggered by infections medications or fava beans
to diagnose g6pd deficiency
FBC AND BLOOD FILM- heinz bodies
decrease in G6PDH LEVELS
TREATMENT FOR G6PD
avoid triggers and precipitans
what is hereditary spherocytosis
a deficiency in structural membrane protein spectrin– increase in splenic recycling
what does Hereditary spherocytosis cause
spenomegaly
sx of hereditary spherocytosis
general anaemia, neonatal jaundice , splenomegaly, gall stones
treatment of hereditary spherocytosis
splenectomy and folate supplementation
what is autoimmune haemolytic anaemia
when antibodies are created against the patients red blood cells
leads to destruction on ones own RBC
two types of autoimmune haemolytic anaemis
warm
cold
is warm or cold more common
warm
describe warm type autoimmune haemolytic anaemia
occurs at normal or above normal temperatures
usually idiopathic
describe cold type autoimmune haemolytic anaemia
also called cold agglutin disease
at lower temperatures the antibodies against red blood cells attach themselves to RBC anc clump together
agglutination-
management of autoimmue haemolytic anaemia
blood transfusions
prednisolone
rituximab
splenctomy
what issues are associated with microcytic anaemia
iron deficiency
thalassaemias
what issues are associated with normocytic anaemia
chronic disease
renal disease
acute bleeding
what issues are assocaited with macrocytic anaemia
folate deficiency
b12 deficiency
how much iron does a regular adult need and how much is absorbed
15mg a day
only 1mg is absorbed
presentation of anaemia
tired
cold
palpitations
How can kidney disease cause decrease in RBC production
Epo is made in the kidney so less epo then less erythropoiesis
Intravascular haemolysis causes
mismatched blood transfusion
G6PD deficiency*
red cell fragmentation: heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold autoimmune haemolytic anaemia
Extravascular haemolysis causes
haemoglobinopathies: sickle cell, thalassaemia
hereditary spherocytosis
haemolytic disease of newborn
warm autoimmune haemolytic anaemia
Blood film for thalassaemia would show ?
Heinz bodies
Target cells
Basophiloic stippling
Bleeding problems, normal platelets, raised bleeding time, slightly raised APTT in a question is most likely to indicate:
Von willerbrand disease
10-year-old child with a history of neonatal jaundice develops pallor and jaundice after an upper respiratory tract infection associated with erythematous cheeks. Splenomegaly is noted on examination is a stereotypical history of:
Hereditary spherocytosis
Presentation of hereditary spherocytsis
failure to thrive
jaundice, gallstones
splenomegaly
aplastic crisis precipitated by parvovirus infection
degree of haemolysis variable
MCHC elevated
