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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Defined as a low level of haemoglobin in the blood.

This is the result of an underlying disease and is not a disease itself.

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2
Q

Whats an essential ingredient in creating haemoglobin?

A

Iron

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3
Q

What is the mean cell volume (MCV)?

A

size of the red blood cells.
Check this in anaemic patient

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4
Q

Normal ranges:

A

Women:
Haemaglobin: 120 – 165 grams/litre
MCV: 80-100 femtolitres
Men:
Haemaglobin: 130 -180 grams/litre
MCV: 80-100 femtolitres

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5
Q

What are 3 categories of anaemia divided into?

A

Microcytic anaemia (low MCV indicating small RBCs) <80
Normocytic anaemia (normal MCV indicating normal sized RBCs) 80-100
Macrocytic anaemia (large MCV indicating large RBCs) >100

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6
Q

What is the most common cause of anaemia?

A

Fe deficiency

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7
Q

What is the social history for anaemia?

A

Alcohol – chronic alcohol intake can cause macrocytic anaemia – MCV larger
Diet –
Vegan? – not as much iron
Age – menorrhagia -15-35 change in periodds

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8
Q

What is the family history for anaemia?

A

Autoimmune Disease :Pernicious Anaemia
Malabsorptive Conditions

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9
Q

Past medical history for anaemia

A

Liver disease
Hypothyroidism

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10
Q

What are the causes of microcytic anaemia?

A

TAILS

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

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11
Q

Diagnosis and investigations for microcytic anaemia?

A

FBC
Fe studies

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12
Q

Example of microcytic anaemia?

A

Fe deficiency

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13
Q

Treatment for Iron deficient anaemia?

A

Ferrous sulphate for 3 months

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14
Q

What are the causes of normocytic anaemia?

A

3As 2Hs
A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism
Renal disease - CKD
Haem malignancy
Sickle cell
Malaria

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15
Q

What virus causes aplastic anaemia?

A

Parovirus B19 - – can cause aplastic crisis – blood coagulates in baby – can lead to miscarriages

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16
Q

What are some markers for cell turnover?

A

Increased: Lactate dehydrogenase, Unconj bilirubin
Decreased: Haptoglobin

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17
Q

Macrocytic anaemia can be…

A

megaloblastic or normoblastic

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18
Q

What is megaloblastic anaemia caused by?

A

Megaloblastic anaemia is the result of impaired DNA synthesis preventing the cell from dividing normally. Rather than dividing it keeps growing into a larger, abnormal cell. This is caused by a vitamin deficiency.

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19
Q

What is megoblastic (macrocytic) anaemia caused by?

A

B12 deficiency
Folate deficiency
Haemolysis
Bone marrow disorders

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20
Q

What is normoblastic macrocytic anaemia caused by?

A

Liver disease
Alcohol
Hypothyroidism
Myelodysplasia

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21
Q

What is normoblastic anaemia caused by?

A

Alcohol
Reticulocytosis (usually from haemolytic anaemia or blood loss)
Hypothyroidism
Liver disease
Drugs such as azathioprine

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22
Q

What are the (generic) symptoms of anaemia?

A

Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions such as angina, heart failure or peripheral vascular disease

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23
Q

What are the specific signs and symptoms of iron deficiency anaemia?

A

Pica describes dietary cravings for abnormal things such as dirt and can signify iron deficiency

Hair loss can indicate iron deficiency anaemia

Koilonychia is spoon shaped nails and can indicate iron deficiency

Angular chelitis can indicate iron deficiency
Atrophic glossitis is a smooth tongue due to atrophy of the papillae and can indicate iron deficiency
Brittle hair and nails can indicate iron deficiency

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24
Q

Signs of anaemia?

A

Jaundice occurs in haemolytic anaemia
Bone deformities occur in thalassaemia
Oedema, hypertension and excoriations on the skin can indicate chronic kidney disease

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25
Q

What do we use for initial investigations for anaemia?

A

Haemoglobin
Mean Cell Volume (MCV)
B12
Folate
Ferritin
Blood film

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26
Q

Further investigations of anaemia?

A

Oesophago-gastroduodenoscopy (OGD) and colonoscopy to investigate for a gastrointestinal cause of unexplained iron deficiency anaemia. This is done on an urgent cancer referral for suspected gastrointestinal cancer.

Bone marrow biopsy may be required if the cause is unclear

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27
Q

What % of cells we make everyday are RBC’s?

A

65% of the 300 billion cells the body makes every day are red blood cells

28
Q

What causes decreased production of RBC?

A

Iron deficiency
Folate deficiency
B12 deficiency
Bone marrow failure

29
Q

What causes increased loss of RBC’s?

A

BLEEDING
Haemolysis

30
Q

What FBC parameters are relevant to anaemia?

A

Haemoglobin
MCV
MCH: mean cell haemoglobin = amount of haemoglobin in each cell. Hypochromic = less haemoglobin in each cell than normal, normochromic = normal amount of haemoglobin in each cell

Reticulocyte count – not part of routine FBC, request specifically – number of ‘young’ red blood cells; measure of rate of red blood cell production

31
Q

What are hypochromic RBC’s?

A

Pale coloured RBCs

32
Q

How much iron do we need in a day?

A

15mg/day in normal diet; approx. 1mg/day absorbed. Needed for haemoglobin synthesis.

33
Q

Where is iron absorbed?

A

Duodenum and upper jejunum

34
Q

Causes of iron deficiency?

A

assume blood loss until proved otherwise (?gastrointestinal, menstrual)

Pregnancy (500mg-1000mg transferred to foetus, body stores 4g)

Impaired absorption; coeliac, gastrectomy. Dietary deficiency very unusual (risk in vegans, elderly)

35
Q

Investigations for iron deficiency?

A

microcytic, hypochromic red cells, low ferritin diagnostic,

normal/high ferritin difficult to interpret as acute phase protein.

Low transferrin saturation, high total iron binding capacity.

36
Q

Management of iron deficiency?

A

investigate/treat source of blood loss. Replace iron; oral iron preferred (e.g. ferrous sulphate 200mg one to three times daily)

Hb should rise approx. 2g every 3-4 weeks.

Intravenous iron no faster than oral.

After Hb and MCV return to normal, continue supplementation for a further 3 months to replenish stores.

37
Q

Ferritin

A

measure of iron stores

Male 30-400ug/L.
Female age >60 30-400ug/L.
Female age 17-60 15 – 150ug/L.

(also increased in inflammation, tissue destruction, liver disease, malignancy, iron replacement).

38
Q

Serum iron:

A

Female 6.6 – 26 umole/l,
Male 11 – 28 umole/litre.

(notable day to day and circadian variation)

39
Q

Transferrin saturation:

A

Female 15 – 45%, Male 15 – 50%.

Transferrin synthesis is increased in iron deficiency,so as a proportion less of it is occupied by iron).

40
Q

What is TIBC

A

total iron binding capacity, measures all of the proteins in the serum that bind iron; transferrin is principle amongst these.

41
Q

Normal levels of folate:

A

normal >3.9ug/l

42
Q

Folate features:

A
  • 0.1-0.2mg/day required.
  • minimal body stores; last 3-4 months. Needed for DNA replication.
  • Absorbed in proximal jejunum.
  • Body cant store folate
  • Folate can go down quite quickly if not eaten – cause of anaemia
43
Q

Causes of folate deficiencty?

A
  • Poor nutrition (found in green vegetables, nuts, yeast; destroyed by cooking),
  • malabsorption including coeliac, crohns, pregnancy, haemolysis.
  • Replace orally. Do not replace folate without checking B12.
44
Q

Normal levels of B12?

A

197 – 771ng/l

45
Q

B12 features?

A
  • Exclusively found in animal-derived products; meat, fish, eggs, dairy.
  • Body stores last 3 years.
  • Absorbed in terminal ileum; must bind to intrinsic factor, produced by gastric parietal cells.
46
Q

What is B12 required for?

A

Required for DNA synthesis and fatty acid synthesis; rapid sphingolipid turnover in myelin sheath means deficiency can cause neurological symptoms (paraesthesiae, ataxia from subacute combined degeneration of the cord)

47
Q

What are the causes of B12 deficiency?

A

Pernicious anaemia (autoimmune gastric atrophy; loss of intrinsic factor production), gastrectomy/ ileal resection, vegan diet, bacterial overgrowth, oral contraceptives, hypochloridia, nitric oxide.

48
Q

Test for B12 deficiency:

A

Test for intrinsic factor antibodies.

49
Q

Treatment for B12 deficiency

A

Intramuscular replacement (initially frequent, then maintenance. Consider oral replacement if strongly suspect dietary deficiency).

50
Q

What is haemolysis?

A

Reduction in red cell lifespan due to increased red blood cell destruction.

51
Q

What is compensated haemolysis?

A

increased destruction matched by increased synthesis.

52
Q

What is decompensated haemolysis?

A

rate of destruction exceeds rate of synthesis, causing anaemia.

53
Q

Investigations for haemolysis:

A

blood film (?spherocytes, polychromasia, red cell fragments?), reticulocyte count, bilirubin, including unconjugated bilirubin, lactate dehydrogenase, haptoglobin, direct antiglobulin test.

54
Q

Causes of haemolysis

A
  • red cell membrane disorders (hereditary spherocytosis)
  • abnormal haemoglobins (sickle cell)
  • microangiopathic haemolytic anaemias
  • prosthetic heart valves
  • autoimmune haemolytic anaemias
55
Q

Causes of iron deficicency?

A

Bleeding
diet
malabsorption
pregnancy
malnutrition
menorrhagia
ulcerative colitis

56
Q

Test results for Iron deficiency anaemia?

A

Ferritin: low/normal
Serum iron: Low
Transferrin: High
Transferrin sat: Low
TIBC: High

57
Q

Test results for anaemia of chronic disease?

A

Ferritin: normal/raised
Serum iron: low
Transferrin: low
Transferrin sat:normal/ Low
TIBC: low

58
Q

Test results for thalassaemia?

A

Ferritin: normal/raised
Serum iron: normal/raised
Transferrin: normal/low
Transferrin sat: normal/raosed
TIBC: normal/low

59
Q

Pathophysiology of thlassaemia?

A

Mutation in Alpha / Beta units

60
Q

Presentation of thalassaemia?

A

Microcytosis disproportionate to Hb levels

61
Q

Diagnosis and investigations for thalassaemia?

A

Hb Electrophoresis – Hb A2, Hb H Blood Film

62
Q

Treatment for thalassaemia?

A

Hb Electrophoresis – Hb A2, Hb H Blood Film

63
Q

Complications of thalassaemia?

A

organ failure

64
Q

62 year old comes into ED unsteady on his feet. He smells of alcohol
He seems confused and has nystagmus.
62 year old comes into ED unsteady on his feet. He smells of alcohol
He seems confused and has nystagmus.

Which of the following is a most likely cause of his anaemia
B12 Deficiency
Hypothyroidism
Liver
Disease
Alcohol
Fe Deficiency

A

Alcohol
Alcohol can cause macrocytic and megaloblastic anaemia

65
Q

Normocytic patients

A

What are their reticulocytes :
1. Low: CKD, Haem malignancy, mixed pict, Endocrine
2. High: LDH, Unconj bili Haptoglobin > No Blood loss > Yes Haemolysis

66
Q

Microcytic anaemia patient

A

Look at slide 13 on PTS haemology

Haematology (9 decks)

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