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Heart, Lungs and Blood > anaemia > Flashcards

anaemia Flashcards

1
Q

What are B12 and folate, and how are they related to erythropoiesis?

A

B12 and folate are key components of DNA synthesis, and deficiency of either can result in megaloblastic anemia, a condition characterized by inefficient DNA replication and selective death of more mature precursors, resulting in a macrocytic picture. They are essential for erythropoiesis as they play a vital role in the synthesis of DNA during RBC maturation.

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2
Q

What is erythropoietin, and where is it produced?

A

Erythropoietin is a hormone that stimulates erythropoiesis by acting on proerythroblasts and early erythroblasts, preventing their apoptosis and upregulating their transferrin receptors to increase RBC production. It is produced primarily in the kidneys.

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3
Q

How does erythropoietin regulate erythropoiesis?

A

Erythropoietin stimulates erythropoiesis by acting on proerythroblasts and early erythroblasts, preventing their apoptosis and upregulating their transferrin receptors to increase RBC production. The resultant increase in circulating RBCs relieves the hypoxia, which down-regulates the hormonal control of the process in an example of a negative feedback loop.

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4
Q

What are the effects of androgens and thyroxine on erythropoiesis?

A

Androgens and thyroxine exert a stimulatory effect on erythropoiesis. Patients who take testosterone either recreationally or for hormonal imbalances can develop erythrocytosis, an elevated red cell count.

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5
Q

What is sideroblastic anemia, and how is it related to copper and pyridoxine?

A

Sideroblastic anemia is a type of anemia characterized by the presence of ringed sideroblasts in the bone marrow, which are erythroblasts that contain iron granules that have not been fully incorporated into the heme of hemoglobin. Copper and pyridoxine are key components of iron incorporation into heme, and their deficiency can result in sideroblastic anemia.

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6
Q

What parameters are checked in a full blood count for anemia?

A

The parameters checked in a full blood count for anemia are:

  • Hemoglobin
  • Platelet count
  • Hematocrit
  • Mean corpuscular volume (MCV)
  • Mean corpuscular hemoglobin (MCH)
  • Neutrophils
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7
Q

What does MCV measure in a full blood count?

A

MCV (mean corpuscular volume) measures the average size of the red blood cells in the blood. It is calculated by dividing the hematocrit (the proportion of blood volume occupied by red blood cells) by the red blood cell count.

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8
Q

What does MCH measure in a full blood count?

A

MCH (mean corpuscular hemoglobin) measures the average amount of hemoglobin in each red blood cell. It is calculated by dividing the total amount of hemoglobin by the red blood cell count.

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9
Q

What is the significance of neutrophil count in a full blood count for anemia?

A

The neutrophil count provides information about the body’s response to anemia. Neutrophils are white blood cells that play a key role in the immune system’s response to infections. An elevated neutrophil count may indicate an ongoing infection or inflammation, which can contribute to anemia.

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10
Q

How is a full blood count useful in the diagnosis of anemia?

A

A full blood count provides important information about the different components of blood and can help in the diagnosis of anemia. Hemoglobin, hematocrit, and MCV values can help determine the type of anemia present. For example, a low MCV may suggest iron-deficiency anemia, while a high MCV may indicate megaloblastic anemia. The platelet count can also provide information about bleeding disorders that may contribute to anemia. The reticulocyte count can help determine the rate of RBC production, while the neutrophil count can provide information about the body’s response to anemia.

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11
Q

What is the diameter of red blood cells?

A

6-8μm.

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12
Q

Do red blood cells have a nucleus?

A

No, they don’t.

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13
Q

How many molecules of haem does each red blood cell have to carry?

A

640 million.

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14
Q

What is the normal shape of red blood cells?

A

Biconcave.

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15
Q

What factors contribute to the normal shape of red blood cells?

A

Specific cytoskeletal proteins (e.g., spectrin/ankyrin), normal enzymes (e.g., Glucose 6 phosphate dehydrogenase and Pyruvate Kinase), normal type and amount of Hb.

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16
Q

What is the life span of red blood cells?

A

120 days.

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17
Q

What is haemoglobin?

A

A protein carried by red blood cells that binds to and carries oxygen.

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18
Q

How many globin proteins does each haemoglobin molecule have?

A

4 (2 alpha and 2 beta).

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19
Q

How is haemoglobin measured?

A

In g/L.

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20
Q

What is haematocrit?

A

A measure of the proportion of the mass of the red blood cells that make up the whole blood pool.

21
Q

How is haematocrit calculated?

A

RBCC (red blood cell count) x MCV (mean cell volume)/1000.

22
Q

What is mean cell haemoglobin?

A

The average amount (mass) of Hb in the average cell.

23
Q

How is mean cell haemoglobin derived?

A

Hb/RBCC.

24
Q

What is mean corpuscular volume?

A

The volume of the average red blood cell.

25
Q

What does red cell distribution width (RDW) indicate?

A

The variation in size of the cells, which can be useful in establishing the cause of anaemia.

26
Q

What is a blood film?

A

A direct inspection of the morphology (size and shape) of red blood cells, white cells and platelets.

27
Q

What is the WHO definition of anaemia?

A

Hb < 130g/L in men and <120g/L in women (< 11g/L in pregnant women).

28
Q

What is anaemia and how is it defined in clinical practice?

A

Anaemia is a condition that arises when there is a deficiency in the number of red blood cells and/or the haemoglobin in the circulation. It is not a diagnosis, but a sign of something else. The WHO definition of anaemia is Hb < 130g/L in men and < 120g/L in women (< 11g/L in pregnant women).

29
Q

What are the clinical features of anaemia?

A

The clinical features of anaemia include lethargy, shortness of breath, palpitations, headache, and non-specifically feeling unwell. Signs of anaemia include pallor, pale conjunctivae, tachypnea, tachycardia, and changes to nails and hair.

30
Q

What is the worldwide impact of anaemia?

A

Anaemia contributes to 20% of all maternal deaths, poor pregnancy outcomes, and increased risk of morbidity in children. It can also impair physical and cognitive development. Although its prevalence is widespread, its severity is worse in developing countries, where it can also reduce work productivity in adults.

31
Q

What are the three main causes of anaemia?

A

The three main causes of anaemia are problems with synthesis (such as a deficiency of a building block of RBCs/haemoglobin, or bone marrow failure), consumption (such as premature destruction of RBCs due to inherited or acquired haemolysis), and bleeding or sequestration (such as bleeding from somewhere in the body, or sequestration in the spleen or liver in patients with sickle cell disease, or anaemia of chronic disease where iron is trapped in macrophages due to chronic inflammation).

32
Q

: What is the significance of the mean corpuscular volume and mean cell haemoglobin in the assessment of anaemia?

A

Mean corpuscular volume (MCV) is the average size of all RBCs in the sample and can mask variations in the size of the cells within the sample. The size variation can be assessed using a red cell distribution width (RDW). The greater the RDW, the greater the variation in the size of the cells. Mean cell haemoglobin (MCH) is the average amount (mass) of Hb in the average cell. Both MCV and MCH can be useful in establishing the cause of anaemia.

33
Q

What is the MCV and what values are used to categorize it as microcytic, normocytic, or macrocytic?

A

The MCV stands for mean corpuscular volume and is a measure of the average size of red blood cells in a given blood sample. Microcytic anemia is defined as an MCV of less than 80 fL, normocytic anemia as an MCV between 80-96 fL, and macrocytic anemia as an MCV greater than 95 fL.

34
Q

: What are some causes of microcytic anaemia?

A

Iron deficiency, anaemia of chronic disease, acute bleeding, thalassemia

35
Q

What are some causes of normocytic anaemia?

A

Anaemia of chronic disease, B12 deficiency, renal failure, myelodysplasia, thyroid dysfunction, haemolysis

36
Q

What are some causes of macrocytic anaemia?

A

B12 deficiency, folate deficiency, myelodysplasia, thyroid dysfunction, haemolysis

37
Q

What are some potential causes of iron deficiency anaemia?

A

History of bleeding or dietary deficiency

38
Q

What are some potential causes of anaemia of chronic disease?

A

A chronic condition or chronic inflammation, such as kidney disease or arthritis

39
Q

What are some potential causes of acute bleeding?

A

Acute bleeding, history of autoimmune conditions

40
Q

What are some potential causes of thalassemia?

A

Family origin or family history

41
Q

What are some potential causes of B12 deficiency anaemia?

A

Dietary deficiency, history of autoimmune conditions

42
Q

What are some potential causes of folate deficiency anaemia?

A

Dietary deficiency or increased requirements

43
Q

What are some potential causes of renal failure?

A

Normocytic anaemia

44
Q

What are some potential causes of myelodysplasia?

A

Normocytic or macrocytic anaemia, problems with other bits of the FBC too

45
Q

What are some potential causes of thyroid dysfunction?

A

Normocytic or macrocytic anaemia, any other thyroid symptoms?

46
Q

What are some potential causes of haemolysis?

A

Normocytic or macrocytic anaemia, elevated reticulocytes, known haemolytic disorder such as membranopathy or Hbopathy.

47
Q

What are the tests to evaluate consumption-related causes of anemia?

A

The tests to evaluate consumption-related causes of anemia are haemolysis screen, bilirubin, reticulocytes, LDH, haptoglobin, and direct antiglobulin test (DAT).

48
Q

What are the tests to evaluate prob with synthesis-related causes of anemia?

A

The tests to evaluate prob with synthesis-related causes of anemia are iron studies, B12, folate, and bone marrow biopsy.

49
Q

What are the tests to evaluate bleeding/sequestration-related causes of anemia?

A

The tests to evaluate bleeding/sequestration-related causes of anemia are CT scan or “oscopies” to look inside bowel, bladder, etc., for bleeding.

Heart, Lungs and Blood (51 decks)

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