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MEH > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Condition where haemoglobin conc is lower than normal range

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2
Q

Symptoms of anaemia

A

Shortness of breath
Angina
Claudication
Weakness
Pallor
Lethargy
Palpitations

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3
Q

Signs of anaemia

A

Pallor
Hypotension
Tachypnoea
Tachycardia

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4
Q

Signs of iron deficiency anaemia

A
  • Kolionychia - spoon shaped nails
  • Angular stomatitis - inflammation of corners of mouth
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5
Q

Sign of vitamin B12 deficiency

A

Glossitis - inflammation of tongue

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6
Q

Sign of thalassaemia

A

Abnormal facial bone development

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7
Q

What is koilonychia and what is it a sign of?

A

Spoon shaped nails
Iron deficiency anaemia

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8
Q

What is angular stomatitis and what is it a sign of?

A

Inflammation of corners of mouth
Iron deficiency anaemia

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9
Q

What is glossitis and what is it a sign of?

A

Inflammation of tongue
Vitamin B12 deficiency

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10
Q

Reasons for anaemia to develop

A

In bone marrow:
- reduced erythropoiesis
- abnormal haem synthesis&raquo_space; sideroblastic anaemia
- abnormal globin chain synthesis&raquo_space; thalassaemia

In peripheral RBCs: - removed by spleen
- abnormal structure
- mechanical damage
- abnormal metabolism

Excessive bleeding
Increased removal by reticuloendothelial system

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11
Q

What is a sideroblast?

A

Immature RBC with nuceli

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12
Q

What can decreased or dysfunctional erythropoiesis be due to?

A
  • lack of response from haemostasis loop
    e.g. chronic kidney disease - kidney stops producing EPO
  • bone marrow not responding to erythropoietin
  • myelodysplastic syndrome (blood cancer) - bone marrow produces abnormal blood cells
  • anaemic of chronic disease - iron not available for RBC production
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13
Q

What is erythropoietin?

A

Hormone secreted by the kidneys that increases the rate of erythropoiesis in response to falling level of O2 in tissues

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14
Q

What type of anaemia can be caused by defects in haemoglobin synthesis?

A

Sideroblastic anaemia
Iron deficiency anaemia
Anaemic of chronic disease&raquo_space; functional iron deficiency

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15
Q

What is functional iron deficiency?

A

Sufficient iron but not available for erythropoiesis

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16
Q

What does microangiopathic haemolytic anaemia result from?

A

Mechanical damage&raquo_space; schistocytes
- shear stress
- snagging on fibrin strands

Heat damage - severe burns
Osmotic damage - freshwater drowning

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17
Q

What causes haemolytic anaemia?

A

Abnormal structure
Mechanical damage

18
Q

Explain inherited haemolytic anaemia

A
  • Mutations in genes coding for proteins involved in interactions between plasma membrane and cytoskeleton e.g. ankyrin, spectrin
  • Abnormal structure
  • Less flexible + more easily damaged
  • Break up in circulation or removed by RES
19
Q

How can G6PDH deficiency cause anaemia?

A
  • Used in the pentose phosphate pathway to generate NADPH
  • deficiency&raquo_space; less NADPH made
  • NADPH needed for reduction of GSSG to GSH to manage oxidative stress
  • if an able to do that > RBCs get damage
  • damaged RBCs removed
  • anaemia
20
Q

How can pyruvate kinase deficiency cause anaemia?

A
  • Enzyme in glycolysis
  • RBCs lack mitochondria so need glycolysis for energy production
  • lack of pyruvate kinase > reduced glycolysis > deficient in ATP > RBCs undergo haemolysis
21
Q

Examples of chronic bleeding that can cause anaemia

A

Chronic bleeding - small amount of bleeding over a long period of time

  • heavy menstrual bleeding
  • repeated nosebleeds
  • haemorrhoids
  • gastrointestinal bleeding > blood lost in stool
  • kidney or bladder tumours > blood lost in urine
22
Q

Side effect of chronic NSAID usage

A

Induce GI injury + bleeding via
- inhibition of cyclooxgenase activity
- direct cytotoxic effects on epithelium

23
Q

Examples of NSAIDs

A

aspirin
ibuprofen
naproxen

24
Q

2 key features which can help work out the cause of anaemia

A

RBC size - macrocyctic, microcytic, normocytic
Presence or absence of reticulocytosis

25
Q

What are reticulocytes?

A

Immature RBCs
Slightly larger than mature RBCs so more reticulocytes will increase mean cell volume

26
Q

Why is reticulocytes count useful in evaluating anaemia?

A

Shows if marrow is capable of responding

27
Q

What are the microcytic anaemias?
What is the MCV?

A

Small RBCs - low MCV <80fL

TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia

28
Q

What are the macrocytic anaemias?
What is the MCV?

A

Large RBCs - high MCV >100fL

  • megaloblastic anaemia: B12/folate deficiency
  • macronormoblastic erythropoiesis: liver disease, alcohol toxicity
  • stress erythropoiesis: recovery from haemolytic anaemia or haemorrhage
29
Q

What are the normocytic anaemias?
MCV

A

Abnormal but same size - 80-100fL

Sickle cell disease
Anaemic of chronic disease
Blood loss

30
Q

Types of macrocyctic anaemias

A

Megaloblastic anaemias
Macronormoblastic erythropoiesis
Stress erythropoiesis

31
Q

Outline anaemia of chronic disease

A

Patient has an inflammatory condition which causes cytokine release e.g. IL6 causing:
- inhibition of EPO production
- increases hepcidin production > inhibiton of ferroportin > decreases iron release from RES + absorption in gut > plasma iron reduced

All inhibits erythropoiesis in bone marrow

32
Q

What is the underlying pathophysiology behind hereditary spherocytosis

A

Increased RBC rigidity - spherocyte shape
Mutations in loss of function of proteins - ankyrin, spectrin, band 3 + protein 4.2

33
Q

What is haemoglobinanemia ?

A

Excess haemoglobin in blood

34
Q

What does the Coombs test measure?
When is it used?

A

Antibodies bound directly to the surface of RBCs
When immune-mediated haemolytic anaemia is suspected

35
Q

What are two causes of anaemia due to defects in red blood cell metabolism?

A

G6PDH deficiency
Pyruvate kinase deficiency

36
Q

What can be seen on a blood film of a patient with G6PDH?
Why?

A

Heinz bodies
- Aggregates of cross linked haemoglobin due to oxidative stress

37
Q

Describe Megaloblastic anaemias
Examples

A
  • type of macrocytic anaemia MCV >100fL
  • interference with DNA synthesis > decreased nucleus development compared to cytoplasm > delayed cell division > megaloblasts > larger RBCs
  • e.g. B12/folate deficiency
38
Q

Describe macronormoblastic erythropoiesis
Examples

A
  • type of macrocytic anaemia MCV >100fL
  • normal relationship between nucleus + cytoplasm
  • erythroblastosis are larger than normal > larger RBC
  • e.g liver disease, alcohol toxicity
39
Q

Describe megaloblasts

A
  • much larger than usual erythroblasts in bone marrow
  • very large immature nuceli
40
Q

Describe stress erythropoiesis
Examples

A
  • type of macrocytic anaemia MCV >100fL
  • high levels of EPO > increased erythropoiesis > high reticulocyte count (larger than mature RBCs)
    e.g. recovery from haemolytic anaemia or blood loss due to haemorrhage
41
Q

Where is EPO released from?

A

Kidneys

42
Q

What is aplastic anaemia?

A

Condition where the bone marrow fails to produce enough blood cells

MEH (23 decks)

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