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haemotology > anaemia > Flashcards

anaemia Flashcards

1
Q

define anaemia

A

low level of haemoglobin - result of underlying disease

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2
Q

what can cause microcytic anaemia?

A

TAILS
thalassaemia
anaemia of chronic disease
iron deficiency
led poisoning
sideroblastic

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3
Q

what is sideroblastic anamaeia?

A

has enough iron but can not put the iron into haemoglobin
defective protoporphyrin and prevents formation of haem

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4
Q

how do you manage microcytic anaemia?

A

vit C supplement and iron supplements
treat underlying cause

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5
Q

what can cause normocytic anaemia?

A

3As and 2Hs
acute blood loss, anaemia of chronic disease, aplastic anaemia
haemolytic anaemia, hypothyroidism

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6
Q

what is aplastic anaemia?

A

stops producing enough new RBC

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7
Q

how do you manage normocytic anaemia?

A

controlling blood loss, treat underlying disease, blood tranfusion, medication to promote RBC production

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8
Q

what can cause macrocytic anaemia?

A

megaloblastic - B12/ folate deficiency
normoblastic - alcohol, reticulocytosis, hypothyroidism, liver disease, drugs

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9
Q

how do you manage macrocytic anaemia?

A

B12 before folate!
targeting underlying cause, encourage diets with rich in folate (fortified cereals, leafy veg)

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10
Q

why do you treat B12 before folate deficiencies?

A

B12 deficiency can sub acute degeneration of spinal cord
folate can mask B12 deficiency
treat B12 first as a precaution

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11
Q

what are the general symptoms of anaemia?

A

tiredness, SoB, headaches, dizziness, palpitation worsening of other conditions - angina, HF, peripheral vascular disease

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12
Q

what are specific symptoms of iron deficiency anaemia?

A

pica (dietary cravings for abnormal things eg dirt)
hair loss
koilonychia - spoon shaped nails
angular chelitis - red and swollen around edge of lips
atrophic glottitis - red swollen smooth tongue
brittle hair and nails

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13
Q

what does jaundice in the eyes indicate?

A

haemolytic anaemia - build up of bilirubin

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14
Q

what would bone deformities with general anaemia symptoms indicate?

A

thalassaemia due to bone marrow expansion

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15
Q

how many blood groups are there?

A

38

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16
Q

which are the most significant blood groups and why?

A

ABO and Rh - due to being the most immunogenic

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17
Q

what is the ABO system based off?

A
  • ABO system is based of presence/ absence of inherited ABO oligosaccharide antigens on the surface of patients erythrocytes as well as presence of the opposite AVO-related antibodies within patients serum
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18
Q

how can you be group A blood type?

A

AO or AA
O is recessive

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19
Q

how can you group AB blood group?

A

ab alleles - they are codominant

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20
Q

how can you be group O?

A

oo - recessive alleles

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21
Q

what is the rhesus system compromised of?

A
  • Compromised of over 50 different antigens but most significant is D antigen – most immunogenic and defined by positive (presence) or negative (absence)
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22
Q

how are anti-D AB generated?

A

through exposure to Rh - D proteins
in positive cases

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23
Q

what is alloimmunisation?

A

process of being exposed to foreign antigen then produces the specific AB required

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24
Q

what % of blood transfusions result in alloimmunisations?

A

1%

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25
Q

what Rh group of women are risk during pregnancy?

A

Rh- negative if baby is potentially positive
baby’s Ig can can cross placenta and get into mothers bloodstream - mothers immune system recognises the foreign antigens and produces antibodies to fight it

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26
Q

if mothers (Rh - negative) AB attack foetus (Rh - pos) what can occur?

A

haemolytic disease of the foetus or newborn

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27
Q

how does HDFN present?

A

asymptomatic to jaundice to life threatening

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28
Q

what is done to prevent HDFN?

A

prophylaxis anti- D to Rh-neg mothers and then testing umbilical cord to determine the severity to work out how much anti-D is required in future pregnancies

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29
Q

what can happen with an incompatible blood tranfusion?

A

shock, kidney failure, circulatory collapse, death

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30
Q

what happens during a blood cross match?

A

find out ABO and Rh group
checks for other AB within receipts serum

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31
Q

what is the universal donor?

A

O neg

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32
Q

what is a haemolytic transfusion reaction?

A

destruction of incompatible donor RBC cells - can be acute or delayed response

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33
Q

what is a febrile non haemolytic reaction?

A

destruction of incompatible donor WBC

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34
Q

what can destruction of incompatible donor platelets cause?

A

post transfusion purpura - leaky capillaries under the skin

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35
Q

what is leukodepeltion?

A

all leukocytes are removed from blood - removes risk of infection or reaction to different antigens

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36
Q

describe acute haemolytic transfusion reaction

A

<24hrs
can occur during transfusion
impending feeling of doom, burning sensation at site, chills, fever, back pain

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37
Q

what is the most severe haemolytic transfusion reaction?

A

intravascular haemolysis - within blood vessels
activates complement, lyses donor RBC, haemoglobin released into plasma, bilirubin also released

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38
Q

what can haemolytic transfusion reaction trigger?

A

massive complement activation from RBC lysis - uncontrollable clotting cascade then triggers disseminated intravascular coagulation - DIC

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39
Q

what is most common cause of intravascular haemolytic reaction?

A

incompatible ABO

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40
Q

can transfusion result in extravascular haemolysis?

A

yes - donor RBC removed by macrophages within spleen and liver
donor RBC may be covered in macrophages by recipient AB

41
Q

when would delayed haemolytic transfusion present?

A

1-14 days post transfusion

42
Q

can patients have allergic reactions to blood transfusions?

A

yes - heightened IgE response
feeling ithcy and breaking out in hives
stop transfusion and antihistamines

43
Q

can you have a transfused iron overload?

A

yes - numerous blood transfusions

44
Q

what does excess iron do?

A

deposit in organs - causing damage
leads to fibrosis, cirrhosis

45
Q

what diagnostic signs are seen in chronic disease anaemia?

A

high or normal ferritin stores
iron conc is decreases - distrupted to other areas
inflam response markers

46
Q

what diagnostic signs are seen in IDA?

A
  • Microcytic
  • Increase TIBC – total iron binding capacity – how much transferrin is bound to iron
  • Decrease in ferritin – more sensitive – no stores left
  • Then iron conc will decrease as a result
  • Check B12 and folate to rule other causes
47
Q

what are IDA specific symptoms?

A
  • Koiloncyhia: spoon shaped nails. Quite brittle
  • Atrophic glossitis – inflammation of tongue, smooth and swollen
  • Angular chelitis – red swollen patches on lip edges
  • Post-cricoid webs (plummer vinson syndrome) – thin membranes causing dysphagia
48
Q

what would IDA blood film look like?

A
  • Microcytic anaemia and hypochromic (pale due to lack of iron which is red)
  • Can be varying sizes (anisocytosis) as well as abnormal shapes (poikilocytosis)
49
Q

what are the IDA investigations?

A
  • All patients require a coeliac serology testing
  • All men and post-menopausal women should have urgent upper and lower GI endoscopy unless other obvious blood loss
  • Small bowel investigtaions only required if – suspect pathology or ID refractory to treatment
50
Q

what is haemolytic anaemia?

A

premature RBC lysis

51
Q

when does haemolysis of RBC occur (in terms of days)?

A

40days into life cycle

52
Q

why does haemolysis occur?

A
  • RBC recognised by lympho-reticulum system as abnormal
  • They are not abnormal they are recognising self antigens
53
Q

what are haemolytic diagnostic signs?

A
  • High bilirubin levels
  • Very high LDH – lactate dehydrogenase hormone – RBC breakdown increased (also seen in cells with high turnover – high in tumours)
  • Increases reticulocyte count – immature RBC. They are rounder and smaller and contain DNA fragments so stain blue on blood films
54
Q

what would indicate intra-vascular haemolysis?

A
  • Increased methaemalbuminaemia – this binds to albumin – albumin released in breakdown
  • Heamosiderinuria – excessive free Hb is filtered by renal glomeruli
55
Q

what are acquired causes of haemolytic anaemia?

A

immune mediated seen on direct antiglobulin test positive – drug induced, autoimmune haemolytic anaemia, paroxoysmal cold haemogloburia (donath-landsteriner AB bind to RBC during cold) – (AB bind self AG during cold can have warm version

56
Q

what are hereditary causes of haemolytic anaemia?

A

G6PD deficiency
pyruvate kinase deficiency
membrane defects

57
Q

why does G6PD deficiency cause haemolytic anaemia?

A

puts RBC at risk of oxidative damage

58
Q

what would indiciate haemolytic anaemia on a blood film?

A

heinz bodies and blister cells
different shape - spherocytosis or elliposis
loss of central palor - not biconcave

59
Q

what membrane defects can cause haemolysis and why?

A

spherocytosis - loose part of cell as pass through spleen
elliptocytosis

60
Q

what haemoglobinopathies can cause anaemia?

A

sickle cell anaemia and thalassaemia

61
Q

what is produced in sickle cell anaemia?

A

HbS rather than HbA

62
Q

why does HbS cause sickle cell anaemia?

A

HbS tend to polymerise - all proteins bind together and lose biconcave shape - get stuck in small vessels

63
Q

what symptoms specific to sickle cell?

A

vaso-occlusie crisis- can lead to ischaemia, severe bone bone, dacyltitis 9severe swelling of hands and feet), leg ulcers, abdo pain, stroke/ seizures, cognitive impairment. Priapism

64
Q

what are sickle cell complications?

A

: engorged spleen – blood gets stuck. In children can lead to atrophic spleen. Aplastic crisis: due to parovirus B19 – sudden reduction in marrow cells
- Splenic infarction ( more at risk of infections especially encapsulated organisms), poor growth, chronic renal failure, gall stones (more bilirubin production), iron overload or blood borne infections due to more blood transfusions

65
Q

what is the most common cause of IDA in adults?

A

blood loss

66
Q

who is most at risk of IDA?

A

pregnancy, menorrhagia, vegetarian/ vegan, coeliac disease, hookworm infection, NSAID use

67
Q

what dietary products contain iron?

A

animal products- eggs, red meat, fish, poultry

68
Q

what is he difference between folate and B12?

A

they are both vit B - have different sources - slightly different roles

69
Q

what dietary products contain folate?

A

green leafy veg, citrus fruits, fruit, dry beans, peas, liver, yeast

70
Q

what type of anaemia can vit b12 deficiency cause?

A

pernicious anaemia

71
Q

what is the pathophysiology responsible for b12 deficient anaemia?

A

parietal cells of stomach produce intrinsic factor- essential for B12 absobrtion in the ileum
pernicious anaemia is auto-immune where AB form against parietal cells/ intrinsic factor
B12 is required for the production of RBC

72
Q

what are b12 deficient specific symptoms?

A

neurological
visual/ mood/ cognitive changes
numbness/ paraesthesia
loss of vibration sense or proprioception

73
Q

what is paraesthesia?

A

pins and needles sensation - seen in b12 deficiency

74
Q

why are IDA usually asymptomatic or may only have fatigue?

A

body can try and compensate - if healthy usually can

75
Q

what diseases can cause dysphagia which results in anaemia?

A

oesophageal malignancy, oesophageal webs (thinning membranes)

76
Q

what pathologies causing dyspepsia can cause anaemia?

A

gastric cancer, peptic ulcer

77
Q

what underlying anaemia causing pathology may present as abdo pain?

A

coeliac pain, intra abdo malignancy

78
Q

weight loss and anaemia may indicate?

A

IBS, bowel cancer

79
Q

which blood cells does acute leukaemias mainly affect?

A

WBC

80
Q

why might Vit B12indicate pancytopenia?

A

B12 deficiency leads to defective DNA synthesis in hemopoietic precursor - hence resulting in macrocytic and megaloblastic anaemia

81
Q

what is megaloblastic anaemia?

A

unusually large and structurally abnormal immature RBC released

82
Q

what shape does aplastic anaemias have?

A

normocytic

83
Q

what is aplastic anaemia?

A

body stopes producing new RBC - alot less cellular contents

84
Q

what are symptoms of aplastic anaemia?

A

SoB, tachycardia, recurrent infections, unexplained bruising, epistaxis, rash, headaches, fever

85
Q

what does icteric mean?

A

yellowish pigment - jaundice

86
Q

why does jaundice occur?

A

build up of bilirubin - biproduct of RBC breakdown

87
Q

what is the most common childhood cancer?

A

acute lymphoblastic leukaemia

88
Q

what is most common inherited haemolytic anaemia?

A

hereditary spherocytosis

89
Q

what do spherocytes look like on blood film?

A

spherical RBC
no central pallor - due to loss of biconcavity

90
Q

what is AIHA?

A

auto-immune haemolytic anaemia
shorted RBC survival can be warm/ cold reactive

91
Q

on a blood film how does Vit b12 deficiency/ folate show?

A

macrocytic

92
Q

what occurs during hereditary spherocytosis?

A

RBC breakdown as enter spleen

93
Q

what are signs of hereditary spherocytosis?

A

jaundice, gall stones, splenomegaly, aplastic crisis in parovirus presence

94
Q

on a blood film what would hereditary spherocytosis show?

A

MCHC raised, high reticulocytes, spherocytes

95
Q

what diagnostic test can be used for AIHA?

A

coombs test

96
Q

what is warm AIHA associated with?

A

similar symptoms to HF/ angina

97
Q

is cold AIHA more likely to be chronic?

A

yes

98
Q

what is cold AIHA linked to?

A

malaria, EBV

haemotology (4 decks)

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