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PHSIO - BLOOD AND IMMUNE > ANAEMIA > Flashcards

ANAEMIA Flashcards

1
Q

Define Anaemia

A

State at which patient’s blood haemoglobin level is below the normal range for their age and sex.

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2
Q

range of Hb concentration for anaemia (in general, adult male, adult female, neonate, one year to puberty) .11.5-

A

If below 10 g/dl then anaemia.
Adult male = 13.5-17.5
Adult female = 11.5- 15.5
Neonate= 15-21
One year before puberty = 11-13.5

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3
Q

3 Causes of Anaemia ?

A
  1. Inc. blood loss.
  2. Inadequate RBC production.
  3. Excessive destruction of RBC .
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4
Q

4 Symptoms of Anaemia

A
  1. Easy fatiguability , weakness - breathlessness on exertion
  2. Headache
  3. Palpitations , inc. output of heart to compensate - skipped heart beat
  4. Angina - inc. output of heart to compensate - pain or uncomfortable feeling
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5
Q

4 Signs of a Anaemia

A
  1. Pallor of skin and mucous membrane
  2. Inc. heart rate ( tachycardia)
  3. Bound pulse
  4. Systolic flow murmur
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6
Q

Specific signs (approx. 4 each ) for each 4 types of Anaemia

A
  1. Fe deficiency - koilonychia ( spoon nails ) , glossitis( inflamed tongue ) , pica, poor cognitive function
  2. Megaloblastic anaemia - glossitis, Angular stomatitis ( inflammatory skin condition ) , mild jaundice , progressive neuropathy due to Vit B12 deficiency ( neurological abnormalities causing numbness in feet, difficulty in walking )
  3. Aplastic anaemia - recurrent infections, bleeding manifestations ( gum bleed , nose bleed)
  4. Haemolytic Anaemia - jaundice , haemoglobinuria ( high conc. Of haemoglobin in urine ), hepato - splenomegaly ( swelling of abdomen and liver )
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7
Q

What is polycythemia?

A

condition in which there is an absolute
increase in the number of circulating RBC

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8
Q

2 types of polycythemia ?

A
  1. Primary - polycythaemia rubra Vera . neoplastic disorder of haemopoietic stem cells (not due
    to stimulation by erythropoietin)
  2. Secondary – due to stimulation by erythropoietin ( a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.) – when
    there is tissue hypoxia
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9
Q

4 groups of effects of polycythemia

A

1.dizziness, headache, blackouts
2.Plethoric ( full of body fluid ), reddened conjunctiva
3.Increased Hb, PCV ( packed cell volume),RBC – increased viscosity of blood
4.Bonemarrow - hypercellular

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10
Q

4 ways inc. blood loss causes Anaemia ?

A

Acute ( major blood loss ) ,
chronic ( hookworm infestation so chronic bleeding from intestinal walls ) ,
gastrointestinal bleeding ( peptic ulcer, NSAID, carcinoma of intestine),
uterine bleeding

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11
Q

Why and how does inadequate rbc production cause anaemia ?

A

deficiency of essential factors for erythropoiesis
( Iron, Vit B12, folic acid, erythropoietin)

  1. Problems in the bone marrow ( aplastic anemia )
    a. Failure of haemopoietic stem cells and
    reduction in the number of stem cells– Aplastic
    anaemia – reduced number of RBC, WBC,
    platelets (pancytopaenia)
    b. Radiation damage
    c. cytotoxic drugs, other drugs and toxins (viral
    hepatitis) which destroy stem cells
    d. Invasion of the bonemarrow – leukaemias,
    fibrosis
  2. Fe def anaemia
  3. Megaloblastic anaemia
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12
Q

2 types of Anaemia caused by inadequate production of RBC ?

A
  1. iron deficiency Anaemia
  2. megaloblastic Anaemia
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13
Q

Causes of iron deficiency Anaemia ?

A

Loss of iron due to blood loss
- chronic loss – hookworm infestation, GI
2. Inadequate intake
3. Malabsorption
4. States of increased demand
( pregnancy, infancy, lactation, menstuation )

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14
Q

Uniqueness of blood picture of iron deficiency anemia

A

hypochromic, microcytic red cells

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15
Q

Uniqueness of megalobalstic anaemia in blood picture

A

Macrocytes seen in blood picture ( larger and less likely to divide ) - Megaloblasts in bone marrow

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16
Q

What is megaloblastic Anaemia

A

In Vit B12 and folate deficiency

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17
Q

Causes of megaloblastic anaemia ?

A

Vit B12 deficiency
- Poor diet
– true vegetarians
- IF deficiency – pernicious anaemia (Pernicious anemia is a type of megaloblastic anemia in which the body isn’t able to absorb vitamin B12 due to a lack of intrinsic factor in stomach secretions. Intrinsic factor is needed for the body to absorb vitamin B12)
- Diseases of the ileum
Folate deficiency
- Inadequate diet - When body demand exceeds intake –
pregnancy
- Disease of the upper small intestine ( blood loss in the stomach or intestine cannot be matched by duodenal iron absorption, creating a negative iron balance)

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18
Q

What is Haemolytic anaemia ?

A

Anaemia due to excessive destruction of RBC

19
Q

2 causes of haemolytic anaemia ?

A

intra-erythrocytic
extra-erythrocytic

20
Q

5 Intra-erythrocytic causes ?

A

Hereditary
a. Congenital spherocytosis
- autosomal dominant inheritance
- defect in RBC membrane (deficiency of a
membrane protein) - spherocytes have increased osmotic fragility - haemolysis is extra-vascular

b.RBC enzyme deficiencies eg: G6PD deficiency - X- linked disorder (affecting males, carried by
females) - enzyme deficiency causes lack of production of
NADPH in red cells – causes the red blood cell
to be damaged by oxidants - Causes intra-vascular haemolysis with
haemoglobinuria eg. of oxidant agents – infections, drugs
(antimalarial, sulpha drugs)

c. Inherited disorders of haemoglobin (Haemoglobinopathies) – inherited disorders
characterized by defective synthesis of
polypeptide part of Hb

  1. Sickle cell anaemia
  2. Thalassemia
21
Q

7 Extra- erythrocytic causes ?

A

Malaria
Drugs causing haemolysis
Immune disorders
Autoimmune haemolytic anaemia
Incompatible blood transfuions
Haemolytic disease of the newborn
Mechanical – artificial heart valves

22
Q

What is Sickle cell anaemia ?

A

Haemoglobin S (HbS) – Beta chain is abnormal - Hypoxia causes polymerization (ppt) of HbS in
RBC – results in sickle shaped RBC – undergo
extravascular haemolysis - Sickle cells can block small vessels- ischaemic
bone pain, leg ulcers

23
Q

What is Thalassaemias and 2 types ?

A

genetic disorders which result from reduced rate
of synthesis of alpha or beta chains
Alpha thalassaemia – no alpha chains , beta
chains B4 ppt. – causes haemolysis

Beta Thalassaemia – no beta chains –alpha chains ppt. – result in
haemolysis and ineffective erythropoiesis Hepato –splenomegaly is seen – due to increased
RBC destruction and extramedullary haemopoiesis ( leads to enlarged liver) Expansion of bones (bony deformities) is seen due
to marrow hyperplasia ( bone on end appearance )

24
Q

General lab tests for anaemia?

A

Hb concentration, PCV, RBC count ( all 3 dec. if anaemia )

25
Q

What do RBC indice ?

A

MCV – mean corpuscular volume (fL)
MCH – mean corpuscular haemoglobin (pg)
MCHC - mean corpuscular haemoglobin
concentration (g / dL)

26
Q

Specific tests for Fe deficiency ?

A

serum iron levels
TIBC (total iron binding capacity - % saturation of
transferrin)
BM biopsy – for iron stores

27
Q

Specific tests Haemolytic anaemias?

A

reticulocyte count, serum unconjugated bilirubin

28
Q

Specific tests Congenital spherocytosis?
‘

A

osmotic fragility test

29
Q

Specific tests Haemoglobinopathies?

A

Hb electrophoresis

30
Q

What causes microcytic , hypochromic anemia ?

A
  1. Iron deficiency
  2. Thalassaemia
  3. Anaemia of chronic disease ( some cases )
  4. Lead poisoning
  5. Sideroblastic anaemia ( some cases ) ( coz of less rbc and too much iron in system )
31
Q

What are 6 causes of normocytic, Normochromic Anaemia ?

A
  1. Renal disease
  2. Mixed deficiencies
  3. After acute blood loss
  4. Anaemia of chronic disease ( some cases )
  5. Many haemolytic anemias
  6. Bone marrow failure ( ex. Post chemotherapy, infiltration by carcinoma etc. )
32
Q

2 types of causes of macrocyctic Anaemia ?

A

Megaloblastic - vitamin B12 or folate deficiency
Non- megaloblastic - alcohol , liver disease , myelodysplasia (a group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells), aplastic anaemia etc.

33
Q

What is value of MCV and MCH in mycrocytic, hypochromic anaemia ?

A

MCV < 80 fL
MCH < 27 pg

34
Q

What is value of MCV and MCH in normocytic, normochromic anaemia ?

A

MCV 80-95 fL
MCH > 27 pg

35
Q

What is value of MCV and MCH in macrocyctic anaemia ?

A

MCV > 95 fL

36
Q

What 6 values does iron deficiency decrease

A

Hb
MCV
MCHC
MCH
Serum iron
Retic count

37
Q

What value does iron deficiency increase

A

TIBC ( total iron binding capacity )

38
Q

Which 2 values does B12 deficiency decrease ?

A

Hb
MCHC

39
Q

Which values does B 12 def increase ?

A

MCV
MCH

40
Q

Which 5 values does B12 deficiency keep the same

A

MCHC
MCH
Serum Iron
TIBC
Retic count

41
Q

Which 5 values does haemolytic anaemia keep the same ?

A

MCV
MCHC
MCH
Serum Iron
TIBC

42
Q

Which values does haemolytic anaemia increase ?

A

Retic count

43
Q

Which values does haemolytic anaemia decrease ?

A

Hb

44
Q

Appearance of blood picture during haemolytic anaemia ?

A

Normochromic , normocytic ( other than in thalassemia/ haemoglobinopathies )

PHSIO - BLOOD AND IMMUNE (2 decks)

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