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BRS YR2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What causes hereditary spherocytosis?

A
  • an inherited defect in the red cell membrane
  • disruption of vertical linkages in the membrane, usually ankyrin/spectrin
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2
Q

What is haemolytic anaemia?

A

increased destruction with shortened RBC survival and resultant anaemia

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3
Q

How would you treat haemolytic anaemia?

A
  • folic acid (increased need)
  • splenectomy (if severe, it increase RBC life span)
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4
Q

What can haemolytic anaemia cause?

A

gallstones, due to increased breakdown of haemoglobin into bilirubin

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5
Q

What is AutoImmune Haemolytic anaemia (DAT positive)?

A
  • Idiopathic
  • associated with disorders of the immune system: systemic autoimmune disease (SLE), and underlying lymphoid cancers (lymphoma)
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6
Q

What in bloods can prove haemolysis?

A
  • raised LDH
  • unconjugated hyperbilirubinaemia
  • reduced haptoglobins
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7
Q

What is the bone marrow response to haemolysis?

A
  • reticulocytosis
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8
Q

When should haemolysis be considered?

A
  • anaemia with raised bilirubin
  • elevated reticulocytes, LDH and unconjugated bilirubin
  • blood film
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9
Q

What are the possible impacts of inherited RBC defects?

A
  • abnormal RBC membrane
  • abnormal haemoglobin
  • defect in glycolic pathway
  • defect in the enzymes of pentose shunt
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10
Q

What does the pentose shunt do?

A
  • protects cells from oxidant damage
    key enzyme: G6PD
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11
Q

What in a blood film suggests oxidant damage?

A
  • irregularly contracted cells
  • Heinz bodies
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12
Q

What are Heinz bodies?

A

precipitated oxidised haemoglobin

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13
Q

What does the presence of ghost cells on a blood film suggest?

A

intravascular haemolysis

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14
Q

What should be advised during a G6PD deficiency?

A
  • avoid oxidant drugs
  • don’t eat broad beans
  • avoid naphthalene
  • awareness that haemolysis can result from infection
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15
Q

What can be seen on a blood film with a G6PD deficiency?

A
  • irregularly contracted cells
  • Heinz bodies
  • ghost cells
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16
Q

What can be a symptom of G6PD deficiency?

A

jaundice

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17
Q

What questions should be asked if iron deficiency anaemia is suspected?

A
  • diet
  • GI symptoms (dysphagia, dyspepsia, abdominal pain, change in bowel habits, rectal bleeding)
  • menstrual history/post-menopausal bleeding
  • weight loss
  • medications (NSAIDs)
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18
Q

What are the signs and symptoms of iron deficiency anaemia?

A
  • Koilonychia
  • Glossitis and Angular stomatitis
  • fatigue
  • dyspnoea on exertion
  • restless legs
  • impaired muscular performance
  • dyspepsia
  • pallor
  • hair loss
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19
Q

What investigations should be done for suspected iron deficiency anaemia?

A
  • Faecal Immunochemical Test (blood in stool)
  • Upper GI endoscopy (oesophagus, stomach and duodenum)
  • Duodenal biopsy
  • Colonoscopy
  • Coeliac antibody testing
  • FBC
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20
Q

What are the possible causes of iron deficiency?

A 
Increased blood loss
- hookworm
- menstrual (menorrhagia)
- GI (occult)
Insufficient iron intake
- dietary 
- malabsorption (coeliac, H. pylori)
Increased iron requirements
- physiological
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21
Q

How is iron deficiency anaemia seen on a blood film?

A
  • microcytosis (low MCV)
  • hypochromia (low MCHC)
  • occasional target cells
  • ellipocytes
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22
Q

How much iron is absorbed daily?

A

1-2mg per day

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23
Q

What controls iron absorption?

A

Hepcidin (absorption and release of stores)

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24
Q

What increases hepcidin production?

A

inflammatory state

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25
Q

What is Koilonychia?

A

soft nails that looks scooped out (can hold a drop of liquid)

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26
Q

What is Glossitis Angular Stomatitis?

A

inflamed tongue and sides of mouth

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27
Q

Does a normal ferritin always exclude iron deficiency?

A

NO - ferritin can be normal with iron deficiency/anaemia of chronic disease

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28
Q

What does hepcidin do?

A

blocks the absorption and release of storage iron

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29
Q

What are the common causes of anaemia of chronic disease?

A
  • infections (TB, HIV)
  • Rheumatoid arthritis and autoimmune disorders
  • Malignancy
30
Q

What is the pathophysiology of anaemia of chronic disease?

A
  • IL-1, TNFa, IL-6 inhibit iron release from macrocytes to erythroids, reducing EPO production
  • Hepcidin (triggered by inflammatory proteins) reduced the transport, availability and absorption of iron.
31
Q

What is megaloblastic anaemia?

A

anaemia associated with megaloblastic morphological changes in bone marrow due to asynchronous nucleocytoplasmic maturation.

32
Q

What causes megaloblastic anaemia?

A
  • Vitamin B12 deficiency
  • Folic acid deficiency
  • methotrxate
  • cytotoxic chemotherapy
33
Q

What can cause a Vitamin B12 deficiency?

A
  • diet
  • gastric: structural (gastrectomy) or autoimmune (pernicious anaemia)
  • terminal ileum: structural (resection) or inflammation (Crohn’s disease)
34
Q

What can cause a Folic acid deficiency?

A
  • diet
  • proximal jejenum (coeliac disease)
  • excess demand
  • haemolysis
  • pregnancy
35
Q

How does megaloblastic anaemia present on a blood film?

A
  • macrocytic RBC
  • very high MCV
  • Impaired DNA synthesis, nuclear maturation and cell division
36
Q

What are the neurological impacts of a Vitamin B12 deficiency?

A
  • dementia
  • SACD (sub-acute combined degeneration) of the spinal cord
37
Q

What are the neurological impacts of a Folic acid deficiency?

A
  • affects the development of neural tube defects
38
Q

Where is folic acid absorbed?

A
  • duodenum
  • jejunum
39
Q

Where is Vitamin B12 absorbed?

A
  • ileum
  • jejunum
40
Q

What is microcytic anaemia?

A

average cell size is decreased

41
Q

What are the common causes of microcytic anaemia?

A
  • defect in haem synthesis
  • defect in globin synthesis
42
Q

What are the 2 disorders due to defects in globin synthesis?

A
  • alpha thalassaemia: defect in the alpha chain
  • beta thalassaemia: defect in the beta chain
43
Q

What are the 2 difference types of microcytic anaemia?

A
  • anaemia of chronic disease
  • iron deficiency anaemia
44
Q

What are the blood features of anaemia of chronic disease?

A 
Hb - Low
MCV - Low/Normal
Ferritin - High
Serum Iron - Low
Transferrin - Low/Normal
Transferrin saturation - Normal
ESR - High
45
Q

What are the blood features of iron deficiency anaemia?

A 
Hb - Low
MCV - Low
Ferritin - Low
Serum Iron - Low
Transferrin - High
Transferrin saturation - Low
ESR - High
46
Q

What is the difference in Hb electrophoresis between iron deficiency anaemia and B thalassaemia trait?

A

Hb A2 raised in B-thalassaemia trait

47
Q

What are the mechanisms of normocytic anaemia?

A
  • recent blood loss
  • failure of RBC production
  • reduced survival or RBCs
  • pooling of RBCs in the spleen
48
Q

What are some causes of normocytic anaemia?

A
  • GI haemorrhage
  • trauma
  • early stage iron deficiency
  • bone marrow failure/supression (chemotherapy)
  • bone marrow infiltration (leukaemia)
  • hypersplenism (liver cirrhosis)
  • splenic sequestration in sickle cell
49
Q

What are the common causes of macrocytic anaemia?

A
  • lack of VItamin B12 or Folic acid
  • drugs that interfere with drug synthesis
  • liver disease and ethanol toxicity
  • haemolytic anaemia (increased reticulocytes)
50
Q

What are the causes of haemolytic anaemia?

A

A defect in:

  • integrity of the membrane
  • haemoglobin structure and function
  • cellular metabolism
51
Q

What haemolytic anaemias are cause by a defect in the integrity of the membrane?

A
  • hereditary spherocytosis
  • autoimmune haemolytic anaemia
52
Q

What haemolytic anaemias are cause by a defect in the cellular metabolism?

A

G6PD deficiency

53
Q

What are the non-immune environmental factors that can damage RBCs?

A
  • Microangiopathic
  • Haemolytic uraemic syndrome
  • Malaria
  • Snake venom
  • Drugs
54
Q

What are the immune mediated (DAT+ive) environmental factors that can damage RBCs?

A
  • autoimmune
  • allo-immune (post blood transfusion)
55
Q

Which two blood disorders both have spherocytes?

A
  • Hereditary spherocytosis
  • Acquired auto immune haemolytic anaemia
56
Q

What test distinguishes between hereditary spherocytosis and acquired autoimmune haemolytic anaemia?

A

Direct Antiglobulin test (DAT)

57
Q

What does the Direct Antiglobulin test detect?

A

whether self-antibodies have formed

58
Q

What is the treatment for when a gastrectomy or antoimmune pernicious anaemia cause Vitamin B12 deficiency?

A

Hydroxocobalamin injections (IM)

59
Q

What is the treatment for Vitamin B12 deficiency caused by Chron’s disease or an Ileal resection?

A

Hydroxocobalamin injections (IM)

60
Q

What is the treatment for VItamin B12 deficiency caused by an inadequate diet?

A

Oral supplementation

61
Q

How does autoimmune pernicious anaemia cause Vitamin B12 deficiency?

A
  • produces anti GPC and IF antibodies
  • IF is necessary for Vitamin B12 absorption
62
Q

What is used to treat folic acid deficiency irrelevant of the cause?

A

Oral supplementation

63
Q

What are the causes of non- megaloblastic anaemia?

A
  • liver disease
  • hypothyroidism
  • alcohol
64
Q

What does the Hb in a bloodcount indicate?

A

whether you are anaemic or not

65
Q

What does the mean corpuscular volume (MCV) indicate?

A

Whether cells are microcytic, normocytic or macrocytic

65
Q

What does the mean corpuscular haemoglobin (MCH) indicate?

A

Whether the cells are hypochromic, normochromic or hyperchromic

66
Q

What is unconjugated bilirubin?

A
  • bound to albumin in blood
  • insoluble
  • pre-hepatic
67
Q

What is conjugated bilibrubin?

A
  • unbound to albumin
  • soluble
  • post-hepatic
68
Q

What is a complication of haemolytic anaemia?

A

obstructive jaundice

69
Q

Why does haemolytic anaemia lead to obstructive jaundice?

A
  • increase in unconjugated bilirubin leads to gallstones
  • gallstones block billary duct leading to build up of conjugated bilirubin in the blood
  • this causes jaundice

BRS YR2 (67 decks)

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