Anaemia Flashcards
What is anaemia?
Anaemia is defined as a low concentration of haemoglobin in the blood. This is the consequence of an underlying disease, not a disease itself.
What is haemoglobin?
Haemoglobin is a protein found in red blood cells. Haemoglobin is responsible for picking up oxygen in the lungs and transporting it to the body’s cells. Iron is essential in creating haemoglobin and forms part of it’s structure.
Anaemia is divided up into 3 categories based on mean cell volume:
-microcytic- low MCV
-normocytic- normal MCV
-macrocytic- large MCV
Causes of microcytic anaemia (mneumonic)
TAILS
Thalassaemia (inherited blood disorder that causes your body to have less haemoglobin)
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia (the body produces enough iron but is unable to put it into haemoglobin)
-anaemia of chronic disease often occurs with chronic kidney disease due to reduced production of erythropoietin by the kidneys, the hormone responsible for stimulating red blood cell production and treatment is with erythropoietin.
Causes of normocytic anaemia
3 As and 2 Hs
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia (bone marrow doesn’t make enough blood cells)
Haemolytic anaemia (red blood cells are destroyed faster than they can be made)
Hypothyroidism
Macrocytic anaemia can be…
-megaloblastic or normoblastic
Causes of megaloblastic anaemia
-megaloblastic anaemia results from impaired DNA synthesis, preventing the cells from dividing normally. Rather than dividing, they grow into large abnormal cells.
-B12 deficiency
-folate deficiency
Normoblastic anaemia is caused by…
-alcohol
-reticulocytosis (usually from haemolytic anaemia or blood loss) (reticulocytes=immature red blood cells)
-hypothyroidism
-liver disease
-drugs, such as azathioprine (immunosuppressant e.g. RA)
What is reticulocytosis?
An increased concentration of reticulocytes (immature red blood cells). This happens when there is a rapid turnover of red blood cells, such as with haemolytic anaemia or blood loss.
Symptoms of anaemia
tiredness, SOB, headaches, dizziness, palpitations, worsening of other conditions, such as angina, heart failure or peripheral arterial disease
Symptoms specific to iron deficiency anaemia
-pica (dietary craving for abnormal things, such as dirt or soil)
-hair loss
Signs of anaemia
-pale skin
-conjunctival pallor
-tachycardia
-raised respiratory rate
What does Koilonychia (spoon-shaped nails) indicate?
Iron deficiency anaemia
What does angular cheilitis indicate?
iron deficiency anaemia
atrophic glossitis indicates…
iron deficiency anaemia
brittle hair and nails indicate…
iron deficiency anaemia
what type of anaemia is indicated by jaundice?
haemolytic anaemia
bone deformities can indicate…
thalassaemia
oedema, hypertension and excoriations on the skin can indicate….
chronic kidney disease
What blood tests can be used to investigate anaemia?
Full blood count for haemoglobin and mean cell volume
Reticulocyte count (indicates red blood cell production)
Blood film for abnormal cells and inclusions
Renal profile for chronic kidney disease
Liver function tests for liver disease and bilirubin (raised in haemolysis)
Ferritin (iron)
B12 and folate
Intrinsic factor antibodies for pernicious anaemia
Thyroid function tests for hypothyroidism
Coeliac disease serology (e.g., anti-tissue transglutaminase antibodies)
Myeloma screening (e.g., serum protein electrophoresis)
Haemoglobin electrophoresis for thalassaemia and sickle cell disease
Direct Coombs test for autoimmune haemolytic anaemia
A … and … are indicated for unexplained iron deficiency anaemia to exclude gastrointestinal cancer as a source of bleeding.
A biopsy is indicated for unexplained anaemia or possible malignancy (e.g., leukaemia or myeloma).
colonoscopy and oesophagogastroduodenoscopy (OGD
bone marrow
