Anaemia Flashcards
Causes of IDA?
Excess blood loss.
Inadequate intake.
Poor intestinal absorption - coeliacs.
Increased iron requirement - growth spurts in children, pregnancy.
Features of IDA
Fatigue
Shortness of breath on exertion
Palpitations
Pallor
Nail changes: this includes koilonychia (spoon-shaped nails)
Hair loss
Atrophic glossitis
Post-cricoid webs
Angular stomatitis
Investigations for IDA?
History (ask about diet, menstruation, meds, weight loss, bowel habit)
FBC - Hypochromic microcytic anaemia,
Serum ferritin - Low (be careful as it is an acute phase reactant)
Total iron-binding capacity/transferrin - High TIBC and low transferrin saturation.
Blood film
Endoscopy (post menopausal women with Hb < 10 and men with Hb < 11 should ger 2 week wait referral)
Management of IDA?
Investigate underlying cause
Oral ferrous sulfate - should be continued for further 3 months after deficiency is corrected.
Iron rich diet
Difference between IDA and AOCD?
IDA - TIBC is high, transferrin sat is low and ferritin is low.
AOCD - TIBC is low, tsat is low and ferritin is high.
What are some causes of microcytic anaemia?
TAILS:
Thalassaemia,
Anaemia of chronic disease,
Iron def anaemia
Lead posioning
Sideroblastic anaemia
What are some causes of normocytic anaemia?
2 A’s and 2 H’s:
Acute blood loss,
Anaemia of chronic disease
Aplastic anaemia
Haemolyic anaemia
Hypothyroidism
What are the causes of megaloblastic anaemia?
B12 deficiency,
Folate deficiency,
Drugs: Hydroxycarbamide, azathioprine
What are the causes of non-megaloblastic macrocytic anaemia?
Liver disease,
Alcohol,
Hypothyroidism
Myelodysplastic syndrome,
Pregnancy
Reticulocytosis
What are the causes of a vitamin B12 deficiency?
Pernicious anaemia (most common cause),
Gastrectomy/achlorhydria,
Terminal ileum issues (Crohn’s or resection)
Vegan diet,
Metformin use,
PPI use
What are some causes of a folate deficiency?
Dietary (main cause)
Small bowel disease such as coeliac’s or Crohns,
Increase cell turn over (haemolysis, severe skin disorders and pregnancy)
What are the investigations for macrocytic anaemia?
FBC,
Haematinics,
Blood film: Macrocytosis and hypersegmented neutrophils,
TFTs to look for hypothyroidism,
LFTs to assess liver function,
Antibodies to intrinsic factor,
Markers of heamolysis: LDH, brilirubin
What is the management of macrocytic anaemia
Megaloblastic: Pernicious anaemia requires IM hydroxocobalamin. However if deficient in both Vit B12 and folate, must address B12 first. If you replace folate first then may worsen neuro symptom’s and cause subacute degeneration of the spinal cord.
Non-megaloblastic - Treat underlying cause.
What is aplastic anaemia?
bone marrow failure resulting in pancytopenia. Can be acquired or inherited. Presents with:
Hb < 10.
Platelets < 50.
Neutrophil count < 1.5
