anaemia Flashcards
when do RBC have nucleus
dont have nucleus in blood
have nucleus in bone marrow
reticulocytes
not quaite mature rbc
normal to see a few in blood
not lots
bigger and purple - still making haemoglobin
when do reticulocytes inc
- go up during bleeding, haemolysis and if recently been put on iron/B12/folate
what receptor is needed to absorb iron?
ferreportin
how is ferreportin controlled?
hepcidin
high hepsidin - lower iron absorbtion- inflam, liver disease
- keeps iron in macrophages
- made in liver
breaks down ferroportin - less iron absorbtion
anemia definition
A pathological condition in which the number of RBC or the Hb within them is reduced in number and unable to meet the body’s physiological oxygen-carrying needs
A reduction in haemoglobin concentration below normal levels for age and gender
Hb reference ranges
Hb <130g/L in men, <120g/L in women
role of B12 and folate in rbc creation
Folate helps make DNA for red blood cells.
B12 makes sure folate can do its job properly.
B12 - homocysteine to methionine
- methoionine - dna synthesis
folate - synthesis of purine precursers
if deficient or reactions inhibited - not as much dna made - not as much rbc made
production issues or excess loss cause ishcemia, what can these be?
production issue
- iron deficiency
- B12/folate deficiency
- anaemia of chronic disease
- pregnancy
insufficient europoiten - renal failure
bone marrow failure - malignmancy or drugs
execss loss:
- bleeding
- breakdown of RBC so haemolytic anaemias
examinations?
- Abdominal exam
- Examine for nodes/spleen
- Signs of bleeding inc petechiae/purpura
- Signs of haematinic deficiency inc koilonychia (spoon nails)/stomatitis/glossitis (tongue inflam)
- Consider PR exam
- Conjunctival pallor
3 types of anaemia and MCV readings for each
microcytic <80
normocytic 80-100
macrocytic >100
basic tests for all
Ferritin, B12, folate
U&Es
LFTs
CRP (or ESR)
Calcium profile
TSH
Blood film
tests if no clear cause
riased CRP with normal / high ferratin:
- iron profile
full haemolysis screen
myeloma screen
when would you begin to suspect there was something wrong with the haemotology
Anaemia + immature white blood cells on blood film - leukaemia
Anaemia + renal impairment/hypercalcaemia - myeloma
Anaemia + lymphadenopathy and/or splenomegaly - lymphoma
MCV normal size
range 80-98fl
MCH - mean cell haemoglobin
Hypochromic = less than normal
Normochromic = within the normal range
Hyperchromic = more then normal
Symptoms of Anaemia:
- Tiredness
- Shortness of breath
- Headaches, irritability, dizziness, difficulty concentrating
- New or worsened intermittent claudication or angina
- Palpitations
anaemia findings on blood film and what they may indicate
- anisocytosis - mylodysplastic syndrome
- target cells - iron deficiency anaemia / post splenectomy
- heinz bodies - GD6D deficiency / alpha-thalassaemia
- howell-jolly bodies - post splenectomy / severe anaemia
- reticulocytes - haemolytic anaemia
- smudge cells - chronic lymphocyte leukaemia
