Anaemia Flashcards
What Hb level is anaemia for men?
Lower than 135
What level Hb is anaemia for women?
115
What 3 mechanisms of action cause anaemia?
Lowered RBC production
Increased Loss of RBC
Or increased plasma volume
Symptoms of anaemia?
Fatigue
Dyspnoea
Faintness
Palpitations
headache
tinnitus
anorexia
Signs of anaemia?
Pallor is severe = less than 80
tachycardia, flow murmurs + heart failure
- mumur : ejection systolic
What does High MCV anaemia mean?
There is a decreased production of RBC
What does low MCV anaemia mean?
Microcytic:
There is a normal number of RBC but not much to put in them e.g. iron def + thalassaemia
Examples of high MCV anaemias?
Macrocytic
Folate def
B12 defW
Examples of low MCV anaemia?
FAST
Iron def anaemia
Anaemia of chronic disease
Sideroblastic
Thalassaemia
Examples of normal MCV anaemia?
Normocytic anaemia
Acute blood loss
Anaemia chronic disease
Bone marrow failure
Renal failure
Hypothyroidism
haemolysis
Pregancy
Examples of high MCV anaemias?
FATRBC
Fetus- pregnancy
Antifolates - phenytoin
Thyroid
Reticulocytosis
B12 or folate def
Cirrhosis
Myelodysplastic syndromes
What are the specific signs of iron deficiency anaemia?
Koionychia
Atrophic glossitis
Angular cheilosis
Post cricoid webs = plummer vinson syndrome
Brittle hair and nails
What is seen on blood film for iron deficiency anaemia?
Microcytic, hypochromic
anisocytosis - varying sizes
poikilocytosis pencil cells
How do you consider iron deficiency presentations for management?
Bleeding until proven otherwise
menorrhagia in young women
What can cause blood loss -> iron def anaemia?
GI losses:
Meckel’s diverticulum in older children
Peptic ulcers - chronic nsaid use
polyps, colorectal ca - adults 50+
menorrhagia - girls
hookworm infestation - developing countries
What conditions that cause decreased absorption can cause iron def anaemia?
Coeliac disease : absence in villous surface
post gastric surgery : decrease in acid which helps Fe absorption
How can intravascular haemolysis lead to iron def anaemia?
Microangiopathic haemolytic anaemia
- causes chronic loss of Hb in urine = Fe deficiency
when are patients with iron def anaemia further investigated?
if no obvious cause then patients should have:
OGD + colonoscopy, urine dip, coeliac investigations.
Patients >60 years with Iron deficiency anaemia = 2WW
S/E of oral iron tablets?
(SE: nausea, abdominal discomfort, diarrhoea/constipation, black stools).
What indications are there to give a iron def anaemia patient IV iron?
Indications:
poor oral absorption, failure of oral iron trial, or need for rapid rise (e.g. imminent
major surgery)
What IV iron is given for iron def anaemia?
Ferrinject / monofer
Why are iron infusions not given in sepsis rather blood transfusion if preferred?
in sepsis and severe infection, iron will not absorb well and can fuel sepsis. Blood transfusions
are better in this scenario.
How does anaemia of chronic disease cause iron def anaemia?
Cytokine driven inhibition of red cell production
What conditions cause anaemia of chronic disease?
Chronic infection = TB, osteomyelitis
Vasculitis
RA
Malignancy
Why is iron def anaemia seen in renal failure?
Due to erythropoietin deficiency
What is sideroblastic anaemia?
Ineffective erythropoiesis = iron loading in bone marrow causing haemosiderosis
Get organ damage due to iron deposits
How to diagnose sideroblastic anaemia?
Ring sideroblasts seen in bone marrow
WHat can cause sideroblastic anaemia?
Myelodysplastic disorders
after chemo
alcohol excess!
How to treat sideroblastic anaemia?
Remove the cause and consider Pyridoxine (vitamin B6 promotes RBC production).
Consider giving EPO
How to tell apart iron def anaemia and anaemia of chronic disease from blood test?
total Iron binding capacity is high in IDA and normal in anaemia of chronic disease
Microcytic picture in both but ferritin would also be lower in IDA
What can show a false low HbA1c?
Haemodialysis
what is aplastic crisis
An aplastic crisis happens when your bone marrow suddenly stops making red blood cells so you develop severe and potentially life-threatening anemia.
What patients with parvovirus b19 are at risk of getting aplastic anaemia?
Patients with hereditary spherocytosis getting parvovirus -> trigger aplastic crisis
