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anaemia Flashcards

1
Q

what is the main function of red blood cells (RBCs)?

A

to transport oxygen from the lungs to tissues and remove carbon dioxide

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2
Q

what protein do RBCs contain that binds oxygen?

A

Hb - each has 4 haem groups - can bind 4 oxygen molecules

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3
Q

what shape are RBCs and why is it important?

A

biconcave
increases surface area for better oxygen absorption

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4
Q

why don’t red blood cells have a nucleus?

A

to make more room for Hb and maximise oxygen transport

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5
Q

what happens to oxygen in the lungs?

A

it binds to oxygen to form oxyhaemoglobin

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6
Q

what happens when RBCs reach tissue?

A

oxygen is released from haemoglobin, becoming deoxyhaemoglobin

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7
Q

how long do RBCs live?

A

120 days

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8
Q

what is a by-product of RBC breakdown?

A

bilirubin
build-up can = jaundice
signs
can be a sign of haemolytic anaemia (body destroys RBCs faster than it makes them)
also sign of liver failure as liver processes bilirubin

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9
Q

what is erythropoiesis?

A

the process of making red blood cells in the bone marrow (stem cells are the precursor –> myeloid progenitors –> erythroblast –> reticulocyte –> erythrocyte)

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10
Q

what hormone stimulates erythropoiesis and where is it made?

A

erythropoietin (EPO)
kidneys

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11
Q

what nutrients are essential for red blood cell production?

A

iron, vitamin B12, and folate (vitamin B9)
folate is involved in DNA synthesis – needed to produce cells
use of folate is dependent on vit B12 – needed to remove CH3 from
THF
B12 and folate are needed for multiple functions in the body, including CNS function

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12
Q

what is anaemia in patient-friendly terms?

A

condition with fewer red blood cells or less haemoglobin than normal, leading to less oxygen being carried in the blood

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13
Q

what is the definition of anaemia?

A

reduction from normal of the quantity of Hb in the blood
* Males: Hb < 13g/dL
* Females: Hb <12g/dL - lower for women due to menstruation

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14
Q

how does anaemia affect oxygen delivery?

A

reduces the amount of oxygen carried to tissues, causing symptoms like tiredness and breathlessness

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15
Q

what are the symptoms of anaemia?

A

fatigue, low BP, dizziness, chest pain, SOB, headaches
symptoms are not usually seen till iron source lost
non specific therefore need blood test

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16
Q

what are the 3 classes of anaemia?

A

microcytic (iron deficiency,
chronic diseases, sideroblastic [rare])
megaloblastic (folate, vit B12 deficiency)
haemolytic (autoimmune, sickle cell, thalassaemia, G6PD deficiency)

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17
Q

how can anaemia be classified by red blood cell size?

A

microcytic (MCV <80), normocytic (MCV 80–100), macrocytic (MCV >100)
mcv = mean corpuscular volume

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18
Q

what 2 ways can we classify anaemia?

A

type of disease - i.e., aplastic
size and colour - i.e., microcytic

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19
Q

what 2 ways can increased blood loss cause microcytic anaemia?

A

menstruation - uterus
NSAIDs, ulceration induced bleeds - GI tract

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20
Q

what is dilutional anaemia?

A

when there is a higher need of blood
this occurs in pregnancy where there is an expansion of blood volume - happens because more blood needs to be transported to the uterus to supply foetus

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21
Q

what complications can be caused by anaemia in pregnancy?

A
  1. increased morbidity risk factors for mothers and infants
  2. preterm birth
  3. maternal postpartum fatigue, altered cognition and depression
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22
Q

what causes anaemia?

A

Hb loss - haemorrhage, haemolysis (i.e., from infections, meds, overactive spleen)
decreased Hb synthesis - lack of nutrients (iron, folate, vit B12 = defection maturation of precursors), aplastic anaemia (reduced blood cell production = decreased proliferation of precursors),

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23
Q

what are common causes of microcytic anaemia?

A

iron deficiency, chronic disease, sideroblastic anaemia

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24
Q

what are signs specific to iron deficiency anaemia (IDA)?

A

pica (i.e., eating ice), koilonychia (nail changes), angular cheilitis (sore cracks on side of mouth), dry skin/hair/alopecia, glossitis (glass tongue, pallor

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25
which blood tests help diagnose anaemia?
FBC (Hb, MCV, RBC count), ferritin (iron stores), haematocrit
26
why is ferritin a better marker for IDA?
iron levels show different values in morning and evening ferritin indicates iron stores - it is a protein complex that binds iron if measure serum iron, does not show how much iron is incorporated into RBCs therefore we check ferritin
27
what ferritin level suggests iron deficiency?
<30mcg/L
28
what are key causes of IDA?
malabsorption (e.g. coeliac, IBD, H.pylori), blood loss (menstruation, GI), dietary deficiency - poor intake (veg diet), pregnancy
29
what is the first-line treatment for IDA?
oral iron supplements: ferrous sulfate/fumarate/gluconate, once daily on an empty stomach ferrous fumarate has more elemental iron --> dose of 65mg elemental iron once daily on an empty stomach is needed to treat iron-deficiency anaemia, ferrous fumarate offers this
30
how long should oral iron be continued after Hb normalises?
for 3 more months to replenish iron stores Hb should rise by about 20g/L after 3-4 weeks
31
what side effects can iron tablets cause?
constipation, nausea, diarrhoea, epigastric pain, dark stools
32
what reduces iron absorption?
dairy, tea/coffee, antacids, tetracyclines, bisphosphonates, whole grains
33
what improves iron absorption?
vitamin C (minimal effect) and taking on an empty stomach
34
why are MR iron tablets not advised?
they bypass the main site of absorption (duodenum), so less effective
35
when should Hb be rechecked after starting oral iron?
after 3-4 weeks, then again at 2-4 months.
36
what are signs of treatment failure with oral iron?
no Hb rise after 3 weeks, suggests non-adherence, malabsorption, or incorrect diagnosis
37
who should be referred urgently with anaemia?
any men with Hb <11g/dL, non-menstruating women <10g/dL, suspected GI bleed, malabsorption, or malignancy, coeliac serology
38
what are key counselling points?
iron rich foods: green leafy veg, red meat, fish, apricots, prunes, raisins
39
when is IV iron used instead of oral?
in malabsorption, intolerance to oral iron, or ongoing blood loss
40
name examples of IV iron preparations
Ferinject, CosmoFer, Venofer, Monofer
41
what must be done before giving IV iron?
hold oral iron for 5 days to avoid absorption interference
42
what are key risks with IV iron?
anaphylaxis, iron overload, hypophosphataemia (Ferinject)
43
what emergency meds should be available during IV iron administration?
chlorphenamine, IV hydrocortisone, IV paracetamol, fluids, oxygen
44
what are the three main types of anaemia based on MCV?
microcytic: iron deficiency, anaemia of chronic disease (ACD), sideroblastic megaloblastic: B12 and folate deficiency haemolytic: sickle cell, thalassaemia, G6PD deficiency, autoimmune
45
what is the most common cause of microcytic anaemia?
iron deficiency
46
what is ACD associated with?
inflammatory conditions (e.g. RA, IBD), impaired EPO response, iron trapped in stores
47
why isn’t iron given in ACD?
because it’s a functional issue, not a deficiency. iron is present but can’t be used
48
how is anaemia in chronic kidney disease (CKD) managed?
erythropoiesis-stimulating agents (e.g. epoetin) IV iron if iron-deficient avoid excessive supplements monitor ferritin (<800 mcg/L)
49
what’s unique about sideroblastic anaemia?
iron is present but cannot be used effectively; ring sideroblasts are seen on marrow exam
50
what causes megaloblastic anaemia?
defective DNA synthesis due to vitamin B12 or folate deficiency
51
what are the neurological signs of B12 deficiency?
neuropathy (esp. symmetrical in legs) cognitive changes optic issues incontinence psychiatric symptoms
52
what must you always do before treating folate deficiency?
check B12 levels first - treating folate alone can mask B12 deficiency and cause nerve damage
53
what is pernicious anaemia?
autoimmune destruction of gastric parietal cells → ↓ intrinsic factor → B12 malabsorption
54
how is B12 deficiency treated?
IM hydroxocobalamin (esp. if neuro signs) oral cyanocobalamin (if dietary cause) maintenance: IM every 2–3 months, or PO daily
55
what are causes of folate deficiency?
poor diet, alcoholism, GI disorders (coeliac), pregnancy, drugs (e.g. MTX, trimethoprim)
56
how is folate deficiency managed?
folic acid 5mg daily for 4 months improve diet check B12 first!
57
what’s the hallmark of haemolytic anaemias?
RBCs break down faster than they are produced → anaemia despite normal MCV
58
what are common symptoms of haemolysis?
jaundice, dark urine, fatigue, splenomegaly
59
what causes sickle cell anaemia?
abnormal Hb → sickle-shaped RBCs → poor O2 delivery + blockages
60
what is a sickle cell crisis?
painful episodes caused by blocked blood vessels, needing IV fluids, analgesia
61
how is sickle cell managed?
folic acid hydroxycarbamide blood transfusions chelation therapy penicillin prophylaxis
62
what is thalassaemia?
genetic condition → ↓ Hb production → severe anaemia
63
how is it managed?
regular transfusions chelation therapy only cure = stem cell or bone marrow transplant
64
what is G6PD deficiency?
inherited enzyme deficiency that makes RBCs vulnerable to oxidative damage
65
what can trigger haemolysis in G6PD patients?
drugs (e.g. dapsone, nitrofurantoin, sulfonamides) infections fava beans
66
case study: adult woman with tiredness, COPD – what to investigate?
ask: diet, bleeding, periods, alcohol, meds bloods: FBC (MCV, bilirubin), ferritin, B12, folate, TSH differentials: anaemia (iron deficiency anaemia/ anaemia of chronic disease/ megaloblastic anaemias)- depending on results depression anxiety hypothyroidism menopause cancer – rule out
67
case study: elderly woman with tingling, poor diet, drinks tea – what’s likely?
bloods: FBC - ferritin, B12 + folate --> could then consider e.g. IF antibody and parietal cell antibody tests for pernicious anaemia do physical assessment - depending on symptoms, consider cardiac or respiratory tests, CXR if breathless differentials: megaloblastic anaemia (likely B12-deficient or pernicious anaemia based on FHx, nutrition) cancer – rule out hypothyroidism depression could neuropathy be due to T2DM? physical damage to nerves? shingles? (due to age) --> may consider additional diagnoses with information on symptoms (e.g. chronic pain) start IM B12 if neuro symptoms

phay85 (19 decks)

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