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defence > anaemia > Flashcards

anaemia Flashcards

1
Q

what two types of anaemia depend on the size of red blood cells?

A

Mircocytic and macrocytic (and normocytic)

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1
Q

what blood tests would you do to test iron deficiency anaemia?

A

ferritin (decreased)
transferrin saturations (decreased)
TIBC (increased)

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2
Q

list 4 causes of microcytic anaemia

A

thalassaemia
iron deficiency
anaemia of chronic disease
sideroblastic anaemia

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3
Q

when might ferritin levels be falsely raised?

A

in infection as it is also an acute phase protein

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4
Q

what would you expect on a blood test indicating anaemia of chronic disease?

A

increased ferritin

decreased or normal TIBC (as decreased transferrin levels)

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5
Q

what abnormal bowel conditions may lead to reduced absorption of iron?

A

crohn’s
coeliac
atrophic gastritis

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6
Q

4 causes of iron deficiency

A
  1. poor intake
  2. reduced absorption (post gastrectomy)
  3. increased losses
  4. increased demand (growth pregnancy)
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7
Q

name two foods which interfere with the absorption of iron

A

thalins

chocolate

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8
Q

name two medications which interfere with the absorption of iron

A

PPIs
Calcium supplements

an acidic environment is required for the absorption of iron, as these alter the pH they will interfere. Iron supplements are usually advised to be taken with orange juice as it helps absorption

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9
Q

name two conditions which could cause occult blood loss leading to iron deficiency

A

GI ulcer

GI malignancy

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10
Q

three reasons for poor intake of iron

A

vegetarian
eating disorders
‘tea and toast’ diet in the elderly

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12
Q

3 states which increase the demand for iron intake

A

childhood
pregnancy
breastfeeding

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13
Q

koilonychia is a sign of what

A

longstanding iron deficiency anaemia

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14
Q

jaundice is indicative of which type of anaemia

A

haemolytic anaemia

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15
Q

bone deformities are seen in which type of anaemia

A

thalassaemia major

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16
Q

leg ulcers are associated with which type of anaemia

A

sickle cell

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17
Q

which protein acts at the intestinal haem transporter? where is it expressed most? and in what situations might its expression be increased

A

HCP1
Duodenum - prime sight for non-ahem iron absorption
ureg’d in hypoxia and iron deficiency

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18
Q

what is the normal serum iron level

A

13-32 micromol/L

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19
Q

what is transferrin

A

a beta globulin synthesized in the liver
transports iron in the plasma
each molecule can bind 2 iron atoms

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20
Q

in which cells is iron stored

A

hepatocytes, skeletal muscle and reticuloendothelial cells

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21
Q

what is ferritin

A

water soluble iron store present in the plasma

it is also an acute phase protein and so may be falsely raised in the presence of inflammatory or malignant diseases

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22
Q

what is haemosiderin

A

insoluble iron store found in macrophages in bone, marrow and spleen

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23
Q

which conditions cause increased body iron content

A

hereditary haemochromatosis - mutation in HFE gene incr absorption

secondary haemochromatosis - iron overload in conditions with regular blood transfusion

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24
Q

presence of target cells on a blood film are due to what?

A 
breakdown of RBCs
lecithin cholesterol acyl transferase deficiency
haemoglobinopathies
iron deficiency
liver disease
spleen removal
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25
Q

what are sideroblastic anaemias

A

inherited (X linked) or acquired disorders (myelodysplastic syndromes/ lead poisoning) with refractory anaemia

26
Q

what is the diagnostic feature of sideroblastic anaemia

A

ring sideroblasts

27
Q

which endocrine disorders can cause normocytic anaemia

A

hypopituitarism
hypothyroidism
hypoadrenalism

28
Q

what is the difference between megaloblastic and normoblastic microcytic anaemia

A

bone marrow findings

megaloblastic -> bone marrow erythroblasts with delayed nuclear maturation owing to defective DNA synthesis

29
Q

which condition is a physiological cause of normoblastic microcytic anaemia

A

pregnancy

30
Q

what is intrinsic factor and where is it produced

A

a glycoprotein which combines with B12 and carries it to specific receptors on the surface of the mucosa of the ileum

it is produced by the gastric parietal cells

31
Q

what is pernicious anaemia

A

autoimmune disorder in which there is atrophic gastritis and a loss of parietal cells in the gastric mucosa, this leads to a failure of intrinsic factor production and B12 malabsorption

parietal cell antibodies are present in 90% of patients with PA one type stops IF binding to B12 and the other type blocks the receptor in the ileum

32
Q

in which populations is pernicious anaemia more common

A

fair haired, blue eyed female with blood group A

33
Q

which autoimmune diseases is pernicious anaemia associated with

A

it is particularly associated with thyroid disease, addison’s disease

also a higher incidence of gastric carcinoma

34
Q

neurological changes may be present if PA is left for a long time, what are they?

A

progressive polyneuropathy
symmetrical parasthesiae in fingers and toes
Dementia, psychiatric problems
optic atrophy

35
Q

besides PA what else can cause B12 deficiency

A

any disease involving the terminal ileum
bacterial overgrowth in the small bowel
gastrectomy

36
Q

hypothyroidism can cause which type of anaemia

A

macroscopic normoblastic

37
Q

what are the histological findings of aplastic anaemia

A

pancytopenia
virtual absence of reticulocytes
hypo cellular bone marrow with increased fat spaces

38
Q

how might the bone marrow attempt to compensate for haemolytic disease?

A

1) erythroid hyperplasia (increases the proportion of cells committed to erythropoiesis)
2) expanding the volume of active marrow
3) release of immature red cells (reticulocytes)

39
Q

what does Schumm’s test look for

A

a band of methaemalbumin which is characteristic of intravascular homeless when the binding capacity of plasma haemopexin is exceeded.

40
Q

which population is hereditary spherocytosis most common

A

it affects 1 in 5000 northern europeans

inherited as autosomal dominant although 25% of pts do not have affected parents

41
Q

what causes hereditary spherocytosis

A

defect in red cell membrane (spectrum/ankyrin most common)
decrease in surface to volume ratio as disrupted sodium permeability
cells are more rigid and less deformable and so are unable to pass through the spleen –> shortened livespan

42
Q

how does hereditary spherocytosis present

A

may present with jaundice at birth, or may present later
anaemia, splenomegaly and ulcers on legs
aplastic anaemia may develop following parvo virus
chronic haemolysis leads to formation of pigment gallstones

43
Q

would a Coomb’s test be positive in hereditary spherocyctosis

A

no as it is not autoimmune haemolytic anaemia

44
Q

what is hereditary elliptocytosis

A

AD inherited disorder of red cell membrane causing a deficiency in spectrin/actin

presents similarly to HS but is milder condition

45
Q

what are stomatocytes

A

red cells with pale central area which appears slit like associated with hereditary haemolytic anaemias and excess alcohol intake

46
Q

thalassaemia affects which part of haemoglobin?

A

the globin chain production: an imbalance of alpha and beta chains.
this causes precipitation of globin chains in red cell precursors and results in ineffective erythropoiesis

47
Q

sickle cell affects which part of haemoglobin

A

structure of the globin chain

48
Q

what are heinz bodies and in which conditions are they present

A

collections of denatured Hb in RBCs

seen in G6PD deficiency and thalassaemia A

49
Q

what are sideroblasts

A

abnormal nucleated erythroblasts with granules of iron accumulated in perinuclear mitochondria as unable to combine with Hb

seen in:
siderblastic anaemias
lead poisoning
thalassaemias
asplenic patients
50
Q

what are Auer rods and in which conditions might they be seen

A

azurophilis granules in the cytoplasm of acute myeloid leukaemia

also rarely seen in megaloblastic anaemia, leukaemia, IDA hyposplenism

51
Q

what are Howell-Jolly bodies and in which conditions might they be present

A

spherical blue-black inclusions or RBCs which are residual nuclear fragments

common in splenic patients
also seen in:
- severe haemolytic anaemia
- pernicious anaemia
- leukaemia
- thalassaemia
52
Q

which organism is most likely to implicated in osteomyelitis in a patient with sick cell disease

A

> 50% of cases Salmonella spp.

In the general population Staph is most common

53
Q

what is Gaisbock’s syndrome

A

relative polycythaemia
tends to occur in middle aged men (esp obese smokers)
may present with CV problems such as MI or cerebral ischaemia
smoking should be stopped

54
Q

myeloma is a disease of which kind of cell

A

plasma cell

infiltration of bone marrow by clonal proliferation of plasma cells occurs

55
Q

cytokine induced suppression of marrow function causes…

A

anaemia of chronic disease

56
Q

infiltration by clonal proliferation of primitive cells is…

A

ALL

57
Q

genetic mutation causing constitutively activated tyrosine kinase mediated clonal proliferation and reduced apoptosis is most likely to describe…

A

CML

58
Q

bone marrow infiltration by REED STERNBERG cells, sclerosis and lymphocytes is most likely to describe

A

Hodgkins disease

59
Q

clonal abnormality of stem cells giving rise to infiltration of bone marrow by primitive myeloid precursors is most likely to describe…

A

AML

60
Q

clonal abnormality of stem cells causing failure of functional development of all marrow cell lines describes

A

myelodysplasia

defence (12 decks)

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