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Hannah's Intersystem > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is pancytopaenia?

A

Low counts of all blood cells (including RBCs, WBCs and platelets)

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2
Q

What is thrombocytopaenia?

A

Low platelets

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3
Q

What is leukocytopaenia?

A

Low WBCs

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4
Q

What is lymphocytopaenia?

A

Low lymphocytes

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5
Q

What is neutropenia?

A

Low neutrophils

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6
Q

What is anaemia?

A

Low RBCs (Hb is the actual measure used when assessing anaemia)

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7
Q

What is polycythaemia?

A

High RBCs

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8
Q

What is leukocytosis?

A

High WBCs

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9
Q

What is thrombocytosis?

A

High platelets

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10
Q

What is dyserythropoiesis?

A

Dysfunctional RBCs

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11
Q

How is anaemia diagnosed?

A

By measuring Hb, not RBCs

Anaemia is defined as a Hb level below that which is considered normal for age and gender

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12
Q

What is the tissue oxygen delivery equation? What units are used?

A

Tissue oxygen delivery = CO x Hb x %Satn x 1.34

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13
Q

What are the 3 possible approaches to treating a deficiency in tissue oxygen delivery?

A

Inotropes (improve CO)
Transfusion (improve Hb)
O2 therapy (improve %Satn)

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14
Q

What factors should be considered when considering if a patient is in need of a blood transfusion?

A

Assess HR and consider whether the patient can maintain this and, if so, for how long

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15
Q

List 6 clinical signs of anaemia

A 
Pale
Lethargic
Failure to thrive
Hypoxic (distress, disorientation and confusion)
Ischaemia
Tachycardia
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16
Q

What should you take into consideration when monitoring a child with congenital heart disease for anaemia?

A

Normal Hb for child with congenital heart disease may be much higher than that for a healthy child
Monitor HR and oxygen saturation, look for signs of hypoxia

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17
Q

How does compensation for anaemia vary between acute and chronic presentations?

A

Chronic: may be increased Hb with a nearly normal HR
Acute: Hb very low, HR very high

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18
Q

What parameters are assessed in an FBE?

A 
Hb
RCC
Haematocrit
MCV
MCH
MCHC
Platelets
WCC and differential
Blood film
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19
Q

What can be assessed using a blood film?

A

Morphology of RBCs, WBCs and platelets

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20
Q

What features of RBCs, seen in a blood film, are important in diagnosing anaemia?

A

Size: normo-, micro-, macro-cytic
Shape: many variations
Colour: normo-, hypo-chromic, polychromasia

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21
Q

What is the basis of polychromatic RBCs?

A

Still has RNA (immature)

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22
Q

What is the difference in presentation between an anaemia caused by loss or destruction vs. bone marrow failure?

A

Loss or destruction: Hb drops rapidly, acute presentation

Bone marrow failure: Hb drops ~1g/wk, chronic presentation

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23
Q

What are some signs of increased RBC production observable on a blood film?

A

Reticulocytes

Polychromasia

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24
Q

What are some signs of increased RBC destruction?

A

Jaundice due to increased serum bilirubin
Haptoglobins
LDH

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25
Q

What are the 3 intracellular targets causing a haemolysis? Give examples of haemolytic conditions associated with each

A

Membrane: hereditary pyropoikilocytosis (only in neonates), hereditary spherocytosis
Enzymes: G6PD (most common), pyruvate kinase
Hb: thalassaemias, sickle cell, unstable Hb

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26
Q

What features are seen on a blood film in hereditary spherocytosis vs. G6PD vs. sickle cell anaemia?

A

Hereditary spherocytosis: spherocytes
G6PD: blister/bite cells, spherocytes
Sickle cell anaemia: sickle cells

27
Q

What investigations are performed if a haemoglobinopathy is suspected?

A

Hb electrophoresis

28
Q

Give 4 examples of immune-mediated causes of haemolysis

A

Autoimmune
IgG-mediated (warm)
IgM-mediated (cold)
Alloimmune (following a transfusion)

29
Q

Which immune-mediated haemolysis responds to steroids: IgG-mediated or IgM-mediated?

A

IgG-mediated

30
Q

What features are seen on a blood film in an immune-mediated haemolysis?

A

Spherocytes

Agglutination

31
Q

What tests can be done to investigate an immune-mediated haemolysis?

A

DAT (Coombs test; looks for binding of IgG, c’ or both)

32
Q

List 4 mechanical causes of haemolysis

A

Sepsis
Hardware (e.g. prosthetics, grafts)
Haemangioma
TTP/HUS (haemolytic uraemic syndrome)

33
Q

What features are seen on a blood film in a mechanical haemolysis?

A

Microangiopathic (shattered RBCs)

34
Q

What is a common cause of infectious haemolysis?

A

Malaria

35
Q

What features are seen on a blood film in a haemolysis caused by malaria?

A

The parasites themselves can be seen

36
Q

What tests can be done to confirm a diagnosis of malaria?

A

Thick and thin films

Ag tests

37
Q

What are the 3 broad causes of failure of RBC production?

A

Haematinic deficiency
Marrow failure/suppression
Marrow invasion

38
Q

Give 4 causes of macrocytic anaemia

A

Liver disease
Inherited bone marrow failure
Dyserythropoiesis (due to B12/folate deficiency)
Drugs

39
Q

What investigations should be done for a macrocytic anaemia?

A

B12 assay
Red cell folate
Others

40
Q

List 4 causes of microcytic anaemia

A

Thalassaemia
Sideroblastic
Lead poisoning
Iron deficiency

41
Q

What investigations should be done for a microcytic anaemia?

A 
Ferritin
Transferrin
Iron-binding capacity
Iron saturation
Diet and blood loss should also be investigated
42
Q

What is the difference between an aspirate and a trephine in terms of bone marrow examination?

A

Aspirate: cell morphology examined
Trephine: “coring” biopsy, used to assess solid tumours or large sections of tissue

43
Q

List 5 causes of bone marrow invasion

A 
Leukaemia
Solid tumour
Fibrois
Metabolic/storage
Infection
44
Q

How is anaemia treated?

A

Identify and treat the underlying cause

Transfusion may be required

45
Q

Where are the A, B, O genes located?

A

Ch 9

46
Q

Where is the H gene located?

A

Ch 19

47
Q

What are blood group antigens, chemically?

A

May be proteins, glycolipids, oligosaccharides, or a combination

48
Q

What is the role of the H gene?

A

Codes for H transferase, which converts precursor substance to the H Ag

49
Q

What is the role of the ABO genes?

A

Code for their respective transferase which adds sugars to the H Ag to convert it to their respective Ag (O does not code for a transferase so only H Ags are expressed on the cell surface)

50
Q

What are the 5 different Ags in the Rh blood group system?

A

C, c, D, E, e

51
Q

Where are the genes for the Rh blood group located?

A

Ch 1

52
Q

What is the most important Rh blood group Ag?

A

D

53
Q

What does the term “Rh positive” mean? “Rh negative”?

A

Rh positive: D positive (DD, Dd)

Rh negative: D negative (dd)

54
Q

What % of the population are Rh positive?

A

~98%

55
Q

What is the most common ABO blood group?

A

A or O

56
Q

What is the difference between ABO and Rh blood group antibodies?

A

ABO: naturally occurring, does not require exposure to Ag

Rh (and most others): immune, exposure to Ag is required via blood transfusion or pregnancy for the production of Abs

57
Q

What blood type is the universal recipient for blood?

A

AB

58
Q

What blood type is the universal donor for blood?

A

O

59
Q

What is the difference in blood group compatibility for RBCs vs. plasma?

A

Opposite in plasma (e.g. blood group O is universal donor for blood but group O plasma can only be given to a group O - Abs are contained within plasma)

60
Q

When is blood group matching especially important?

A

If patient will be receiving repeated transfusions, best to match as many blood groups as possible to prevent immune response developing over time

61
Q

What happens if a blood transfusion is given where the patient has not been correctly ABO matched?

A

If not stopped within 5-10mL, there is a ~100% chance of death

62
Q

What happens if a blood transfusion is given where the patient has not been correctly Rh matched?

A

Nothing acutely
After 7-10 days, IgG peak is attained and haemolysis occurs, symptoms appear
Repercussions are significant if a Rh incompatible transfusion is given again in the future (Abs already exist)

63
Q

What care is given for a woman who is Rh negative and pregnant with a Rh positive baby?

A

Given anti-D regularly, when undergoing interventions or if any bleeding occurs, and during delivery (or within 72 hrs post-delivery)

Hannah's Intersystem (16 decks)

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