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Anaemia Flashcards

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1
Q

What is anaemia defined as?

A

Hb less that 13.5 in men and less than 11.5 in women

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2
Q

In which siruation will tere be an anaemia but red cell mass got up?

A

pregnancy

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3
Q

Name symptoms of anemia

A

breathlessness
lethargy
angina /Int. Claudication

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4
Q

Name 7 signs of anaemia

A 
Conjunctival pallor
koilonychia
atrophic glossitis
angular stomatitis
high flow murmur
tachycardia
dysphagia (pharangeal web)
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5
Q

What is koilonychia?

A

spoon shaped nails

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6
Q

Give 3 examples of microcytic anaemia

A

IDA, thalassaemia, sideroblastic anaemia

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7
Q

Give 3 examples of normocytic anaemia

A

Acute blood loss, chronic disease, leukoerythroblastic

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8
Q

Give 5 examples of Macrocytic anaemia

A

Vit. B12 def., folate def. alcoholism, hypothyroidism, liver disease

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9
Q

What is the daily requirement of Iron?

A

1mg for normal adult
2mg for menstruating female
3mg for pregnant female

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10
Q

How much iron is taken in a western diet and how much is absorbed?

A

10-20 mg of which half is absorbed

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11
Q

What are the 4 broad causes of IDA?

A

reduced intake
increased demand
malabsorption
Blood loss

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12
Q

Where is iron absorbed in the GI tract?

A

Duodenum

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13
Q

In which patients will iron not be aborbed efficiently?

A

Coeliac disease

Gastrectomy

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14
Q

What are the most common sites of blood loss (2)

A

upper GI tract

uterus

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15
Q

How does the FBC look in IDA?

A

Hb low
MCV low
Ferritin low
Serum Iron low

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16
Q

What is the low limit of Mean cell volume?

A

<80

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17
Q

How are patients with IDA treated?

A

FIND A CAUSE
ferrous sulphate
parenteral iron (iron sorbitol)
Packed red cell transfusion

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18
Q

What are the side effects of ferrous sulphate?

A

Abdo pain
constipation
black stools

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19
Q

What is the upper limit of normal for MCV?

A

96

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20
Q

Within macrocytic anaemia there are two branches of condition which lead to different types of cell being present. What are these branches and what causes each?

A

Megaloblastic - B12 + folate def.

Non-megaloblastic - Alcohol, reticulocytosis, liver disease

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21
Q

What is iron started as in the liver?

A

Ferritin

Haemosiderin

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22
Q

What cell lines are affected in megaloblastic anaemias?

A

red cell
leukocytes
Platelets

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23
Q

What will happen to leukocytes in megaloblastic anaemia?

A

Hypersegmented

leukopenic

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24
Q

How is B12 absorbed?

A

Binds to intrinsic factor and absorbed in terminal ileum

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25
What cells produce intrinsic factor?
Parietal cells of the stomach
26
What causes B12 definicency?
``` Reduced intake Impaired absorption: Gastrectomy Crohn's Ileal resection Pernicous anaemia ```
27
What is the pathophsiology of perncious anaemia?
Ab produced against parietal cells of stomach and Ab against intrinsic factor.
28
What symptoms will be found in Vit b12 def. anaemia? (5)
``` Peripheral Neuropathy Subacute combined degeneration Optic atrophy weight loss dementia ```
29
What is the treatment of Vit B12 Def. anaemia?
IM Hydroxycobalamin + Folate
30
What should always be given along with hydroxycobalamin?
Folate
31
What are the 4 main causes of Folate def. anaemia?
Dietary factors - common Malabsoption - Crohns Inc. demand - pregnancy Drugs - methotrexate, alcohol
32
Which food do you get folate from?
spinach, broccoli
33
How is folate def anaemia diagnosed?
Bloods - reduced red cell folate
34
What is the treatent of Folate def. anaemia?
Oral folate + B12
35
What 3 groups of conditions cause the anaemia of chronic disease?
Chronic infection Chronic Inflamm Malignancy
36
How will a FBC look in the anaemia of chronic disease?
Hb down MCV normal Ferritin normal
37
What is the treatment of the anaemia of chronic disease?
EPO injections packed RBCs
38
What is the triad of pancytopaenia?
anaemia Neutropaenia thromboctopaenia
39
How does the blood film look in bone marrow failure?
Leukoerythroblastic film - immature while and red cells
40
What haematological features of haemolytic anaemia?
Raised unconjugated bilirubin reduced haptoglobin raised LDH raised urobilinogen reticulocytosis
41
What is haptoglobin?
a protein which binds free Hb in the blood and takes it to the reticulcoendothelial system for breakdown.
42
What is LDH?
Lactate Dehydrogenase It is an enzyme which is released during tissue damage and so can be useful in assessing severity of cancer of haemolysis
43
Haemolytic anaemias can be acquired or inherited. Which of these causes intrinsic problems of RBCs?
Inherited haemolytic anaemias cause problems within the the red blood cell
44
Which 3 locations on the red blood cell can inherited haemolytic anaemias affect?
cell membrane cell cytoplasm haemoglobin
45
Which inherited haemolytic anaemia affects the RBC's cell membrane?
Spherocytosis
46
Which inherited haemolytic anaemia affects the RBC's cell cytoplasm?
Glucose-6-phosphate dehydrogenase deficiency
47
Which inherited haemolytic anaemia affects the RBC's Haemoglobin?
Sickle cell anaemia | thalassaemia
48
How is hereditary sphereocytosis inherited?
Autosomal dominant
49
How does hereditary spherocytosis cause anaemia?
red cells have abnormal shape and so get trapped in spleen and phagocytosed
50
How is hereditary spherocytosis diagnosed?
blood film with spherocytes
51
How is hereditary spherocytosis treated?
Splenectomy and folate
52
What cells would you find in a blood film in G6PD deficiency?`
Heinz bodies | Bite cells
53
What type of haemoglobin is produced in sickle cell anaemia?
HbS
54
In sickle cell anaemia HbS is produced, why does that lead to problems?
It is insoluable at low O2 levels and so once the oxygen becomes unbound from the HbS the cells become inflexible and cause occlusions in small vessels
55
What precipitated sickling of RBCs in sickle cell anaemia? (3)
Infection, dehydration and hypoxia
56
What are the two branches of problem in sickle cell anaemia?
Shortened red cell survival Vaso-occlusion
57
In sickle cell anaemia what are the features of shortened RBC lifespan?
Chronic haemolysis: Splenomegaly Gallstones (unconj. billirubin) Folate def.
58
In sickle cell anaemia what are the consequences of the vaso-occlusive disease?
Obstruction and infarct of small vessels in distal sites and skin Organ dysfunction and failure
59
In a sickle cell crisis what are the main consequences? (7)
``` Stroke Retinopathy Pulmonary Syndrome Bone pain Dactylitis (children) Priapism Lower Limb ulceration ```
60
How is sickle cell anaemia diagnosed?
Hb electrophoresis + sickle solubility tests
61
How do you treat sickle cell anaemia?
Treat an acute crisis with supportive measures +/- splenectomy prevent disease with vaccines against encapsulated organisms, folic acid Hydroxyurea
62
Why is Hydroxyurea used in sickle cell disease?
shown to inc. amount of HbF and slows clinical prgression of disease
63
What treatment is given in all haemolytic disease?
Folate supplement
64
What is the basica pathology in Thalassaemia?
Imbalance of the alpha and beta haemoglobin chain production
65
What are the two general problems that occur in thalassaemia?
Ineffective erythropoesis Haemolysis
66
What are the two subtypes of thalassaemia?
alpha-thalassaemia | Beta-thalassaemia
67
What are the two types of beta-thalassaemia?
Major and Minor
68
What is the genetic difference the two types of beta-thalassaemias?
Major is homozygous meaning that both B1 and B2 are mutated Minor is heterozygous so one only 1 beta globin is affected
69
What is the clinical difference between Beta- thalassaemia major and minor?
Major - presents within first year of life and requires transfusion +more Minor is asyptomatic but may have features of haemolysis
70
What is Cooley's anaemia?
Beta-thalassaemia Major
71
What are the long term features of beta-thalassaemia major?
Anaemia Bone deformaties - frontal bossing, easy fractures Iron accululation - failure of sexual development, diabetes, hepatic and cardiac dysfunction
72
How many genes can be affected in alpha thalassaemia and how does this affect the severity of disease?
There are 4 genes. 4 genes affected - Incompatible with life and HF in utero 3 - moderate anaemia+ splenomegaly 1/2 - asymptomatic
73
What is the name of the diseased caused by alpha thalassaemia with 3 affected genes?
Haemoglobin H disease
74
What is the most common autoimmune cause of haemolysis?
Auto Immune Haemolytic anaemia
75
How do you test for Autoimmune haemolytic anaemia?
Coombs test (DAT test)
76
What are the types of Autoimmune haemolytic anaemia?
Warm and cold
77
What immunoglobulin mediated Warm autoimmune haemolytic anaemia?
IgG
78
What immunoglobulin mediated cold autoimmune haemolytic anaemia?
IgM
79
What are the mean ages that you get autoimmune haemolytic anaemias (hot/cold)? which is more common?
Warm - 37 (more common) Cold - younger than 37
80
What are the causes of Warm autoimmune haemolytic anaemia?
Autoimmune disorders Myeloproliferation Drugs - penicillin
81
What is the main cause of Cold autoimmune haemolytic anaemia?
Infection from EBV and mycoplasma
82
What is the treatment for autoimmune haemolytic anaemia?
Steroids Immunosuppression (Azothioprine) Splenectomy in Warm
83
What is the triad of symptoms in Paroxysmal nocturnal haemoglobinuria?
Intravascular haemolysis Venous Thrombosis Haemoglobinuria (morning/night)

Haematology (7 decks)

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