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Haematology > Anaemia > Flashcards

Anaemia Flashcards

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
Q

What cells produce intrinsic factor?

A

Parietal cells of the stomach

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26
Q

What causes B12 definicency?

A 
Reduced intake
Impaired absorption:
Gastrectomy
Crohn's
Ileal resection
Pernicous anaemia
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27
Q

What is the pathophsiology of perncious anaemia?

A

Ab produced against parietal cells of stomach and Ab against intrinsic factor.

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28
Q

What symptoms will be found in Vit b12 def. anaemia? (5)

A 
Peripheral Neuropathy
Subacute combined degeneration
Optic atrophy
weight loss
dementia
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29
Q

What is the treatment of Vit B12 Def. anaemia?

A

IM Hydroxycobalamin + Folate

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30
Q

What should always be given along with hydroxycobalamin?

A

Folate

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31
Q

What are the 4 main causes of Folate def. anaemia?

A

Dietary factors - common

Malabsoption - Crohns

Inc. demand - pregnancy

Drugs - methotrexate, alcohol

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32
Q

Which food do you get folate from?

A

spinach, broccoli

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33
Q

How is folate def anaemia diagnosed?

A

Bloods - reduced red cell folate

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34
Q

What is the treatent of Folate def. anaemia?

A

Oral folate + B12

35
Q

What 3 groups of conditions cause the anaemia of chronic disease?

A

Chronic infection
Chronic Inflamm
Malignancy

36
Q

How will a FBC look in the anaemia of chronic disease?

A

Hb down
MCV normal
Ferritin normal

37
Q

What is the treatment of the anaemia of chronic disease?

A

EPO injections

packed RBCs

38
Q

What is the triad of pancytopaenia?

A

anaemia
Neutropaenia
thromboctopaenia

39
Q

How does the blood film look in bone marrow failure?

A

Leukoerythroblastic film - immature while and red cells

40
Q

What haematological features of haemolytic anaemia?

A

Raised unconjugated bilirubin

reduced haptoglobin

raised LDH

raised urobilinogen

reticulocytosis

41
Q

What is haptoglobin?

A

a protein which binds free Hb in the blood and takes it to the reticulcoendothelial system for breakdown.

42
Q

What is LDH?

A

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
Q

Haemolytic anaemias can be acquired or inherited. Which of these causes intrinsic problems of RBCs?

A

Inherited haemolytic anaemias cause problems within the the red blood cell

44
Q

Which 3 locations on the red blood cell can inherited haemolytic anaemias affect?

A

cell membrane
cell cytoplasm
haemoglobin

45
Q

Which inherited haemolytic anaemia affects the RBC’s cell membrane?

A

Spherocytosis

46
Q

Which inherited haemolytic anaemia affects the RBC’s cell cytoplasm?

A

Glucose-6-phosphate dehydrogenase deficiency

47
Q

Which inherited haemolytic anaemia affects the RBC’s Haemoglobin?

A

Sickle cell anaemia

thalassaemia

48
Q

How is hereditary sphereocytosis inherited?

A

Autosomal dominant

49
Q

How does hereditary spherocytosis cause anaemia?

A

red cells have abnormal shape and so get trapped in spleen and phagocytosed

50
Q

How is hereditary spherocytosis diagnosed?

A

blood film with spherocytes

51
Q

How is hereditary spherocytosis treated?

A

Splenectomy and folate

52
Q

What cells would you find in a blood film in G6PD deficiency?`

A

Heinz bodies

Bite cells

53
Q

What type of haemoglobin is produced in sickle cell anaemia?

A

HbS

54
Q

In sickle cell anaemia HbS is produced, why does that lead to problems?

A

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
Q

What precipitated sickling of RBCs in sickle cell anaemia? (3)

A

Infection, dehydration and hypoxia

56
Q

What are the two branches of problem in sickle cell anaemia?

A

Shortened red cell survival

Vaso-occlusion

57
Q

In sickle cell anaemia what are the features of shortened RBC lifespan?

A

Chronic haemolysis:
Splenomegaly
Gallstones (unconj. billirubin)
Folate def.

58
Q

In sickle cell anaemia what are the consequences of the vaso-occlusive disease?

A

Obstruction and infarct of small vessels in distal sites and skin

Organ dysfunction and failure

59
Q

In a sickle cell crisis what are the main consequences? (7)

A 
Stroke
Retinopathy
Pulmonary Syndrome
Bone pain
Dactylitis (children)
Priapism
Lower Limb ulceration
60
Q

How is sickle cell anaemia diagnosed?

A

Hb electrophoresis + sickle solubility tests

61
Q

How do you treat sickle cell anaemia?

A

Treat an acute crisis with supportive measures +/- splenectomy

prevent disease with vaccines against encapsulated organisms, folic acid

Hydroxyurea

62
Q

Why is Hydroxyurea used in sickle cell disease?

A

shown to inc. amount of HbF and slows clinical prgression of disease

63
Q

What treatment is given in all haemolytic disease?

A

Folate supplement

64
Q

What is the basica pathology in Thalassaemia?

A

Imbalance of the alpha and beta haemoglobin chain production

65
Q

What are the two general problems that occur in thalassaemia?

A

Ineffective erythropoesis

Haemolysis

66
Q

What are the two subtypes of thalassaemia?

A

alpha-thalassaemia

Beta-thalassaemia

67
Q

What are the two types of beta-thalassaemia?

A

Major and Minor

68
Q

What is the genetic difference the two types of beta-thalassaemias?

A

Major is homozygous meaning that both B1 and B2 are mutated

Minor is heterozygous so one only 1 beta globin is affected

69
Q

What is the clinical difference between Beta- thalassaemia major and minor?

A

Major - presents within first year of life and requires transfusion +more

Minor is asyptomatic but may have features of haemolysis

70
Q

What is Cooley’s anaemia?

A

Beta-thalassaemia Major

71
Q

What are the long term features of beta-thalassaemia major?

A

Anaemia
Bone deformaties - frontal bossing, easy fractures

Iron accululation - failure of sexual development, diabetes, hepatic and cardiac dysfunction

72
Q

How many genes can be affected in alpha thalassaemia and how does this affect the severity of disease?

A

There are 4 genes.

4 genes affected - Incompatible with life and HF in utero

3 - moderate anaemia+ splenomegaly

1/2 - asymptomatic

73
Q

What is the name of the diseased caused by alpha thalassaemia with 3 affected genes?

A

Haemoglobin H disease

74
Q

What is the most common autoimmune cause of haemolysis?

A

Auto Immune Haemolytic anaemia

75
Q

How do you test for Autoimmune haemolytic anaemia?

A

Coombs test (DAT test)

76
Q

What are the types of Autoimmune haemolytic anaemia?

A

Warm and cold

77
Q

What immunoglobulin mediated Warm autoimmune haemolytic anaemia?

A

IgG

78
Q

What immunoglobulin mediated cold autoimmune haemolytic anaemia?

A

IgM

79
Q

What are the mean ages that you get autoimmune haemolytic anaemias (hot/cold)? which is more common?

A

Warm - 37 (more common)

Cold - younger than 37

80
Q

What are the causes of Warm autoimmune haemolytic anaemia?

A

Autoimmune disorders
Myeloproliferation
Drugs - penicillin

81
Q

What is the main cause of Cold autoimmune haemolytic anaemia?

A

Infection from EBV and mycoplasma

82
Q

What is the treatment for autoimmune haemolytic anaemia?

A

Steroids
Immunosuppression (Azothioprine)
Splenectomy in Warm

83
Q

What is the triad of symptoms in Paroxysmal nocturnal haemoglobinuria?

A

Intravascular haemolysis
Venous Thrombosis
Haemoglobinuria (morning/night)

Haematology (7 decks)

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