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Acute > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What does PCV stand for? What else is it known as? What does it mean?

A

Packed cell volume
Haemocrit
Volume percentage of RBCs in blood.

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2
Q

What Is normal haemocrit/PCV in:
Men?
Women?

A

45% men

40% women

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3
Q

What are the 3 most common symptoms of anaemia?

A

Fatigue, faintness, breathlessness

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4
Q

What 2 symptoms can people experience when anaemia exists alongside atheromatous arterial disease?

A

Angina pectoris

Intermittent claudication

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5
Q

What are normal Hb levels for:
Males?
Females?

A

Males: 13.5 - 17.5
Females: 11.5 - 16

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6
Q

What does MCV stand for? What is it?

A

Mean corpuscular volume

- the mean red blood cell size

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7
Q

Why does microcytosis come about? How does it appear on a blood film?

A

Decreased Hb content within the RBC

Hypochromic

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8
Q

What are the 4 main causes of microcytic anaemia?

A

Iron deficiency
Anaemia of chronic disease
Thalassaemia
Sideroblastic anaemia

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9
Q

Why is iron related to anaemia?

A

It is necessary for the formation of haem

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10
Q

How much iron is absorbed from the diet?

A

10%

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11
Q

Where in the GI tract is iron absorbed?

A

Duodenum

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12
Q

Name 3 factors that increase intestinal iron absorption?

A

Gastric acid
Iron deficiency
Increased erythropoietic activity

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13
Q

Where is non haem iron found in the diet? (2)

A

Vegetables

Fortified cereals

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14
Q

Where is haem iron found?

A

Derived from haemoglobin and myoglobin in red or organ meats

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15
Q

Of haem and non-haem iron, which is better absorbed?

A

Haem iron

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16
Q

How is iron transported in the blood?

A

Transferrin

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17
Q

Where is transferrin synthesised?

A

Liver

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18
Q

How is the body’s iron incorporated into haemoglobin

A

In developing erythroid precursors and mature red cells

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19
Q

How is body irod stored?

A

As ferritin and haemosiderin in hepatocytes, skeletal muscle and reticuloendothelial macrophages

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20
Q

What are the 4 main reasons for iron deficiency?

A

Blood loss (most common) - e.g. menorrhagia or GI bleeding
Incr demands - eg. growth and pregnancy
Decreased absorption - eg. small bowl disease or post gastroctomy
Poor intake

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21
Q

What is the most common cause of iron deficiency worldwide?

A

Hookworm = intestinal blood loss

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22
Q

What are normal MCV values?

A

80 - 96

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23
Q

What does MCH stand for? What is it?

A

Mean corpuscular haemoglobin

Average mass of haemoglobin per RBC

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24
Q

What do ferritin levels represent?

A

Iron stores

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25
Q

When might ferritin levels be normal despite the presence of iron deficiency?

A

Inflammatory or malignant disease, it is an acute phase reactant

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26
Q

What will the total iron-binding capacity be in iron deficiency?

A

High

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27
Q

How do you work out transferrin saturation?

A

Serum iron/TIBC

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28
Q

What is the transferrin saturation in iron deficiency anaemia?

A

<19%

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29
Q

In anaemia of chronic disease:

  • What happens to the serum iron-binding capacity?
  • What is the MCV?
  • What is the MCH?
  • Serum ferritin levels?
A
  • Low
  • Normocytic or microcytic
  • Normochromic
  • Normal or increased (NB - acute phase reactant)
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30
Q

Name 5 chronic conditions in which anaemia might occur

A 
Crohn's
RA
(chronic infections): TB
Malignancy
Chronic kidney disease
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31
Q

Why does sideroblastic anaemia come about?

A

There is impaired utilisation of iron delivered to developing erythroblasts

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32
Q

What is sideroblastic anaemia characterised by? (3)

A
  • refractory anaemia
  • hypochroic cells in peripheral blood
  • ring sideroblasts in the BM
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33
Q

Sideroblastic anaemia may be inherited, alternatively it may be acquired - how? (4)

A

Myelodysplasia (ineffective production of blood cells)
Alcohol excess
Lead toxicity
Isoniazid

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34
Q

What is the first investigation to order in macrocytotic anaemia.

A

Serum B12 measurement and red cell folate

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35
Q

What are the 2 subdivisions of macrocytic anaemia? How is it determined?

A

Megaloblastic
Non-megaloblastic
Examination of the bone marrow

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36
Q

What do lymphoid stem cells give rise to?

A

Pre T cells (which become T suppressor, T helper, NK cells)

Pre B cells (which become B cells and plasma cells)

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37
Q

What do mixed myeloid progenitor cells give rise to?

A

Units for production of RBCs, platelets, monocytes, neutrophils, eosinophils, basophils

38
Q

Name 4 factors that stimulate production from mixed myeloid progenitor cells? Where do each come from?

A

Erythropoietin (RBCs)
Thrombopoietin (platelets)
Neutrophils (granulocyte colony stimulating factor/G-CSF)
IL 5 (eosinophils)

39
Q

Name a factor that inhibits production from mixed myeloid progenitor cells?

40
Q

What are reticulocytes?

A

Young red cells released form the BM, they still contain RNA

41
Q

What size are they in relation to RBCs? And what proportion of circulating RBCs do they normally represent?

A

Larger

0.5-2.5%

42
Q

What is the reticulocyte count a measure of?

A

Erythroid activity in the bone marrow

43
Q

When is there an increase in the reticulocyte count?

A

Haemmorhage, haemolysis, treatment with haematinics

44
Q

Fill the gaps:

Megaloblastic anaemia is characterised by the presence in the __ __ of developing __ __ __ with delayed __ maturation relative to that of the __.

A

Bone marrow
Red blood cells
Nuclear
Cytoplasm

45
Q

What is the mechanism underlying megaloblastic anaemia?

A

Defective DNA synthesis

46
Q

What else does the defective DNA synthesis underlying megaloblastic anaemia affect?

A

White cells

Platelets

47
Q

How might the neutrophils appear in megaloblastic anaemia? And the platelets?

A 
Hypersegmented
Thrombocytopenia (decr platelet count. NB - thrombocytes = platelets)
48
Q

What are the two most common forms of megaloblastic anaemia? Why?

A

Vitamin B12, folate

They are necessary for DNA synthesis

49
Q

Where in the diet is B12 found?

A

Meat and dairy (especially red meat)

50
Q

Where is B12 absorbed?

A

Terminal ileum

51
Q

Where is B12 stored in the body? How long would the supply last?

A

Liver

2+ years

52
Q

What is the most common cause of B12 deficiency in the western world?

A

Pernicious anaemia

53
Q

What is pernicious anaemia?

A

Autoimmune condition where this atrophic gastritis = loss of parietal cells and failure of intrinsic factor production and malabsorption.

54
Q

What are the 3 main causes of B12 deficiency?

A 
Low dietary intake (vegans)
Impaired absorption (stomach: pernicious anaemia, post gastrectomy, and terminal ileum: ileal resection, Crohn's)
Abnormal utilisation
55
Q

What effect does nitrous oxide have on B12?

A

Inactivates it

56
Q

What are the neurological symptoms of B12 deficiency?

A

Polyneuropathy caused by symmetrical damage to the peripheral nerves and posterior and lateral columns of the spinal cord.

57
Q

How will posterior and lateral spinal cord damage present?

A

Progressive weakness, ataxia and eventually paraplegia.

Dementia and visual disturbances due to optic atrophy.

58
Q

What are the clinical features of anaemia?

A

Conjunctival pallor

Signs of hyper dynamic circulation e.g. tachycardia, flow murmurs, cardiac enlargement, retinal haemorrhage

59
Q

What are the values for anaemia?

A

Hb levels -
< 135g/L (men)
< 115g/L (women)

60
Q

Why does anaemia sometimes occur in pregnancy?

A

Incr plasma volume

61
Q

When should you suspect thalassaemia?

A

Microcytic anaemia, when MCV is ‘too low’ for Hb level.

62
Q

In both sideroblastic anaemia and thalassaemia, how will each of the following appear: And why?
Serum Iron
Ferritin
TIBC

A

Incr
Incr
Low

In these conditions there is an accumulation of iron

63
Q

Name 7 causes of normocytic anaemia

A 
Acute blood loss
Anaemia of chronic disease
BM failure
Renal failure
Hypothyroidism
Haemolysis
Pregnanacy
64
Q

What should each of the following be to suspect haemolytic anaemia?
Reticulocytosis levels?
Bilirubin?

65
Q

What drug should you give alongside a blood transfusion?

A

Furosemide

66
Q

What are the clinical signs of IRON deficiency anaemia? (4 - but 3 important ones)

A

Koilonychia
Atrophic glossitis
Angular cheilosis
Post-cricoid webs (Plummer-Vinson syndrome)(upper oesophageal webs)

67
Q

What is the MCV of iron deficient anaemia?

68
Q

In anaemias of chronic disease, what are the 3 problems?

A

Poor use of iron in erythropoiesis
Cytokine-induced shortening of RBC survival
Decr production of and response to erythropoietin

69
Q

When should you think about sideroblastic anaemia?

A

When microcyctic anaemia is not responding to iron.

70
Q

What is the most common reason for macrocytosis? (without accompanying anaemia)

A

Alcohol excess

71
Q

Which of red cell folate and serum folate is a more reliable indicator of folate status? Why?

A

Red cell folate

Serum folate on reflects recent intake

72
Q

Where is folate found in the diet? (4)

A

Green vegetables
Nuts
Liver
Folate

73
Q

What does maternal folate deficiency cause?

A

Neural tube defects (spina bifida)

74
Q

Which drugs can cause folate deficiency?

A

Anti-epileptics
Methotrexate
Trimethoprim

75
Q

Where is folate absorbed?

A

Duodenum/prox jejunum

76
Q

Why should never give folate without B12 unless it is know that B12 levels are normal?

A

Can precipitate/worsen subacute combines cord degeneration

77
Q

What should you give before you give folate supplements? Mem aid?

A

B12 must be given before folate (unless B12 levels known to be normal).
B is before F in the alphabet

78
Q

What are the general clinical signs of B12 deficiency?

A

Anaemia signs

Angular cheilosis/stomatitis, glossitis, ‘lemon skin’ - due to pallor + mild jaundice

79
Q

What are the neuropsychiatric signs of B12 deficiency? (4)

A

Irritability
Depression
Psychosis
Dementia

80
Q

What are the neurological signs of B12 deficiency?

A

Parasthesiae
Peripheral neuropathy
Subacute combined degeneration of the spinal cord

81
Q

What is subacute combined degeneration of the spinal cord?

A

Combination of:

Dorsal column loss = sensory and LMN signs

+

Symmetrical corticospinal tract loss = motor and UMN signs

82
Q

In subacute combined degeneration of the spinal cord, which sense goes first?

A

Vibration and proprioception, leads to ataxia, then stiffness, weakness.
Eventually paraplegia.

83
Q

What is the classic triad of neurological symptoms seen in B12 deficiency? Are each of these associated with upper or lower motor neurone problems?

A

Extensor planters (UMN), absent knee jerks (LMN), absent ankle jerks (LMN).

84
Q

In B12 deficiency, which 2 sensations remain in tact? Why?

A

Pain and temperature.

Spinothalamic tracts are not damaged

85
Q

Can neurological B12 deficiency signs occur without anaemia?

86
Q

What does B12 deficiency often present as? Why?

A

Nighttime falls - due to vision loss (optic atrophy) and ataxia

87
Q

How do you treat B12 deficiency initially?

A

Hydroxocobalamin IM

88
Q

What levels do you need to watch while a patient is on hydroxocobalamin?

89
Q

In B12 deficiency anaemia, what will you see in the marrow?

A

Megaloblasts

90
Q

In B12 deficiency anaemia, what will the levels of reticulocytes be?

A

Decr or normal as production impaired

Acute (8 decks)

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