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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Reduced haemoglobin level

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2
Q

In what situation would there be an anaemia, along with an increased plasma volume and increased red cell mass?

A

Pregnancy

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3
Q

What type of anaemia is iron deficiency anaemia?

A

Microcytic

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4
Q

What causes insufficient red blood cell production?

A

Haematinic deficiency: reduced levels of iron, folate and vitamin B12

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5
Q

What would cause inefficient red blood cell production?

A

Infiltration of the bone marrow i.e. myelodysplasia

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6
Q

What is the most common type of anaemia?

A

Iron deficiency anaemia

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7
Q

Where is iron stored in the body?

A

In the red blood cells themselves

In the liver in the form of ferretin and haemocidrin

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8
Q

What are the causes of iron deficiency anaemia?

A

Reduced intake
Increased demand e.g. pregnancy
Malabsorption
Blood loss

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9
Q

What is the most common cause of iron deficiency anaemia?

A

Blood loss

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10
Q

What are the most common sites of blood loss leading to iron deficiency anaemia?

A

Uterus - menstruating women

GI tract - particularly upper GI tract

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11
Q

What would an FBC show in iron deficiency anaemia?

A

Reduced MCV
Reduced Hb
Reduced ferritin

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12
Q

What are the main causes of non-megaloblastic anaemias?

A

Alcohol intake

Liver disease

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13
Q

What four abnormalities can be noted on blood film in iron deficiency anaemia?

A

Microcytic cells
Hypochromic
Varied size and shape of cells

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14
Q

How is iron deficiency anaemia treated?

A

1st line ferrous fumarate

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15
Q

How long is iron supplementation prescribed?

A

Until underlying cause treated

Used until iron stores replenished and continued for 3 months after Hb back to normal

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16
Q

What is the usual cause of megaloblastic anaemia?

A

B12 or folate deficiency

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17
Q

What is macrocytosis?

A

Increased numbers of large red cells

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18
Q

What is the pathology of the red cell in megaloblastic anaemia?

A

Large red cell with poorly matured nucleus

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19
Q

Why does anaemia occur in B12 or folate deficiency?

A

Causes reduced red cell output as well as abnormal cells as these are required to form proper red blood cells

20
Q

What are the causes of B12 deficiency?

A

Reduced intake (uncommon)
Malabsorption - problems in stomach or ileum
Chronic pancreatitis

21
Q

What auto-antibodies should be tested for in blood?

A

Anti-parietal cell antibodies

Anti-intrinsic factor antibodies

22
Q

What are the problems with autoantibody tests in pernicious anaemia?

A

Anti-intrinsic factor antibodies are specific but not sensitive
Anti-parietal cell antibodies are sensitive but not specific

23
Q

What symptoms specific to B12 deficiency might be seen?

A

Neurological disturbance:
Peripheral neuropathy
Subacute combined degeneration

24
Q

Why are folate and B12 checked together?

A

If folate treatment is given when there is underlying B12 deficiency, it could cause subacute combined degeneration of the spinal cord

25
Q

What are the causes of folate deficiency?

A

Reduced dietary intake (common)
Malabsorption
Increased demand e.g. pregnancy
Drugs e.g. methotrexate, alcohol, anti-convulsants

26
Q

What is the key diagnostic test for folate deficiency?

A

Reduced red blood cell folate

27
Q

How is folate deficiency treated?

A

Oral folate supplements

28
Q

What is the underlying cause of anaemia of chronic disease?

A

Cytokine induced failure of the transfer of iron from reticuloendothelial cells in the bone marrow to normoblasts
IL-6 is produced by macrophages, which stimulate production of hepcidin, blocking the absorption of iron from the gut

29
Q

What illness is anaemia of chronic disease associated with?

A

Chronic infection e.g. TB
Chronic inflammation e.g. Crohn’s
Malignancy

30
Q

Why is NADH important in maintaining efficient oxygen transportation?

A

Iron in the form Fe3+ means the Hb is oxidised
In this state is it not effective at transporting oxygen and so free iron is left to travel in the blood
NADH maintains iron in the Fe2+ state and prevents oxidation of haemoglobin

31
Q

What is the treatment for anaemia of chronic disease?

A

Erythropoetin injections

Regular blood transfusions

32
Q

What are the two main causes of sprurious macrocytosis?

A

Reticulocytosis

Cold agglutination

33
Q

What is a reticulocyte?

A

An immature red blood cell that has just left the bone marrow and is larger than the average red blood cell

34
Q

What does deficiency of any of the components of haemoglobin do to the red blood cell affected?

A

Produces small red blood cells with reduced amounts of haemoglobin

35
Q

What does reticulocytosis indicate?

A

Indicates compensatory erythropoesis is occurring to replenish numbers of red blood cells,

36
Q

What are the two main causes of reticulocytosis?

A

Blood loss

Haemolysis

37
Q

Why does cold agglutinin disease appear as macrocytic anaemia?

A

The analyser gets confused as clumps of ‘agglutinated’ red cells go through and are registered as 1 big cell

38
Q

What is the risk associated with chronic transfusions?

A

Free iron will begin to circulate in the blood and potentially generate free radicals

39
Q

What is needed to make Hb?

A

Haem
Globin
Fe2+
Porphyrin ring

40
Q

What kind of globin is found in adults?

A

Alpha and beta

41
Q

What does deficiency of any of the components of haemoglobin do to the red blood cell affected?

A

Produces small red blood cells with reduced amounts of haemoglobin

42
Q

What is thalassaemia?

A

An autosomal recessive disorder causing abnormal formation of haemoglobin, resulting in a microcytic anaemia

43
Q

Why is iron freely circulating the body toxic?

A

It can generate free radicals

44
Q

What form is iron stored in when not bound to haemoglobin?

A

Ferritin

45
Q

What is the risk associated with chronic transfusions?

A

Free iron will begin to circulate in the blood and potentially generate free radicals

46
Q

What is transferrin?

A

A transporter molecule with two binding sites for iron

47
Q

When is transferrin saturation reduced?

A

It reflects supply of iron, therefore reduced in iron deficiency and anaemia of chronic disease

Haematology (9 decks)

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