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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia.

A

Low Hb concentration.

May be due to either low red cell mass or increased plasma volume (eg pregnancy).

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2
Q

How is anaemia classified. (2)

A

It is classified according to either red cell morphology or aetiology.

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3
Q

What are the symptoms of anaemia. (5)

A 
Lethargy. 
Shortness of breath. 
Palpitations. 
Chest pains. 
Headaches.
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4
Q

What are the physical signs of anaemia. (3)

A

Pallor (eg conjunctival).
Systolic flow murmur (in severe anaemia).
Specific signs according to the underlying condition.

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5
Q

What are the types of anaemia. (3)

A

Macrocytic.
Normocytic.
Microcytic.

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6
Q

What happens to the MCV of a patient with microcytic anaemia.

A

It is reduced.

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7
Q

What happens to the MCV of a patient with macrocytic anaemia.

A

It is increased.

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8
Q

What conditions can cause a microcytic anaemia. (3)

A

Iron deficiency anaemia.
beta-thalassaemia.
Sickle cell disease.

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9
Q

What is the daily requirement of iron for a female (non-pregnant).

A

1.5mg/day.

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10
Q

What is the daily requirement of iron for a female (pregnant).

A

7.5mg/day.

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11
Q

What is the daily requirement of iron for a male.

A

1mg/day.

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12
Q

Where is iron absorbed.

A

In the small intestine.

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13
Q

What molecule transports iron in the blood.

A

Transferrin.

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14
Q

What molecule stores iron.

A

Ferritin.

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15
Q

What are the causes of iron deficiency anaemia. (4)

A

Chronic blood loss (GI, menstruation).
Malabsorption.
GI malignancy.
Increased physiological demand (eg infancy, puberty, pregnancy).

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16
Q

What should you assume to be the cause of iron deficiency anaemia in the elderly until proven otherwise.

A

Colon cancer.

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17
Q

What are the physical signs of iron deficiency anaemia. (5)

A 
Koilonychia. 
Sore tongue/ atrophic glossitis.
Angular stomatitis. 
Plummer-Vinson syndrome (post-cricoid webbs) rare. 
Painless gastritis.
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18
Q

What is Plummer-Vinson syndrome.

A

Dysphagia secondary to oesophageal web.

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19
Q

What investigations should be carried out in iron deficiency anaemia. (3)

A

FBC.
OGD.
Colonoscopy/barium enema.

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20
Q

What are the blood results in an iron deficiency anaemia. (5)

A 
Low ferritin. 
Low serum iron. 
Raised TIBC. 
Low transferrin saturation. 
Raised soluble transferrin receptor.
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21
Q

What is the treatment for iron deficiency anaemia. (3)

A

Diagnose and treat the underlying cause.
Ferrous sulphate until Hb and MCV normal.
Blood transfusion only if patient is symptomatic or a cardiac patient (keep Hb>10g/dL).

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22
Q

What are some causes of macrocytic anaemia. (8)

A 
Megaloblastic anaemia (vitamin B12 deficiency, folate deficiency). 
Alcohol excess. 
Reticulocytosis. 
Cytocoxics. 
Myelodysplastic syndromes. 
Marrow infiltrates. 
Hypothyroidism. 
Antifolate drugs (eg phenytoin).
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23
Q

What are some causes of normocytic anaemia. (8)

A 
Anaemic of chronic disease (normocytic normochromic anaemia). 
Aplastic anaemia. 
Acute blood loss. 
Haemolysis. 
Bone marrow failure. 
Renal failure. 
Pregnancy. 
Hypothyroidism.
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24
Q

What is megalobastic anaemia.

A

Vitamin B12/folate deficiency.

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25
Q

What is the pathology involved in megaloblastic anaemia.

A

Large erythroblasts in the bone marrow - fully mature due to defective DNA synthesis.

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26
Q

How is B12 usually absorbed.

A

Vitamin B12 binds to intrinsic factor (IF) which is produced by the stomach parietal cells, and then is absorbed in the terminal ileum.

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27
Q

Where is IF produced.

A

The parietal cells in the stomach.

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28
Q

What causes B12 deficiency. (4)

A

Pernicious anaemia deficiency (Ab against gastric parietal cells, IF).
Malabsorption (secondary to Crohn’s disease affecting the terminal ileum, bacterial overgrowth).
Post-total gastrectomy.
Dietary deficiency.

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29
Q

What are the physical signs of vitamin B12 deficiency anaemia. (3)

A

Pernicious anaemia can be associated with other autoimmune conditions.
Neurological manifestations (peripheral neuropathy, subacute combined degeneration of the cord, dementia, depression, psychosis, irritability).
Infertility.
Symptoms of anaemia.
‘Lemon tinge’ to the skin due to combination of pallor and mild jaundice.
Glossitis.
Angular stomatitis.

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30
Q

What tests should be carried out if you suspect a B12 deficiency anaemia. (4)

A

FBC.
IF antibodies test.
Schilling test.
Folate levels.

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31
Q

What do you expect to see in the blood results of a patient with a B12 deficiency anaemia. (5)

A 
Increased MCV. 
Low B12. 
Low platelets. 
Low WBC. 
IF antibodies.
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32
Q

What is the treatment for vitamin B12 deficiency anaemia. (2)

A

IM B12 injections (if cause is due to malabsorption).
Replenish stores with hydroxocobalamin (B12) 1mg IM alternate days (eg for 2 weeks), or until CNS signs improve.
Then maintain the dose with 1mg IM every 3 months for life.
If the cause is dietary, the B12 can be given orally after initial acute course.

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33
Q

Why is a Schilling test performed. (2)

A

A Schilling test is performed to detect whether the body can absorb B12 normally.
It is a test to detect the presence of pernicious anaemia.

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34
Q

How is a Schilling test performed. (5)

A

A small dose of radioactive B12 is given orally with a large intramuscular dose of normal B12.
Urine is collected to see if the radioactive B12 is excreted (and hence has been absorbed).
If negative, then the test can be repeated with the addition of oral IF.
If the test becomes positive after this, then the diagnosis is pernicious anaemia (lack of IF).
If the test is still negative, the diagnosis is small bowel disease.

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35
Q

Where is folate found.

A

In green leafy vegetables.

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36
Q

Where is folate usually absorbed.

A

In the upper part of the small intestine.

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37
Q

What are some causes of folate deficiency. (4)

A

Dietary inadequacy.
Malabsorption.
Increased requirements (pregnancy, haemolysis).
Folate antagonists (eg methotrexate).

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38
Q

What is seen in the blood results of a patient with a folate deficiency. (2)

A

Low folate.

Raised MCV.

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39
Q

What is the treatment for folate deficiency. (2)

A

Folic acid supplements (5mg/day) PO for 4 months.

Never give folate without B12 unless the patient is known to have a normal B12 level.

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40
Q

What are the characteristics of non-megaloblastic anaemia. (6)

A 
Raised MCV. 
Normoblastic bone marrow. 
Low Hb. 
Low or normal platelets, leucocytes.
Elevated ferritin. 
Elevated plasma lactate dehydrogenase (PLD).
41
Q

What are some causes of non-megaloblastic anaemia. (5)

A 
Alcohol excess (common). 
Reticulocytosis. 
Hypothyroidism. 
Physiological (pregnancy). 
Liver disease.
42
Q

What is the treatment for non-megaloblastic anaemia.

A

Treat the underlying cause.

43
Q

What are some causes of anaemia of chronic disease. (5)

A 
Chronic renal failure. 
Chronic infections.
Rheumatoid arthritis. 
Connective tissue diseases. 
Malignant diseases.
44
Q

What is seen on a blood test of a patient with anaemia of chronic disease. (5)

A

Reduced total iron binding capacity (TIBC).
Low or normal soluble transferrin receptor.
Low transferrin saturation.
Low serum iron.
Normal or high ferritin.

45
Q

What is the treatment for anaemia of chronic disease. (2)

A

Treat the underlying cause.

Erythropoietin injections in CRF.

46
Q

What is the cause of aplastic anaemia.

A

Due to a decrease in pluripotential stem cells resulting in pancytopenia.

47
Q

What are some causes of aplastic anaemia. (6)

A

Idiopathic.
Congenital.
Secondary to: drugs (phenytoin, carbamazepine), parvovirus, viral hepatitis, ionizing radiation.

48
Q

What are the symptoms of aplastic anaemia. (6)

A 
Shortness of breath. 
Palpitations. 
Chest pain. 
Bleeding. 
Easy bruising. 
Recurrent infection.
49
Q

What investigations should be carried out in a patient with aplastic anaemia. (5)

A 
FBC. 
Blood film. 
Bone marrow aspirate and trephine. 
LFT.
VIral titres.
50
Q

What is the treatment for aplastic anaemia. (5)

A

Remove or treat precipitant.
Supportive: blood and platelet transfusions, G-CSF (granulocyte cell stimulating factor).
Specific: immunosuppression, bone marrow transplantation.

51
Q

What is the prognosis of aplastic anaemia.

A

It is related to the severity of the disease.

52
Q

What is haemolysis.

A

Abnormal premature destruction of RBCs.

53
Q

What are the two broad causes of haemolysis.

A

Congenital.

Acquired.

54
Q

What are some congenital causes of haemolysis. (4)

A

Hereditary spherocytosis.
Thalassaemia.
Sickle cell disease.
G6PD (glucose-6-phosphate dehydrogenase) defiency.

55
Q

What are some acquired causes of haemolysis. (3)

A

Autoimmune haemolytic anaemia (AIHA).
Microangiopathic haemolytic anaemia (MAHA).
Infection.

56
Q

What are the physical signs of haemolytic anaemia. (5)

A 
Pallor. 
Jaundice. 
Splenomegaly. 
Gallstones (pigmented). 
Leg ulcers.
57
Q

What investigations should be carried out in a patient with suspected haemolytic anaemia. (7)

A

FBC.
Coombs’ test.
Blood film (are there reticulocytes, sickle cells, schistocytes, etc…).
Bilirubin.
LDH.
Urinary urobilinogen.
Thick and thin blood films for malaria if there is a travel history.

58
Q

What will you see in the FBC of a patient with haemolytic anaemia. (5)

A 
Raised unconjugated bilirubin. 
Raised lactate dehydrogenase (LDH). 
Low haptoglobins. 
Raised reticulocyte count. 
Raised urinary urobilinogen.
59
Q

What will be seen in the blood film of a patient with haemolytic anaemia.

A

Polychromasia.

60
Q

What sort of condition is hereditary spherocytosis.

A

Autosomal dominant.

61
Q

What is hereditary spherocytosis.

A

Defect in the cell membrane, resulting in increased cell fragility.

62
Q

What are the clinical signs of hereditary spherocytosis. (4)

A

Splenomegaly.
Mild anaemia.
Reticulocytes on blood film.
Mild hyperbilirubinaemia.

63
Q

What test should be done in a patent with hereditary spherocytosis.

A

Blood film.

64
Q

What is seen on the blood film of a patient with hereditary spherocytosis.

A

Spherocytes.

65
Q

What do spherocytes look like.

A

Small spherical darkly stained RBCs with no central pallor.

66
Q

What is the treatment for hereditary spherocytosis.

A

Nil specific unless symptomatic (splenomegaly).

67
Q

What sort of condition is G6PD deficiency.

A

X linked.

68
Q

What does G6PD normally do.

A

Normally G6PD generates NADPH, which is responsible for maintaining a healthy Hb so that it can withstand the stresses caused by drugs, sepsis, etc…

69
Q

What is the consequence of G6PD deficiency.

A

Deficiency of G6PD means that Hb breaks down under stress resulting in haemolytic anaemia.

70
Q

What are some causes of G6PD haemolysis of RBCs. (7)

A 
Analgesics. 
Antimalarials. 
Antibiotics. 
Neonatal jaundice. 
Infection or acute illness. 
Chronic compensated haemolysis. 
Favism (acute haemolysis after ingestion of broad beans).
71
Q

What is the treatment for G6PD deficiency.

A

Avoidance of drugs known to precipitate haemolysis.

72
Q

What percentage of the world’s population is anaemia.

A

About 30%.

73
Q

What is the basis of megaloblastic anaemia.

A

Vitamin B12 or folate deficiency result in an inability to synthesise new bases to make DNA.

74
Q

What are the two measurements of iron availability. (2)

A

Plasma iron levels.

Total iron binding capacity (TIBC).

75
Q

In men and post-menopausal women, what cause of iron deficiency must be excluded.

A

Malignancy of the GIT must be excluded.

76
Q

What are the typical symptoms of megaloblastic anaemia. (12)

A 
Malaise (90%). 
Breathlessness (50%). 
Paraesthesia (80%). 
Sore mouth (20%). 
Weight loss. 
Altered skin pigmentation. 
Impotence. 
Poor memory. 
Depression. 
Personality change. 
Hallucinations. 
Visual disturbances.
77
Q

What are the physical signs of megaloblastic anaemia. (6)

A 
Smooth tongue. 
Angular cheilosis. 
Vitiligo.
Skin pigmentation. 
Heart failure. 
Pyrexia.
78
Q

What are the usual findings on the blood film of a patient with megaloblastic anaemia. (4)

A

Oval macrocytosis.
Poikilocytosis.
Red cell fragmentation.
Neutrophil hypersegmentation.

79
Q

What sort of paraesthesia is found in B12 deficiency.

A

Glove and stocking distribution.

80
Q

What reflexes are los in vitamin B12 deficiency.

A

Ankle reflexes.

81
Q

What is haemolytic anaemia.

A

Shortening of the lifespan of the RBC of 120days.

82
Q

What are the two broad branches of haemolytic anaemia.

A

Intravascular haemolysis.

Extravascular haemolysis.

83
Q

What is the pathogenesis of extravascular haemolysis.

A

Physiological red cell destruction in the reticulo-endothelial cells in the liver or spleen.

84
Q

What is the pathogenesis of intravascular haemolysis.

A

Red cell lysis occurs within the blood stream due to membrane damage by complement, infections, mechanical trauma or oxidative states.

85
Q

What are the causes of intravascular haemolysis. (4)

A

Membrane damage by complement.
Infections.
Mechanical trauma.
Oxidative stress.

86
Q

What is the incidence of hereditary spherocytosis.

A

1 in 5,000.

87
Q

What is the most common cause of iron deficiency in the elderly.

A

GI blood loss.

88
Q

What is the most common cause of vitamin B12 deficiency in the elderly.

A

Pernicious anaemia.

89
Q

In what percentage of menstruating women is iron-deficiency anaemia present.

A

Seen in up to 14%.

90
Q

What is seen in the blood film of macrocytic anaemia.

A

Hypersegmented polymorphs in B12 and folate deficiency.

91
Q

Define pernicious anaemia.

A

This is caused by an autoimmune atrophic gastritis, leading to achlorhydria and lack of gastric acid intrinsic factor secretion.

92
Q

What is the incidence of pernicious anaemia.

A

1:1,000

93
Q

What is the female:male ratio of pernicious anaemia.

A

1.6:1.

94
Q

What blood group has a higher incidence of pernicious anaemia.

A

Blood group A.

95
Q

What are the associations with pernicious anaemia. (6)

A

Other autoimmune diseases: thyroid disease, vitiligo, Addison’s disease, hypoparathyroidism.
Carcinoma of the stomach is 3 times more common in pernicious anaemia.

96
Q

What is the usual age of diagnosis of pernicious anaemia.

A

> 40.

97
Q

What is the prognosis for patients with pernicious anaemia.

A

Supplementation usually improves peripheral neuropathy within the first 3-6 months.

98
Q

What are the side effects of iron treatment (for iron deficiency anaemia). (4)

A

Nausea.
Abdominal discomfort.
Diarrhoea or constipation.
Black stools.

Haematology (17 decks)

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