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3/ IIH > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What are the parameters for anaemia in men and women?

When may these ranges be different?

A

Hb <130g/L in men
Hb <120g/L in women
In pregnancy, extremes of age, different labs

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2
Q

What are the three layers of a centrifuged blood sample and what is contained in each?
What are their relative %’s?

A 
Plasma 55% (91% water)
- plasma proteins
- electrolytes
- hormones
- nutrients 
Buffy coat
- platelets 
- white cells
Red cells
45%
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3
Q

Describe the structure and function of erythrocytes

A

Biconcave –> deform easily
No nucleus –> more Hb
O2 and CO2 transport

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4
Q

What are the four types of haemoglobin?
What chains are they made up of?
What is their quantity in normal adult blood?

A

HbA, alpha x 2, beta x2, >95%
HbA2, alpha x2 delta x2, <3.5%
HbF, alpha x2, gamma x2, <1%
HbS, alpha x2, 2 beta x2 (sickle mutation), Pathological

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5
Q

How does the oxygen dissociation curve shift in relation to pH, temperature, CO2, 2,3DPG, Haemoglobin type

A
  • low pH shifts curve right
  • higher temperature shifts curve right
  • high CO2 shifts curve right
  • high 2,3DPG shirts curve right
  • HbF is left shifted, HbS is right shifted, methaemoglobin is right shifted
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6
Q

Explain the impact of 2,3DPG on oxygen affinity

A

High levels of 2,3DPG reduces oxygen affinity.
When oxygen is released, the beta chains of Hb are pulled apart, allowing entry of 2,3DPG, This results in lower affinity of HB for oxygen and improved delivery for O2 to the tissues

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7
Q

What can anaemia be due to? x3

A

Lack of blood
Reduction in Hb
Reduction in red cells
Reduction in haematocrit

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8
Q

What is meant by ‘aneamia is relative’? Give an example

A

Hb concentration is dependent on plasma volume.
For example, in pregnancy plasma volume is increased so Hb concentration appears to be lowered but oxygen capacity has not changed

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9
Q

What’s in the full blood count?

A 
Haemoglobin
- haematocrit 
- red blood count
- mean cell volume
- mean cell haemoglobin
White Blood Count (+differential)
Platelet Count
Reticulocyte Count
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10
Q

What are the symptoms of anaemia?
What are the signs of anaemia?
What do the clinical features depend on?

A

Symptoms
- fatigue, breathlessness, palpitations, audible pulse, angina
Signs
- pallor, tachycardia, bounding pulse, flow murmur, signs of heart failure
Depend on:
- Hb level, time taken to fall (adaptation), cause, concurrent changes (e.g. 2,3DPG), other organ reserve

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11
Q

What are the two classic signs on anaemia on inspection?

A

koilonychia - spooned fingernails

angular stomatitis - inflammed corners of mouth

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12
Q

How can anaemia be classified?

A

In terms of cause

  • Reduced production
  • Destruction
  • Poor function

In terms of mean cell volume (MCV)

  • microcytic
  • normocytic
  • macrocytic
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13
Q

List the causes of anaemia that result in reduced production

A 
Deficiencies
- iron: dietary, malabsorption, bleeding
- B12
- folate
Bone marrow pathology 
- aplastic anaemia 
- myelodysplasia
- myeloma
Displacement in bone marrow
- leukaemia 
- other cancer
- myelofibrosis
Chronic disease
- renal failure
- myeloma
- chronic inflammatory conditions
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14
Q

List the causes of anaemia that result in destruction of red cells

A

Haemolysis (increased reticulocytes)
- immune (destroyed in spleen)
- non-immune
Bleeding

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15
Q

List the causes of anaemia that result in poor function of red cells (mostly congenital, also haemolysis)

A 
Membrane defect
- hereditary spherocytes
- hereditary elliptocytosis
Haemoglobin defect
- sickle cell anaemia
- thalassaemia 
Enzyme defect
- G6PD 
- pyruvate kinase deficiency
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16
Q

How is the parvo virus related to anaemia?

A

Childhood virus, usually incocuous
Affects those with congenital anaemias
Shits down bone marrow for 4-5 days
Patients cannot compensate so go into stress

17
Q

What is aplastic anaemia?

A

Autoimmine disorder against production of all 3 blood counts

18
Q

What is myelodysplasia?

A

Older age, wear and tear
Can be precancerous
Similar to barrels oesophagus

19
Q

What is myeloma?

A

Cancer of plasma cells, look at IG cells

20
Q

What is myelofibrosis?

A

Scarring in bone marrow

21
Q

What is haemantic absorption the absorption of?

Where are they absorbed?

A

Absorption of B12, folate and iron
B12 absorbed in terminal ileum, requires IF from stomach parietal cells
Folate is absorbed in the duodenum and jejunum
Iron is absorbed in duodenum

22
Q

What is hereditary spherocytosis?
What are some of the symptoms?
What is the treatment?

A
  • Mutation in cytoskeleton proteins, spectrin and ankyrin,
  • Autosomal dominant
  • Symptoms of haemolysis: slenomegaly, increased bilirubin, increased reticulocyte
  • Treatment: folic acid, splenectomy, rarely transfusion
23
Q

If the red blood cells are small what are the two most likely causes? How can these be differentiated?

A

Iron deficiency = low blood cell count

Thallasemia = high blood cell count

24
Q

What is thalassemia?

What is the treatment for major? What is a complication?

A

Alpha or beta global chain disorder
Major, intermedia or minor
Features of haemoylsis (increased reticulocytes, increased bilirubin, splenomegaly)
Treatment is transfusion, iron overload syndromes
Transfused at 6 months, given more than needed in order to turn off bone marrow

25
Q

What is sickle cell anaemia?

A

Autosomal recessive
Glutamic acid –> valine at positive 6 of beta global gene
Deoxygenation –> polymerisation of Hb
Obstructed capillaries –> painful crises and end organ damage
Hyposplenism
Treatment includes exchange transfusion and hydroxycarbamide

26
Q

What G6PD deficiency?

A

ATP required for membrane shape, ion exchange and reduce methaemoglobin to deoxyhaemoglobin
Mature red cells are unable to synthesise protein and have no mitochondria
ATP form anaerobic glycolysis
Red cells unable to manage oxidative stress s
Favism
X-linked

27
Q

What are the clinical features of congenital anaemias?

What are the laboratory evidence of haemolysis?

A

jaundice
splenomegaly
anaemia
gallstones

anaemia, hyperbilirubinaemia, reticulocytosis, raised LDH, reduced haptoglobin, direct anti globulin test negative

28
Q

Categorise the causes of anaemia a in terms of MCV

A 
Microcytic
- iron deficiecny
- thalassaemia
- chronic disease (less common)
- sideroblastic anaemia
Normocytic
- acute bleeding
- anaemia of chronic disease 
Macrocytic
- B12/folate deficiency
- haemolysis
- durgs
- myelofibrosis
- alcohol excess and liver disease
hypothyroidism, pregnancy
29
Q

What are the basic investigations for anaemia?

A

Full history
Examination

Full blood count
Ferritin, B12 and folate
Biochemistry: liver and kidney function
Haemolysis screen
Immunoglobulins

3/ IIH (28 decks)

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