Anaemia Flashcards
1
Q
Pathophysiology
A
- hypovolaemia- GI bleed, trauma, menorrhagia.
- increased RBC breakdown- malaria, sickle cell, sphero or elliptocytosis.
- decreased production- iron deficiency, folate deifciency, B12 deficiency, bone marrow neoplasm, renal disease less EPO and abnormal substance accumululation.
2
Q
Definition
A
Low Hb concentration due decreased RBC mass or increased plasma volume. Reduced production or increased loss.
Under 1355g/L men, 115 women.
3
Q
Symptoms
A
Fatigue, weakness, lethargy SOB Dyspnoea Faintness Palpitations Headache Tinnitus Anorexia Pallor Altered taste Angina, HF, claudication, confusion. Mood change Peripheral neuropathy Haemolytic- jaundice, dark urine.
4
Q
Signs
A
Can be none even if severe Pallor Hyperdynamic circulation eg tachy, systolic flow murmur, cardiac enlargement, retinal haemorrhage, later HF. Koilonykia Atrophic glossitis Jaundice Hepatosplenomegaly Gallstones Leg ulcer Angular stomatitis HF
5
Q
Management
A
Treat cause Fe supplement Transfusion only if very severe Search for bleed if iron deficiency suggested Renal transplant Recombininant EPO
6
Q
Diagnosis
A
FBC for RBC count and Hb
Blood film
Folate, Fe and B12 levels
Investigate internal bleeding
7
Q
Differentials
A
Haemoglobinopathy eg sickle, thalassaemia, Hb uria. Enzyme deficiency (PK) Meds AI Trauma to RBCs eg fragmentation Ovalocytosis Liver disease Osmotic fragility in hereditary sphero and elliptocytosis G6PD deficiency Infection Splenic destruction Transfusion related eg thalassaemia
8
Q
Low MCV microcytic
A
- Causes- TAILS Thalassaemia Anaemia of chronic disease Iron deficiency Lead Sideroblastic Blood loss Poor diet Malabsorption Hookworm
9
Q
Normal MCV normocytic
A
Acute blood loss chronic disease bone marrow fail renal fail hypothyroid haemolysis pregnancy myeloma
10
Q
High MCV macrocytic
A
Causes-
- B12 deficiency eg pernicious autoAb to IF, vegan, crohns, gastrectomy, tapeworm, metformin, NO tx, alcohol.
- folate deficiency or antifolates eg phenytoin.
- alcoholism/liver disease
- poor diet or poor absorption eg coeliac, malignancy
- lactation
- reticulocytosis
- cytotoxics
- marrow infiltration
- drugs eg trimethoprim, methotrexate, sulfasalazine.
11
Q
Anaemia of chronic disease
A
malignancy inflammation eg RA infection eg TB renal fail Vasculitis
12
Q
Drug effects
A
- Drugs that interfere with Fe absorption- cimetidine, ranitidine.
- Fe can decrease absorption of- tatracyclines, quinolones, levodopa, levothyroxine.
13
Q
haemolytic normo or macrocytic
A
Causes- -autoimmune -infection eg malaria -G6PD and PK deficiency -hereditary sphero or elliptocytosis -sickle cell -thalassaemia Sickle cell- beta chain glu to val causes HbS not HbA. HbS polymerises when deO forming fragile deformed cells. Pain triggered by cold, dehydration, infection, hypoxia.
14
Q
Explanation
A
- RBCs are cells in the blood that carry oxygen. The part that carries it is called haemoglobin. Anaemia is where you dont have enough functional Hb so cant get enough oxygen around the body.
- LT this will dad to worsening symptoms and can cause damage to organs that use a lot of oxygen from the blood.
- can be related to diet- so foods high in iron and folate.
- iron supplements
