Anaemia Flashcards
Haemoglobin levels in anaemic Px
In F <120
in M <140
MCV vs MCH
Mean corpuscular volume - mean cell size
Mean corpuscular Haemoglobin (MCH) Haemoglobin amount per RBC
What does MCV tell you?
Microcytic if <80
Normocytic if 80-100
Macrocytic if >100
Causes of Microcytic Anaemia
Iron deficiency
Thalassaemia
lead poisoning
Anaemia of chronic disease (More common in normocytic tho)
What is the commonest cause of microcytic anaemia
Iron Deficiency
What does a blood film look like in iron deficiency anaemia
Hypochromic
RBC look like they have a hole in the middle but they are pale because of low Hb
Causes of Iron deficiency anaemia
inadequate intake - vegetarians/vegans
impaired absorption - Coeliac disease, Crohn’s
Chronic blood loss - menstruation, GI malignancy, Hookworm
Where is iron absorbed in the body?
Duodenum and upper jejunum
Normocytic Anaemia causes?
Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Macrocytic Anaemia causes?
Folate deficiency B12 deficiency Alcohol liver disease Hypothyroidism - why? - check TSH Drugs - phenytoin Reticulocytosis
What does the blood film look like in thalassaemia
Target cells
What is reticulocytosis
Increased reticulocytes (immature RBC)
What is haemolytic anaemia
it is the anaemia caused by haemolysis
haemolysis can be caused by acquired or inherited causes
How does anaemia present
Many are asymptomatic Lethargy Dysponoea Chest pain Sx of cardiac failure Sx related to blood loss - Menorrhagia, altered bowel habits, dyspepsia
What is dyspepsia?
indigestion
75 F seeing GP because of feeling tired and washed out. Lost 1 stone in last 3 Months
What would you ask
Is weight loss intentional?
any pain? abdo pain?
Bleeding from anywhere? vomiting or back passage?
bowel habits?
water works
tell me about your sleep
Swallowing difficulty? did it change since started?
what are the ALARM Symptoms
Anaemia Loss of weight Anorexia Recent osnet of progressive symptoms Malaena/haematamesis Swallowing difficulty? did it change since started?
what is dysphagia
difficulty swallowing
what is odynophagia
painful swallowing
what is malaena
dark sticky faeces mixed with partly digest food and blood
haematemesis
vomiting blood
42M in A&E cuz he “turned yellow”, itching and a little confused
Take a history
When did it start happened before pain? bleeding? PR or vomiting when itchy started? Alcohol?
what to ask about alcohol?
What u drink?
How much in one day
When do u drink
22F in GP complaining of being very tired in last 2 months
Take a history
Sleep travel work stress pain? abdo Sx? cramping? SOB cardiac Sx bleeding? vomiting or PR periods? heavy? bowel habits coeliac?
What Sx can B12 and folate deficiency give
Loose stools
intermittent abdo cramping
macrocytic anaemia
What Sx occur with increased bilirubin
Yellow appearance
Itching
Sideroblastic Anaemia
Microcytic anaemia - think of sideroblastic anaemia when iron Rx is not effective
A bone marrow problem - investigate bone marrow
haemosiderin within mitochondria
Alcoholism
Hereditary
