Anaemia Flashcards
What Hb values indicate an anaemia?
Men: <13.5 (135)
Women: <11.5 (115)
How can the causes of anaemia be categorised?
Macro / Normo / Microcytic
Causes of macrocytic anaemia?
FAT RBC
Folate/B12 Antifolate drugs Thyroid disorder (hypo) Reticulocytosis Booze Cirrhosis
Causes of normocytic anaemia?
Acute blood loss
Anaemic of chronic disease
Marrow failure
Pregnancy
Causes of microcytic anaemia?
Find Those Small Cells
Fe deficiency
Thal
Sideroblastic anaemia (bone marrow produces abnormal red cells)
Chronic disease
Which cause of anaemia does not fall into the 3 categories?
Haemolytic anaemia - due to increased RBC breakdown
Causes of iron deficiency anaemia?
Blood loss i.e. GI bleed/period
Impaired iron absorption i.e. in coeliacs
Dietary insufficiency
Clinical presentation of someone with an IDA
Signs:
- koilonychia
- Angular stomatitis
Symptoms:
- fatigue
- dyspnoea
- tinnitus
- headache
- palpitations
- pre-syncope
Investigations to order in suspected IDA
Haematinics: ferritin (low) + total iron binding capacity (inc) + transferrin saturation (low)
FBC: Hb, MCV, MCH (all low)
Film: looking for poikilocytosis + anisocytosis
If Hx does not suggest obvious blood loss site then scope
Management of IDA
- Treat underlying cause
2. Ferrous sulphate
Most common cause of B12 def. in UK?
Pernicious anaemia
Pathophysiology of pernicious anaemia
B12 requires intrinsic factor to be absorbed
Intrinsic factor secreted by parietal cells of stomach
PA = autoimmune gastritis + Ab against gastric parietal cells = less secretion of intrinsic factor
Importance of B12
DNA and myelin synth.
other causes of B12 def. excluding pernicious anaemia
Surgery to terminal ileum
Diet low in B12 (vegans)
Chronns
Clinical presentation of B12 def.
Symptoms of anaemia Glossitis Mild jaundice Weight loss Angular stomatitis
Which spinal condition can pernicious anaemia lead to?
Subacute Combined Degeneration of the Cord
- results in distal sensory loss
- pain and temperature sensation remains the same
Investigations to request in suspected B12 def.
Serum B12
Antibodies against gastric parietal cells
Thyroid antibodies and function
Schilling test (B12 swallow test)
Management of B12 deficiency
Replenish B12 stores by IM or oral
Which subgroup of people is pernicious anaemia more likely in?
Blood group A
>40 and above
Causes of folate deficiency
- Dietary insufficiency
- Malabsorbtion
- Increased requirement in pregnancy
- Folate antagonist drugs like methotrexate
Management of folate deficiency anaemia
Folic acid
Treat any underlying cause
