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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What are the general causes of anaemia?

A

Not enough red blood cells

Not enough haemaglobin within red blood cells

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2
Q

What are the causes of anaemia to do with erythropoiesis in the bone marrow?

A

Reduced erythropoiesis

Dyserythropoiesis

Haemaglobin synthesis

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3
Q

What are the causes of reduced erythropoiesis?

A

Chronic kidney disease

Empty bone marrow

Infiltration of bone marrow

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4
Q

Why does chronic kidney disease lead to reduced erythropoiesis?

A

Kidneys don’t produce erythropoietin

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5
Q

Why does empty bone marrow lead to reduced erythropoiesis?

A

Lack of cells in bone marrow

lack of precursors of red blood cells

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6
Q

What can cause bone marrow to be empty?

A

Chemotherapy

Parvovirus infection

Aplastic anaemia

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7
Q

Why does infiltration of bone marrow lead to reduced erythropoiesis?

A

Lack of normal haematopoietic cells

lack of precursors of red blood cells

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8
Q

What can bone marrow be infiltrated with?

A

Cancer cells

Fibrous tissue

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9
Q

What is the term for bone marrow infiltrated by fibrous tissue?

A

Myelofibrosis

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10
Q

How is reduced erythropoiesis by chronic kidney disease treated?

A

Give patient erythropoietin hormone

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11
Q

What are the causes of dyserythropoiesis?

A

Anaemia of chronic disease

Myelodysplastic syndromes

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12
Q

Which chronic conditions might anaemia be a symptom of?

A

Chronic inflammatory conditions

  • inflammatory bowel disease e.g. crohn’s, ulcerative colitis
  • rheumatoid arthritis

Chronic infection
-TB

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13
Q

How do some chronic conditions cause anaemia?

A

Bone marrow doesn’t respond to erythropoietin

Increased activity of macrophages
-circulating red cells have reduced lifespan

Inflammatory cytokines increase production of hepcidin

  • less iron absorption in gut
  • less iron release from macrophages
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14
Q

How does anaemia of chronic disease appear on a blood film?

A

Anaemia can be

  • microcytic
  • normocytic
  • macrocytic
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15
Q

What are the levels of inflammatory markers in anaemia of chronic disease? Give examples

A

E.g. ferritin
CRP

both raised

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16
Q

How is anaemia of chronic disease treated?

A

Treat the underlying cause of the anaemia

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17
Q

What is the pathophysiology of myelodysplastic syndromes?

A

Mutations in cells of bone marrow

As a result

  • do not mature
  • produce clones of themselves
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18
Q

How do myelodysplastic syndromes cause anaemia?

A

Proper red blood cells not produced

Red blood cells prematurely destroyed by reticuloendothelial system

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19
Q

How does anaemia caused by myelodysplastic syndromes appear on a blood film?

A

Macrocytic - red blood cells are large

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20
Q

How is myelodysplastic syndrome diagnosed?

A

Look at chromosomal changes in bone marrow cells

Look at bone marrow cells and blood film under microscope

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21
Q

How is anaemia caused by myelodysplastic syndromes treated?

A

Chronic transfusions of red blood cells

Chemotherapy followed by stem cell transplantation in younger patients

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22
Q

What can myelodysplastic syndromes develop into?

A

Acute leukaemia

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23
Q

What are the causes of anaemia to do with haemaglobin synthesis in the bone marrow?

A

Lack of iron

Lack of vitamin B12, folate

Genetic disorders

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24
Q

What are vitamin B12 and folate required for?

A

Nuclear maturation
nuclear division

Cell division

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25
Q

What is seen on a blood film with vitamin B12 and folate deficiency?

A

Macrocytic - red blood cells are large

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26
Q

What causes macrocytic anaemia with vitamin B12 and folate deficiency?

A

Cytoplasm develops faster than nuclear maturation, nuclear division and cell division

red blood cell precursors have large nuclei, are large themselves

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27
Q

What do neutrophils look like with vitamin B12 and folate deficiency?

A

Hypersegmented nuclei

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28
Q

What can prolonged vitamin B12 and folate deficiency lead to?

A

Pancytopenia - low neutrophils and platelets as well as low red blood cells

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29
Q

What is the term for anaemia caused by vitamin B12 and folate deficiency?

A

Megaloblastic anaemia

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30
Q

What are the genetic disorders of haemaglobin synthesis?

A

Sickle cell

Thalassaemia

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31
Q

What is the inhertiance pattern of sickle cell anaemia?

A

Autosomal recessive

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32
Q

What is the genotype of sickle cell anaemia?

A

HbS HbS

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33
Q

What is the cause of sickle cell anaemia?

A

Point mutation in B-globin gene

Valine replaced by glutamate

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34
Q

What are the symptoms of sickle cell anaemia?

A

Anaemia

Haemolytic crises

Vaso-occlusive crises

Aplastic crises

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35
Q

How severe is the anaemia in sickle cell anaemia? Why?

A

Mild

because HbS gives up oxygen more readily than HbA

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36
Q

What happens to HbS with oxygen gas exchange?

A

Deoxygenated HbS

forms polymers of HbS

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37
Q

How do the polymers of HbS affect red blood cells?

A

Cause red blood cells to sickle - form crescent shape

Damage red blood cell membrane

38
Q

How do vaso-occlusive crises present?

A

Pain in ischaemic area

39
Q

Which tissues and organs are usually involved in vaso-occlusive crises? How?

A

Brain - infarct

Lung - infarct

Spleen - infarct, atrophy

Kidney - infarct

Femur - avascular necrosis of head

Skin - ulcers

40
Q

What can trigger a sickle cell crisis?

A

Temperature change e.g. cold

Stress e.g. infection

41
Q

How do sickled red blood cells affect blood flow?

A

Form thromboses in small blood vessels
block blood flow
give ischaemia

42
Q

HbS is common in which ethnic group? Why?

A

African people

because it confers protection against malaria

43
Q

What are the two types of thalassaemias?

A

Alpha

Beta

44
Q

What are the types of alpha thalassaemia?

A

Carrier state

A-thalassaemia trait

HbH disease

Hydrops fetalis

45
Q

What is the genetic defect in the carrier state of alpha thalassaemia?

A

Deletion of a single a-globin gene

46
Q

What are the symptoms of the carrier state of alpha thalassaemia?

A

Asymptomatic

47
Q

What is the genetic defect in the a-thalassaemia trait?

A

Deletion of two a-globin genes

maybe two on same chromosome, or one on each chromosome

48
Q

What are the symptoms of a-thalassaemia trait?

A

Mild anaemia

49
Q

What is the genetic defect of HbH disease?

A

Deletion of three a-globin genes

50
Q

What is produced in HbH disease?

A

Tetramers of b-globin chains

called HbH

51
Q

What are the symptoms of HbH disease?

A

Severe anaemia

52
Q

What appears on a blood film with HbH disease?

A

Target cells

Heinz bodies

53
Q

What is the genetic defect in hydrops fetalis?

A

Deletion of all four a-globin genes

54
Q

What is produced in hydrops fetalis?

A

In the foetus
Gamma-globin tetramers produced
Called HbBart

55
Q

Does a foetus with hydrops fetalis usually survive? Why?

A

No
intrauterine death

HbBart is unable to deliver oxygen to tissues

56
Q

What are the types of B-thalassaemia?

A

B-thalassaemia trait

B-thalassaemia major

57
Q

What is the genetic defect in B-thalassaemia trait?

A

Deletion of one b-globin genes

58
Q

What are the symptoms of B-thalassaemia trait?

A

Mild anaemia

59
Q

What is the genetic defect in B-thalassaemia major?

A

Deletion of both b-globin genes

60
Q

What are the symptoms of B-thalassaemia major?

A

Severe anaemia

61
Q

When do the symptoms of B-thalassaemia major manifest? Why?

A

6-9 months after birth
when HbF switches to HbA
b-globin chains only produced for HbA

62
Q

How is B-thalassaemia major treated?

A

Transfusions

63
Q

What does a blood film with thalassaemia look like? Why?

A

Hypochromic
due to lack of Hb

Microcytic

64
Q

How are red blood cells affected by thalassaemia?

A

Other globin chain produced in excess
precipitates in red blood cell

Developing red blood cells destroyed within bone marrow

Mature red blood cells destroyed within spleen

65
Q

How are organs affected by thalassaemia? Why?

A

Extramedullary haemopoiesis in liver and spleen
giving hepatomegaly, splenomegaly

Expansion of haemopoiesis into bone cortex
gives skeletal abnormalities

Stimulation of erythropoietin production in kidneys

66
Q

How is iron affected by thalassaemia?

A

Iron overload

  • excess absorption of iron in diet, stimulated by ineffective erythropoiesis
  • repeated blood transfusions
67
Q

How is thalassaemia treated?

A

Transfusions with iron chelation

Folate

68
Q

What do target cells look like and why?

A

Darker region in centre of red blood cell

because Hb has precipitated there

69
Q

What are the causes of anaemia to do with red blood cells?

A

Defects in red blood cell

  • structure
  • metabolism

Loss of red blood cells

70
Q

What is the most common inherited condition to do with a defective red blood cell membrane leading to anaemia?

A

Hereditary spherocytosis

71
Q

What are spherocytes?

A

Abnormal red blood cells

are spherical in shape

72
Q

What are elliptocytes?

A

Abnormal red blood cells

rod-like shape

73
Q

What are acanthocytes?

A

Abnormal red blood cells

irregular shape

74
Q

What are the causes of acquired defective red blood cell membranes?

A

Mechanical damage

Heat damage - burns

75
Q

What are some causes of mechanical damage to red blood cells?

A

Heart valves

Vasculitis

Microangiopathy

DIC

76
Q

What is a shistocyte?

A

Fragment of red blood cell

77
Q

What are some defects in metabolism that lead to anaemia?

A

G6PDH deficiency

Pyruvate kinase deficiency

78
Q

What are some causes of loss of red blood cells?

A

Acute - haemorrage

Chronic - ulceration, cancer, excessive menstruation

79
Q

How might chronic blood loss present? Why?

A

Hypochromic microcytic anaemia

due to development of iron deficiency

80
Q

What are the causes of anaemia to do with the reticuloendothelial system?

A

Haemolytic anaemia

81
Q

What is haemolytic anaemia?

A

Anaemia caused by increased red blood cell destruction

82
Q

Where does the extra red blood cell destruction occur in haemolytic anaemia?

A

Intravascular - within blood vessels

Extravascular - reticulendothelial system in spleen, bone marrow, liver

83
Q

What are the causes of haemolytic anaemia?

A

Defective red blood cells
as with many of the causes of anaemia

Autoimmune haemolytic anaemia

84
Q

What is the pathophysiology of autoimmune haemolytic anaemia?

A

Autoantibodies against bind to red blood cell membrane proteins
spleen destroys those red blood cells

85
Q

What are the types of autoimmune haemolytic anaemia?

A

Warm, IgG

Cold, IgM

86
Q

What are the key lab features of autoimmune haemolytic anaemia?

A

Increased reticulocytes

Increased bilirubin

Increased LDH

87
Q

Why are reticulocytes increased with autoimmune haemolytic anaemia?

A

Bone marrow is producing more red blood cell

to compensate for the increased destruction

88
Q

Why is bilirubin increased with autoimmune haemolytic anaemia?

A

Increased breakdown of red blood cells, haemaglobin, haem

haem is broken down into bilirubin

89
Q

Why is LDH increased with autoimmune haemolytic anaemia?

A

Red blood cells are rich in this enzyme

90
Q

How is a shistocyte produced?

A

Mechanical damage to red blood cells

91
Q

What is seen in a blood film with myelofibrosis? Why?

A

Red blood cells are tear-drop shaped

because were squeezed through fibrotic tissue in bone marrow

Haematology (12 decks)

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