Anaemia Flashcards
Symptoms of anaemia
Lethargy SOB Palpitations Headache Koilonychia
Koilonychia
Spoon shaped nails
A sign of iron deficiency anaemia.
5 broad causes of anaemia
Bleeding
Deficiencies: Iron, B12, folic acid.
Haemolytic: Short RBC lifespan, increase in RBC destruction.
BM dysfunction
Poor O2 utilisation or carriage.
Daily requirement for iron
1-3 mg/day
Tests for iron
Serum iron
Total iron binding capacity
Serum transferrin
% Transferrin saturation
Serum ferritin
Total iron binding capacity (TIBC)
This is an alternative measure of serum transferrin.
When there is an increase in iron loss, TIBC increases.
Ferritin
Protein that stores intracellular iron.
% transferrin saturation
The ratio between iron and transferrin. Will detect iron loss of transferrin:iron ratio is very high.
Causes of iron deficiency
Bleeding: menorrhagia, occult GI malignancy, GI ulceration.
Coeliac disease
Crohn’s disease
Pregnancy
Vitamin B12 requirement
1-3 mcg / day
Folic acid requirement
100 mcg/ day
Microcytic hypochromic anaemia
Anaemia that shows small red blood cells.
Causes:
Iron deficiency
Thalassaemia
Macrocytic anaemia
Anaemia characterised by large red blood cells.
Causes:
B12/ folate deficiency
Myelodysplasia.
MCV
Mean corpuscular volume-
Average volume of red blood cells.
Average-: 80-100 fL
Megaloblastic anaemia
Macrocytic anaemia due to Vit B12 or folate deficiency. MCV is too high.
Features:
There is sufficient iron and precursors for cell growth.
BUT there is insufficient supply of precursors for cell division.
B12 deficiency
Vitamin B12 is required for precursors in cell divisions.
Causes:
Pernicious anaemia- autoimmune disease that destroys parietal cells, leads to loss of intrinsic factor.
Post gastric/ Ileal surgery
Crohn’s disease
Parasitic infection- fish tapeworm.
Folate deficiency
Causes megaloblastic anaemia.
Causes:
Dietary- lack of intake
Coeliac and Crohn’s disease
Excess utilisation: chronic haemolysis and pregnancy.
Alcohol
Drugs: phenytoin, methotrexate.
Poor utilisation of iron in the body
Iron can become stuck in macrophages.
This prevents it from being mobilised to early erythroblasts.
Causes for impaired proliferation of erythroid progenitors
Poor response to erythropoietin.
Unavailable iron prevents erythrocyte development.
Sickle cell anaemia
Autosomal recessive genetic condition.
Point mutation in beta-globin gene- HbS, abnormal haemoglobin.
RBC have very short lifespan- 20 days, compared to 100-120.
Episodes of sick cell crisis
Management of sickle cell anaemia
Analgesics
Hydration
Exchange transfusion for blood cells
Thalassaemia
Inherited autosomal recessive genetic condition that alters Hb gene expression.
Features:
Large spleen, liver, heart.
Misshapen bones.
Microcytic, hypochromic cells.
Distributed similarly to incidence of malaria
Bone marrow infiltration
Bone marrow malignancy.
Leukaemia
Lymphoma
Myeloma
Management of chronic anaemia
If iron deficient- oral ferrous sulphate for 3 months
If folate deficient- oral forate for 3 months
If B12 deficient- B12 injections for 3 months
Kidney failure- EPO
