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ESA 5 - Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What are the cells that form in the process of erythropoiesis?

A

Multipotent haemopoietic stem cell

Common myeloid progenitor cell

Early normoblast

Intermediate normoblast

Late normoblast

Reticulocyte

Erythrocyte

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2
Q

Where does erythropoiesis take place?

A

Bone marrow

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3
Q

What process occurs within in intermediate and late normoblast?

A

Haemoglobin accumulation

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4
Q

What process occurs as a late normoblast becomes a reticulocyte?

A

Ejection of the nucleus

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5
Q

How many red blood cells are produced daily by bone marrow?

A

10^12

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6
Q

What hormone regulates erythropoiesis?

A

Erythropoietin

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7
Q

Where is 90% of erythropoietin produced?

A

Kidneys

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8
Q

Erythropoietin production is stimulated by what?

A

Hypoxia

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9
Q

What initial effect does erythropoietin have?

A

Increases the number of erythroid progenitor cells

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10
Q

What happens to the erythroid progenitor cells?

A

They proliferate, differentiate and produce Hb

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11
Q

What is another name for erythropoietin?

A

EPO

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12
Q

What sort of feedback does red blood cell production as a result of EPO production have on the kidneys?

A

Negative feedback

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13
Q

What is the effect of the negative feedback exerted on the kidneys by increase RBC production?

A

Decreased EPO production

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14
Q

What chronic condition can cause decreased EPO production?

A

CKD

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15
Q

As a result of decreased EPO production, CKD can lead to what presentation?

A

Anaemia

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16
Q

What sort of molecule is haemoglobin?

A

Tetrameric

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17
Q

How many pairs of globin chains make up haemoglobin?

A

2 pairs of identical chains

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18
Q

What does each globin chain have?

A

Its own harm group

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19
Q

How many configurations can haemoglobin exist in?

A

2

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20
Q

What are the two configurations of haemoglobin?

A

High affinity structure

Low affinity structure

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21
Q

What peptide chains make up adult haemoglobin?

A

2 x α-chains + 2 x β-chains

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22
Q

What peptide chains make up foetal haemoglobin?

A

(2 x α-chains) + (2 x γ-chains)

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23
Q

What are the functions of haemoglobin?

A

Carriage of O₂ form lungs to tissues

Carriage of CO₂ from tissues to lungs

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24
Q

Iron is essential for the formation of which molecules?

A

Hb

Myoglobin

Cytochromes

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25
Q

What is the role of myoglobin?

A

Facilitates oxygen use and storage in muscles

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26
Q

Problems with what aspects of the RBC lifecycle can lead to anaemia?

A

Erythropoiesis

Haemoglobin synthesis

Membrane structure

Metabolism

Intravascular haemolysis

Blood loss

Removal

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27
Q

What types of problems can lead to problems creating Hb?

A

Mutations in the genes encoding Hb proteins

Lack of iron

Deficiency in molecules required for DNA synthesis

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28
Q

What type of anaemia can mutations in the genes encoding globin proteins lead to?

A

Haemolytic anaemia

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29
Q

Which conditions can occur as a result of mutation of proteins encoding globin proteins?

A

Thalassaemia

Sickle cell disease

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30
Q

Deficiency in which molecules required for DNA synthesis can lead to anaemia?

A

Vitamin B12

Folate

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31
Q

What shape is a regular red blood cell?

A

Biconcave

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32
Q

What is the average diameter of a red blood cell?

A

8 µm

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33
Q

What property of red blood cells is required for them to be able to fit through blood vessels?

A

Flexibility

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34
Q

What type of anaemia can occur as a result of abnormal red blood cell membrane structure?

A

Haemolytic anaemia

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35
Q

What can lead to abnormal red blood cell membrane structure?

A

Abnormalities of membrane proteins

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36
Q

What conditions result in abnormal red blood cell membrane structure?

A

Hereditary spherocytosis

Hereditary eliptocytosis

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37
Q

What are the 2 main metabolic pathways in red blood cells?

A

Embden Meyerhof Pathway:
- Glucose metabolised to lactate and ATP generated

Hexose Monophosphate Pathway:
- Glucose-6-phosphate metabolised and NADPH generated

38
Q

What type of anaemia do abnormalities of metabolism lead to?

A

Haemolytic anaemia

39
Q

Which metabolic abnormalities can lead to anaemia?

A

G6PD deficiency

Pyruvate kinase deficiency

40
Q

What system is responsible for the removal of damaged or antibody coated red blood cells?

A

The reticuloendothelial system

41
Q

What organ makes up the majority of the reticuloendothelial system?

A

Spleen

42
Q

Enlargement of which organ can lead to anaemia?

A

Spleen

43
Q

What can cause an enlarged spleen?

A

Liver disease

Malaria

Malignancy

44
Q

How does an enlarged spleen lead to anaemia?

A

Increased removal of red blood cells

45
Q

Are abnormal FBC results always indicative of an underlying haematological disorder?

A

No

46
Q

How should abnormal FBC results be interpreted?

A

In light of clinical context and any previous FBC results (if known)

47
Q

How is anaemia defined on the basis of an FBC?

A

Reduced haemoglobin concentration in the blood

48
Q

What is a low haemoglobin count in an adult male?

A

<130g/L

49
Q

What is a low haemoglobin count in an adult female?

A

<115g/L

50
Q

What is a low haemoglobin count in a child?

A

<110g/L

51
Q

What is a low haemoglobin count in a newborn?

A

<150g/L

52
Q

What cardiovascular adaptations occur as a result of anaemia?

A

Increased cardiac output

Increased stroke volume

Tachycardia

53
Q

What other physiological adaptations occur as a result of anaemia?

A

Shift in the Hb-oxygen dissociation curve

Increased erythropoiesis (EPO stimulated)

54
Q

The extent to which physiological adaptations occur as a result of anaemia depends upon what?

A

Speed of onset

Severity

Age

55
Q

What are the symptoms of anaemia?

A

SoB

Weakness/lethargy

Palpitations

Headaches

Angina, hearty failure, clarification, confusion

56
Q

What are the signs of anaemia?

A

Pallor

Tachycardia

Systolic flow murmur

Heart failure

57
Q

What are some specific signs of anaemia?

A

Koilonychia

Glossitis

Leg ulceration

Angular stomatitis

58
Q

When evaluating anaemia, which factors should be considered?

A

Reticulocyte count

Mean cell volume

Mean cell haemoglobin

White cell and platelet count

59
Q

What is a normal reticulocyte count?

A

0.5-1.5% of total red cells

60
Q

What does an absence of an appropriate number of reticulocytes suggest in the setting of anaemia?

A

RBC are not being produced appropriately

61
Q

When evaluating anaemia, which count should be considered first (after Hb concentration)?

A

Reticulocyte count

62
Q

If there is an appropriate number of reticulocytes, what should be considered next?

A

Evidence of haemolysis

63
Q

If there is evidence of haemolysis, what should be done?

A

Look for the cause of the haemolysis

64
Q

If there is no evidence of haemolysis, what should be looked for?

A

Evidence of bleeding

65
Q

Other that bleeding and haemolysis, what else can cause anaemia with reticulocytosis?

A

Splenic sequestration

66
Q

What are some hereditary causes of haemolysis?

A

Abnormalities of cell membrane

Red cell enzymopathies

Abnormal haemoglobin

67
Q

What are the types of acquired haemolysis?

A

Alloimmune

Autoimmune

Non-immune

68
Q

When screening for haemolysis, what should be looked for on a blood film?

A

Spherocytes

Red cell fragments

Polychromasia

69
Q

What else should be looked for during a haemolysis screen?

A

DCT

Bilirubin

LDH

Haptoglobin

Reticulocyte count

Urinary haemosiderin

70
Q

What should be assessed next if there is an inappropriate number of reticulocytes?

A

Mean cell volumn

71
Q

What can microcytic anaemia?

A 
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia
72
Q

What tests should be conducted to investigate iron deficiency?

A

Ferritin

Low serum iron

73
Q

What can cause iron deficiency?

A

Inadequate intake

Increased loss from gut

Excessive use

74
Q

How can iron deficiency be treated?

A

Dietary advice

Oral iron supplements

Intramuscular iron injections

Intravenous iron

Transfusion (if cardiac compromise is imminent)

75
Q

How much of dietary iron is absorbed?

A

10-20%

76
Q

Where are iron supplements absorbed?

A

Duodenum and jejunum

77
Q

What can inhibit iron absorption?

A

H2 blockers, PPIs, tetracyclines

78
Q

What should happen in iron deficiency anaemia once a oral iron is administered?

A

Increase in Hb by 2g/dL in 3 weeks

Increased MCV

Increased serum ferritin

79
Q

What can cause macrocytosis with hypersegmented neutrophils?

A

B12 deficiency

Folate deficiency

Myelodysplasia

80
Q

How long does it take to become B12 deficient?

A

Many years

81
Q

Who is prone to B12 deficiency?

A

Vegans/vegetarians

82
Q

What is a gastric cause of B12 deficiency?

A

Pernicious anaemia

83
Q

What is pernicious anaemia?

A

Autoantibodies to intrinsic factor required to absorb B12

84
Q

How long does it take to become folate deficient?

A

Months

85
Q

What can cause folate deficiency?

A

Diet

Malabsorption

Sickle cell disease

Co-trimoxazole

86
Q

What should be investigated in microcytic anaemia?

A

B12/folate

TFT/LFT

Immunoglobulins

87
Q

What can cause normocytic anaemia?

A

Anaemia of chronic disease

Mixed iron and B12/folate deficiency

Bone marrow failure

88
Q

What is anaemia of chronic disease associated with?

A

Chronic inflammation/infection

89
Q

Describe the pathophysiology of anaemia of chronic disease

A

Cytokines driven reduction in serum iron

Reduction in EPO production

Reduction in RBC life span

90
Q

What MCV does anaemia of chronic disease cause?

A

Normocytic/microcytic

91
Q

In anaemia of chronic disease, what are ferritin levels?

A

Normal or raised

92
Q

In anaemia of chronic disease, what are serum iron levels?

A

Reduced

ESA 5 - Haematology (3 decks)

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