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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
What is the role of myoglobin?
Facilitates oxygen use and storage in muscles
26
Problems with what aspects of the RBC lifecycle can lead to anaemia?
Erythropoiesis Haemoglobin synthesis Membrane structure Metabolism Intravascular haemolysis Blood loss Removal
27
What types of problems can lead to problems creating Hb?
Mutations in the genes encoding Hb proteins Lack of iron Deficiency in molecules required for DNA synthesis
28
What type of anaemia can mutations in the genes encoding globin proteins lead to?
Haemolytic anaemia
29
Which conditions can occur as a result of mutation of proteins encoding globin proteins?
Thalassaemia Sickle cell disease
30
Deficiency in which molecules required for DNA synthesis can lead to anaemia?
Vitamin B12 Folate
31
What shape is a regular red blood cell?
Biconcave
32
What is the average diameter of a red blood cell?
8 µm
33
What property of red blood cells is required for them to be able to fit through blood vessels?
Flexibility
34
What type of anaemia can occur as a result of abnormal red blood cell membrane structure?
Haemolytic anaemia
35
What can lead to abnormal red blood cell membrane structure?
Abnormalities of membrane proteins
36
What conditions result in abnormal red blood cell membrane structure?
Hereditary spherocytosis Hereditary eliptocytosis
37
What are the 2 main metabolic pathways in red blood cells?
Embden Meyerhof Pathway: - Glucose metabolised to lactate and ATP generated Hexose Monophosphate Pathway: - Glucose-6-phosphate metabolised and NADPH generated
38
What type of anaemia do abnormalities of metabolism lead to?
Haemolytic anaemia
39
Which metabolic abnormalities can lead to anaemia?
G6PD deficiency Pyruvate kinase deficiency
40
What system is responsible for the removal of damaged or antibody coated red blood cells?
The reticuloendothelial system
41
What organ makes up the majority of the reticuloendothelial system?
Spleen
42
Enlargement of which organ can lead to anaemia?
Spleen
43
What can cause an enlarged spleen?
Liver disease Malaria Malignancy
44
How does an enlarged spleen lead to anaemia?
Increased removal of red blood cells
45
Are abnormal FBC results always indicative of an underlying haematological disorder?
No
46
How should abnormal FBC results be interpreted?
In light of clinical context and any previous FBC results (if known)
47
How is anaemia defined on the basis of an FBC?
Reduced haemoglobin concentration in the blood
48
What is a low haemoglobin count in an adult male?
<130g/L
49
What is a low haemoglobin count in an adult female?
<115g/L
50
What is a low haemoglobin count in a child?
<110g/L
51
What is a low haemoglobin count in a newborn?
<150g/L
52
What cardiovascular adaptations occur as a result of anaemia?
Increased cardiac output Increased stroke volume Tachycardia
53
What other physiological adaptations occur as a result of anaemia?
Shift in the Hb-oxygen dissociation curve Increased erythropoiesis (EPO stimulated)
54
The extent to which physiological adaptations occur as a result of anaemia depends upon what?
Speed of onset Severity Age
55
What are the symptoms of anaemia?
SoB Weakness/lethargy Palpitations Headaches Angina, hearty failure, clarification, confusion
56
What are the signs of anaemia?
Pallor Tachycardia Systolic flow murmur Heart failure
57
What are some specific signs of anaemia?
Koilonychia Glossitis Leg ulceration Angular stomatitis
58
When evaluating anaemia, which factors should be considered?
Reticulocyte count Mean cell volume Mean cell haemoglobin White cell and platelet count
59
What is a normal reticulocyte count?
0.5-1.5% of total red cells
60
What does an absence of an appropriate number of reticulocytes suggest in the setting of anaemia?
RBC are not being produced appropriately
61
When evaluating anaemia, which count should be considered first (after Hb concentration)?
Reticulocyte count
62
If there is an appropriate number of reticulocytes, what should be considered next?
Evidence of haemolysis
63
If there is evidence of haemolysis, what should be done?
Look for the cause of the haemolysis
64
If there is no evidence of haemolysis, what should be looked for?
Evidence of bleeding
65
Other that bleeding and haemolysis, what else can cause anaemia with reticulocytosis?
Splenic sequestration
66
What are some hereditary causes of haemolysis?
Abnormalities of cell membrane Red cell enzymopathies Abnormal haemoglobin
67
What are the types of acquired haemolysis?
Alloimmune Autoimmune Non-immune
68
When screening for haemolysis, what should be looked for on a blood film?
Spherocytes Red cell fragments Polychromasia
69
What else should be looked for during a haemolysis screen?
DCT Bilirubin LDH Haptoglobin Reticulocyte count Urinary haemosiderin
70
What should be assessed next if there is an inappropriate number of reticulocytes?
Mean cell volumn
71
What can microcytic anaemia?
``` Thalassaemia Anaemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anaemia ```
72
What tests should be conducted to investigate iron deficiency?
Ferritin Low serum iron
73
What can cause iron deficiency?
Inadequate intake Increased loss from gut Excessive use
74
How can iron deficiency be treated?
Dietary advice Oral iron supplements Intramuscular iron injections Intravenous iron Transfusion (if cardiac compromise is imminent)
75
How much of dietary iron is absorbed?
10-20%
76
Where are iron supplements absorbed?
Duodenum and jejunum
77
What can inhibit iron absorption?
H2 blockers, PPIs, tetracyclines
78
What should happen in iron deficiency anaemia once a oral iron is administered?
Increase in Hb by 2g/dL in 3 weeks Increased MCV Increased serum ferritin
79
What can cause macrocytosis with hypersegmented neutrophils?
B12 deficiency Folate deficiency Myelodysplasia
80
How long does it take to become B12 deficient?
Many years
81
Who is prone to B12 deficiency?
Vegans/vegetarians
82
What is a gastric cause of B12 deficiency?
Pernicious anaemia
83
What is pernicious anaemia?
Autoantibodies to intrinsic factor required to absorb B12
84
How long does it take to become folate deficient?
Months
85
What can cause folate deficiency?
Diet Malabsorption Sickle cell disease Co-trimoxazole
86
What should be investigated in microcytic anaemia?
B12/folate TFT/LFT Immunoglobulins
87
What can cause normocytic anaemia?
Anaemia of chronic disease Mixed iron and B12/folate deficiency Bone marrow failure
88
What is anaemia of chronic disease associated with?
Chronic inflammation/infection
89
Describe the pathophysiology of anaemia of chronic disease
Cytokines driven reduction in serum iron Reduction in EPO production Reduction in RBC life span
90
What MCV does anaemia of chronic disease cause?
Normocytic/microcytic
91
In anaemia of chronic disease, what are ferritin levels?
Normal or raised
92
In anaemia of chronic disease, what are serum iron levels?
Reduced

ESA 5 - Haematology (3 decks)

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