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Case 11 Anaemia > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is the normal range for Haemoglobin?

A

Male - 133-167 g/L

Female - 118-148 g/L

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2
Q

What is the normal range for MCV?

A

82-98 fL

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3
Q

What is MCV

A

It is the mean corpuscular volume, or mean cell volume (MCV) and it is a measure of the average volume of a red blood corpuscle (or red blood cell).

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4
Q

What are the symptoms of anaemia

A

Fatigue, weakness, pale skin, yellow skin (haemolytic), irregular hearbeat, SoB, dizziness, chest pain, cold hands and feet, headache

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5
Q

How does microcytic anaemia show on blood tests?

A

FBC - Low Hb, Low MCV, Low MCH

Blood film - usually hypochromic

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6
Q

How does normocytic anaemia show on blood tests?

A

FBC - low Hb. normal MCV, normal MCH

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7
Q

How does macrocytic anaemia show on blood tests?

A

FBC - low Hb, high MCV, normal MCH

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8
Q

What are the causes of macrocytic anaemia?

A

B12 deficiency, folate deficiency, alcohol excess, reticulocytosis, cytotoxics, myelodysplatic syndromes, marrow infiltration, hypothyroidism

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9
Q

What are the causes of normocytic anaemia?

A

Acute blood loss
Anaemia of chronic disease or secondary anaemia
Anaemia of Renal failure (deficiency of erythropoietin)
Bone marrow failure
Hypothyroidism
Haemolysis
Pregnancy

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10
Q

What does hepcidin do?

A

It controls the absorption of iron from the GI tract via its effect on ferroportin. An increase in Hepcidin cause Ferroportin to degrade, reducing Ferroportin levels prevents iron release from GI tract enterocytes into the bloodstream and also traps iron in the marrow macrophages and vice versa.

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11
Q

What are the causes of microcytic anaemia?

A

Iron deficiency anaemia (IDA)
Thalassemia
Sideroblastic anaemia

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12
Q

What are the causes of IDA?

A

Blood loss, poor diet/poverty, malabsorption (coeliac disease), hookworm

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13
Q

How is IDA diagnosed? (4)

A

Low Hb, Low MCV, low MCH. Confirmed by decreased ferritin.

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14
Q

What are signs and symptoms of IDA?

A

tiredness, lethargy, headache, pica, smooth/painful tongue, koilonychia, brittle nails, hair loss

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15
Q

What is the treatment for IDA?

A 
Treat underlying cause
Iron Tablets (ferrous sulphate 200mg/8h) for at least 3 months once Hb normalises
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16
Q

What is macrocytosis?

A

Macrocytosis is the enlargement of red blood cells with near-constant hemoglobin concentration, and is defined by a mean corpuscular volume of greater than 96fL. It may not be accompanied by anaemia.

17
Q

What are causes of macrocytosis?

A

Megaloblastic - B12, folate deficiency, cytotoxic drugs

non-megaloblastic - alcohol excess, reticulocytosis, liver disease, hypothyroidism, pregnancy

Other haematological disorders - Myelodysplasia, myeloma, myeloproliferative disorders, aplastic anaemia.

18
Q

How is is megaloblastic anaemia diagnosed?

A

FBC - ?low RBC, raised MCV

Blood film - hypersegmented neutrophils in B12 and folate.

Bone Marrow Biopsy

19
Q

What are the signs and symptoms of B12 and folate deficiency?

A

Mild jaundice, anaemia, glossitis, angular stomatitis, neuropathy (peripheral neuropathy, cord degen, optic neuropathy, dementia)

20
Q

What is the treatment for folate deficiency?

A

Assess underlying cause

Oral Folic acid 5mg/day. ALWAYS With B12 (unless levels in range) as may precipitate subacute degeneration of the cord.

21
Q

What are the causes of folate deficiency?

A

Nutritional, increased demand, malabsorption, alcohol, drugs, increased turnover, excess loss

22
Q

What are the causes of B12 deficiency?

A

Nutritional, malabsorption (gastric surgery, pernicious anaemia, ideal resection, Crohn’s disease, coeliac, CF)

23
Q

What is sickle cell anaemia?

A

It is an autosomal recessive disorder which causes sickle-shaped RBCs. The production of abnormal haemoglobin results in vaso-occlusive crises. It results when the child inherits the abnormal Hb S gene from both parents, making the child Hb SS

24
Q

How is sickle cell disease diagnosed?

A

Bloods - low Hb, high reticulocyte count, low MCV, increased bilirubin

Blood film - sickle and target cells

Sickle solubility test

Hb electrophoresis - distinguishes between HbSS and HbAS

25
Q

What is a long-term treatment for sickle cell?

A

Hydroxyurea

Stem cell transplantation

26
Q

What are the complications of sickle cell?

A

Crises, stroke, acute chest syndrome, pulmonary HTN, increased vulnerability to infection

27
Q

What is Autoimmune haemolytic anaemia?

A

Mediated by autoantibodies causing mainly extravascular haemolysis and spherocytosis. Classify according to optimal binding temperature to RBCs.

28
Q

What is warm AIHA?

A

IgG-mediated and coombs test +ve, bind at body T° 37°C. Rx: Steroids/immunosuppressants (± splenectomy). - HIGH DOSE PREDNISOLONE (30mg BD)

29
Q

What is cold AIHA?

A

IgM-mediated, bind at low T° (<4°C), activating cell-surface complement in Coombs test (DAT). Causes a chronic anaemia made worse by cold, often with Raynaud’s or acrocyanosis. Rx: keep warm. Chlorambucil may help.

30
Q

What is haemolytic anaemia?

A

Anaemia due to the destruction of RBCs

31
Q

What are the investigations for haemolytic anaemia?

A
  • FBC with reticulocytes
  • Blood film
  • Bilirubin
  • lactic dehydrogenase
  • Coomb’s test
32
Q

How does hereditary spherocytosis present?

A 
failure to thrive
jaundice, gallstones
splenomegaly
aplastic crisis precipitated by parvovirus infection
degree of haemolysis variable
MCHC elevated
33
Q

What is the treatment for Beta-thalassaemia major

A

Life-long blood transfusions

34
Q

What are the two features of Beta-thalassaemia trait?

A

raised HbA2

mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia

Case 11 Anaemia (1 decks)

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