Anaemia Flashcards
What is the normal range for Haemoglobin?
Male - 133-167 g/L
Female - 118-148 g/L
What is the normal range for MCV?
82-98 fL
What is MCV
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).
What are the symptoms of anaemia
Fatigue, weakness, pale skin, yellow skin (haemolytic), irregular hearbeat, SoB, dizziness, chest pain, cold hands and feet, headache
How does microcytic anaemia show on blood tests?
FBC - Low Hb, Low MCV, Low MCH
Blood film - usually hypochromic
How does normocytic anaemia show on blood tests?
FBC - low Hb. normal MCV, normal MCH
How does macrocytic anaemia show on blood tests?
FBC - low Hb, high MCV, normal MCH
What are the causes of macrocytic anaemia?
B12 deficiency, folate deficiency, alcohol excess, reticulocytosis, cytotoxics, myelodysplatic syndromes, marrow infiltration, hypothyroidism
What are the causes of normocytic anaemia?
Acute blood loss
Anaemia of chronic disease or secondary anaemia
Anaemia of Renal failure (deficiency of erythropoietin)
Bone marrow failure
Hypothyroidism
Haemolysis
Pregnancy
What does hepcidin do?
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.
What are the causes of microcytic anaemia?
Iron deficiency anaemia (IDA)
Thalassemia
Sideroblastic anaemia
What are the causes of IDA?
Blood loss, poor diet/poverty, malabsorption (coeliac disease), hookworm
How is IDA diagnosed? (4)
Low Hb, Low MCV, low MCH. Confirmed by decreased ferritin.
What are signs and symptoms of IDA?
tiredness, lethargy, headache, pica, smooth/painful tongue, koilonychia, brittle nails, hair loss
What is the treatment for IDA?
Treat underlying cause Iron Tablets (ferrous sulphate 200mg/8h) for at least 3 months once Hb normalises
What is macrocytosis?
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.
What are causes of macrocytosis?
Megaloblastic - B12, folate deficiency, cytotoxic drugs
non-megaloblastic - alcohol excess, reticulocytosis, liver disease, hypothyroidism, pregnancy
Other haematological disorders - Myelodysplasia, myeloma, myeloproliferative disorders, aplastic anaemia.
How is is megaloblastic anaemia diagnosed?
FBC - ?low RBC, raised MCV
Blood film - hypersegmented neutrophils in B12 and folate.
Bone Marrow Biopsy
What are the signs and symptoms of B12 and folate deficiency?
Mild jaundice, anaemia, glossitis, angular stomatitis, neuropathy (peripheral neuropathy, cord degen, optic neuropathy, dementia)
What is the treatment for folate deficiency?
Assess underlying cause
Oral Folic acid 5mg/day. ALWAYS With B12 (unless levels in range) as may precipitate subacute degeneration of the cord.
What are the causes of folate deficiency?
Nutritional, increased demand, malabsorption, alcohol, drugs, increased turnover, excess loss
What are the causes of B12 deficiency?
Nutritional, malabsorption (gastric surgery, pernicious anaemia, ideal resection, Crohn’s disease, coeliac, CF)
What is sickle cell anaemia?
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
How is sickle cell disease diagnosed?
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
What is a long-term treatment for sickle cell?
Hydroxyurea
Stem cell transplantation
What are the complications of sickle cell?
Crises, stroke, acute chest syndrome, pulmonary HTN, increased vulnerability to infection
What is Autoimmune haemolytic anaemia?
Mediated by autoantibodies causing mainly extravascular haemolysis and spherocytosis. Classify according to optimal binding temperature to RBCs.
What is warm AIHA?
IgG-mediated and coombs test +ve, bind at body T° 37°C. Rx: Steroids/immunosuppressants (± splenectomy). - HIGH DOSE PREDNISOLONE (30mg BD)
What is cold AIHA?
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.
What is haemolytic anaemia?
Anaemia due to the destruction of RBCs
What are the investigations for haemolytic anaemia?
- FBC with reticulocytes
- Blood film
- Bilirubin
- lactic dehydrogenase
- Coomb’s test
How does hereditary spherocytosis present?
failure to thrive jaundice, gallstones splenomegaly aplastic crisis precipitated by parvovirus infection degree of haemolysis variable MCHC elevated
What is the treatment for Beta-thalassaemia major
Life-long blood transfusions
What are the two features of Beta-thalassaemia trait?
raised HbA2
mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia
