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Exodontia > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Calculation of haemoglobin normal range

A

Measure haemoglobin in normal individuals
Work out the mean and SD
Normal range is the Mean +/- 2SD
Different in men and women so different normal ranges are required

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2
Q

Definition of anaemia

A

Haemoglobing concentration below normal range
Males <12.5g/dl
Females <11.5g/dl

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3
Q

Symptoms of anaemia

A

Fatigue, reduced exercise tolerance, shortness of breath: on exertion, at rest
Postural hypotension, dizziness, palpitations
Angina
Heart failure: Shortness of Breath (SOB)

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4
Q

Postural hypotension

A

occurs when a person’s blood pressure falls when suddenly standing up from a lying or sitting position

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5
Q

Signs of anaemia

A 
Palor
Tachycardia
Heart murmurs
Koilonychia (iron deficiency)
Angular stomatitis
Glossitis (B12/folate deficiency)
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6
Q

Full blood count

A 
Haemoglobin
-mean cell volume: MCV
-mean cell haemoglobin concentration: MCHC
White cell count
Platelet count
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7
Q

Mean cell volume: MCV

A

Normal MCV 82-96 fl
Low < 82 Microcytic anaemia
Normal: Normocytic
High >96 Macrocytic anaemia

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8
Q

Classification of anaemia: microcytic

A

Iron deficiency
Thalassaemia
Anaemia of chronic disease (rarely)

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9
Q

Classification of anaemia: Macrocytic

A 
Vitamin B12 deficiency
Folate deficiency
Macrocytosis without anaemia:
-liver disease
-hypothyroidism
-alcohol
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10
Q

Classification of Anaemia: Normocytic

A 
Acute bleeding
Haemolysis	
-congenital	
-acquired
Aplastic anaemia
Anaemia of chronic disease
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11
Q

Adaptation to Anaemia

A 
Tachycardia
Cardiomegaly
Increased cardiac output
Right shift oxygen dissociation curve
- better delivery of oxygen to the tissues
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12
Q

Differential Diagnosis of Microcytic Anaemia

A

Iron Deficiency
Thalassaemia
Anaemia of chronic disease

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13
Q

Causes of Iron Deficiency

A 
Reduced intake ( almost impossible in the UK)
Increased requirements pregnancy/ childbirth, malabsorbtion, coeliac disease
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14
Q

Causes of iron deficiency: Causes blood loss

A

Menorrhagia

GI Blood loss: Upper GI/ Lower GI

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15
Q

Diagnosis of Iron Deficiency

A

FBC: Hb, MCV, MCHC
Serum Ferritin
(Fe and TIBC)
Bone marrow/ liver biopsy = tissue iron stores

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16
Q

Investigation of Iron Deficiency

A 
History
Examination
Ferritin
Gastroscopy
Colonoscopy
17
Q

Treatment of Iron Deficiency

A

Treat the cause

Ferrous sulphate 200mg oral tds, until haemoglobin normal and then further 3 months to rebuild stores

18
Q

B12 and Folate Deficiency

A 
Necessary for haematopoiesis
Necessary for DNA synthesis all cells
Deficiency causes megaloblastic anaemia
-macrocytic anaemia (High MCV, >96fl)
-also leukopenia and thrombocytopenia
19
Q

B12 metabolism

A

Dietary sources- Bacteria, animal products
Adsorption-intrinsic factor from stomach absorbed in terminal ileum as complex
Body storage 4 years

20
Q

B12 Deficiency

A 
Lack of intrinsic factor
Pernicious anaemia, gastrectomy
Failure absorption in terminal ileum	resection, Crohn’s, TB, lymphoma
?Dietary deficiency- vegans
Macrocytic anaemia, megaloblasts in bone marrow
Pancytopenia: low WBC and Platelets
Affects all body cells 
Neuropathy
21
Q

Pernicious Anaemia

A

Autoimmune disorder
Usually seen in elderly
Achlorhydria
Autoantibodies against intrinsic factor – block binding of IF to vitamin B12
Associated with other autoimmune disorders esp thyroid disease and vitiligo

22
Q

B12 Deficiency Diagnosis

A

Serum B12 levels
In Pernicious anaemia
-intrinsic factor antibodies (50%)
-parietal cell antibodies ( 80%, but not specific!)

23
Q

B12 Treatment

A 
Parenteral Hydroxycobalamin
1 mg im every 2 days initially
Give before folate if mixed / unknown deficiency
Reticulocyte response,
Hb increase 1-1.5g per week
Risk of hypokalaemia
1 mg every 3 months for life maintenance
24
Q

Folate Deficiency

A 
Necessary for DNA synthesis
Marcocytic anaemia 
Megaloblastic bone marrow 
Pancytopenia with low WBC and platelets
Dietary sources fresh fruit and vegetables
Absorbed in proximal intestine
Low body stores, easy to deplete
25
Q

Causes of Deficiency of Folate

A 
Dietary
Malabsorption- coeliac disease
Increased requirements:
-pregnancy 
-haemolysis 
-some drugs eg folate antagonists
26
Q

Folate Deficiency Treatment

A

Oral folate 5mg tablet daily

Works for all causes including malabsorption

27
Q

Haemolytic Anaemias: Hereditary

A 
Red cell membrane defect
-eg hereditary spherocytosis
Abnormal red cell metabolism
-eg G6PD deficiency, pyruvate kinase deficiency
Haemoglobin abnormalities
-eg sickle cell disease
28
Q

Haemolytic Anaemias: Acquired

A 
Immune
-autoimmune
-alloimmune eg Rhesus Disease of the newborn
Red cellfragmentation syndromes
Infections
29
Q

Sickle cell disease

A

Autosomal recessive
Afro-Caribbean population
Single point mutation
Heterozygous patients protected from malaria
Develop painful vaso-occlusive sickle cell crises
Crises precipitated by infection, cold, hypoxia etc
Diagnose by requesting FBC, sickle cell test and haemoglobin electrophoresis

Exodontia (21 decks)

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