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MD4003 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is Anaemia?

A
  • Haemoglobin level of <130g/l (13g/dl) in adult males and <115g/l (11.5g/dl) in adult females
    AND/OR
  • Reduction in red blood cell count (RBCs) and haematocrit (Hct)
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2
Q

What does a lowered Haematocrit (Hct) suggest?

A
  • Loss of red cells

- Haemodilution

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3
Q

What does a raised Haematocrit (Hct) suggest?

A
  • Reduced plasma volume

- Increased red blood cell mass

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4
Q

What are Haematinics?

A

Substances required for the normal development of red cells e.g. iron, Vitamin B12, folate

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5
Q

List 4 different Iron Studies?

A
  1. Serum ferritin
  2. Serum iron
  3. TIBC (total iron binding capacity)
  4. Transferrin
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6
Q

List the non-specific symptoms of anaemia?

A
  • Tiredness/ fatigue/ drowsiness
  • Headache
  • Weakness
  • Light headedness/ dizziness/ vertigo
  • Fainting
  • Breathlessness on exertion
  • Palpitations
  • Worsening ischaemic symptoms e.g angina, Intermittent claudication
  • Menstrual disturbance
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7
Q

List the non-specific signs of anaemia?

A
  • Pallor
  • Pale conjunctiva
  • Pale palmar creases
  • Tachycardia
  • Postural hypotension
  • Signs of congestive heart failure e.g. ankle swelling
  • Murmur
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8
Q

What type of anaemia has typical signs of “brittle nails, brittle hair and koilonychia (spoon shaped nails)”?

A

Iron (Fe) deficiency anaemia

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9
Q

What type of anaemia has typical signs of “angular stomatitis and glossitis (redness of the tongue and loss of papillae)”?

A

Iron (Fe) and vitamin B12 deficiency anaemias

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10
Q

What type of anaemia has typical signs of “jaundice”?

A

Haemolytic anaemia

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11
Q

What type of anaemia has typical signs “leg ulcers”?

A

Sickle cell disease

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12
Q

What type of anaemia has typical signs of “bone deformities”?

A

Thalassaemia major

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13
Q

Describe how mature red blood cells are made?

A
  • Released as reticulocytes from the bone marrow and lose their ribosomal network to become mature red blood cells
  • Mature red cells are non-nucleated biconcave discs
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14
Q

What are haemolytic anaemias?

A

Group of anaemias caused by increased destruction of RBCs with a resultant increase in circulating unconjugated bilirubin

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15
Q

Why does haemolytic anaemia cause jaundice?

A

Because bilirubin is a breakdown product of hemoglobin, and can accumulate in the blood, causing jaundice

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16
Q

When does clinical jaundice occur?

A

Once bilirubin levels rise above 30 - 50 μmol/l

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17
Q

Give 10 examples of causes of anaemia?

A
  1. Blood loss
  2. Nutrient deficiency or malabsorption
  3. Chronic System Disease
  4. Immune Disease- autoimmune haemolytic anaemia,
    transfusion reactions e.g. ABO incompatibility
  5. Infections- CMV, Infectious mononucleosis, malaria
  6. Acquired bone marrow disease- aplastic anaemia, Leukaemia
  7. Toxin exposure- drugs, radiation, alcohol
  8. Genetic disorders- thalassaemias, sickle cell anaemia
  9. Microvascular Disease
  10. Others- tregnancy, burns
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18
Q

What is MCV?

A

Mean cell volume ie. average red blood size

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19
Q

What is MCH?

A

Mean cell haemoglobin ie. amount of Hb in an average red cell

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20
Q

What is MCHC?

A

Mean cell haemoglobin concentration ie. amount of Hb relative to the size of cell

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21
Q

How can you tell if its microcytic anaemia?

A

MCV <80fl

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22
Q

How can you tell if its normocytic anaemia?

A

MCV 80-100fl

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23
Q

How can you tell if its macrocytic anaemia?

A

MCV >100fl

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24
Q

How can you tell if its hypochromic anaemia?

A

MCH less than lower limit of normal

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25
Q

How can you tell if its normochromic anaemia?

A

MCH within normal range

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26
Q

How can you tell if its hyperchromic anaemia?

A

MCH greater than upper limit of normal

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27
Q

List 7 causes of normocytic anaemia?

A
  1. Acute blood loss
  2. Endocrine disease (hypopituitary, thyroid, adrenal)
  3. Combined deficiency
  4. Chronic disease
  5. Sepsis
  6. Tumour
  7. Aplastic anaemia
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28
Q

Describe Reticulocytosis?

A

Accelerated erythropoiesis results in an increase in reticulocytes which are immature cells with a relatively large size compared to mature red blood cell

29
Q

What 2 things can hypothyroidism cause?

A
  1. Macrocytosis

2. Normocytic anaemia

30
Q

What is Megaloblastic anaemia?

A

Anaemia as a result of nutritional deficiency of either vitamin B12 or folic acid, or malabsorption of B12 (pernicious anaemia)

31
Q

Why is MCV increased in megaloblastic anaemia?

A
  • Megaloblasts are unusually large nucleated erythroblasts
  • The cells are immature cells because of arrested development due to either B12 or folic acid (folate) deficiency
  • The immature nucleated red cells are larger than normal RBCs and therefore the MCV is increased
32
Q

What is pernicious anaemia?

A
  • Specific autoimmune disorder in which the gastric mucosa is atrophic and there is intrinsic factor deficiency
  • In the absence of intrinsic factor less than 1% of dietary B12 is absorbed
33
Q

What would a patient with pernicious anaemia be diagnosed with?

A

Macrocytic megaloblastic anaemia

34
Q

What happens to the RBC in high alcohol intake?

A

Cells are macrocytic (high MCV), but anaemia is not usual

35
Q

What happens to the RBC in excessive alcohol abuse?

A

Can result in megaloblastic anaemia due to a toxic effect of alcohol on erythropoiesis and/or dietary folate deficiency

36
Q

What type of anaemia is typical of Acute haemorrhage?

A

Rapid development of Normocytic normochromic anaemia

37
Q

What type of anaemia is typical of gradual chronic blood loss?

A

Gradual development of Microcytic hypochromic anaemia with or without a low serum ferritin due to low storage levels of iron

38
Q

When are patients at increased risk of haemorrhage?

A
  • Anticoagulant therapy e.g. warfarin

- Have an underlying defect in haemostasis

39
Q

Give 2 examples of gradual chronic bleeding which could lead to anaemia?

A
  1. Gastrointestinal (GI) bleeding e.g. drugs, cancer, gastric ulcer
  2. Menstrual bleeding
40
Q

What is Menorrhagia?

A

Abnormally heavy and prolonged menstrual periods at regular intervals

41
Q

What is Menometrorrhagia?

A

Prolonged or excessive bleeding occurring irregularly and more frequently than normal

42
Q

What treatment can be given for iron deficiency anaemia?

A

Ferrous sulphate supplements

43
Q

What does thalassaemias and sideroblastic anaemias have in common?

A

Iron stores are normal or increased

44
Q

What is Ferritin?

A

The main protein that stores iron (Iron is stored mainly in the liver and the bone marrow)

45
Q

What is Transferrin?

A

Blood protein that transports iron from the gut to the cells that use it

46
Q

What is Total Iron Binding Capacity (TIBC)?

A

Measures the amount of transferrin in relationship to the

body’s need for iron (when iron stores are low, transferrin levels increase)

47
Q

What typically happens within 6hrs of an acute haemorrhage?

A

Reactive increase in reticulocytes (reticulocytosis)

48
Q

What also typically happen’s after gradual chronic blood loss?

A

There is a reactive increase in the platelet count (thrombocytosis)

49
Q

Where is the main source of iron from?

A

Diet esp. meats (vegetarians and vegans!!!)

50
Q

Describe what type of anaemia typically occurs in Coeliac disease (malabsorption)?

A
  • Combined iron and folate deficiency
  • Folate deficiency leads to macrocytic cells
  • Iron deficiency leads to microcytic cells, giving mixed picture
51
Q

Describe what type of anaemia typically occurs in Crohn’s disease (malabsorption)?

A
  • Usually normocytic, normochromic anaemia
  • However, iron deficiency and/or folate deficiency may also coexist due to malabsorption
  • The size of cells will be mixed and the picture could be microcytic, normocytic or macrocytic
52
Q

List 3 other causes of malabsorption?

A
  1. Achlorhydria
  2. Gastric surgery
  3. Small bowel resection.
53
Q

Iron deficiency gives a _______ picture?

A

Microcytic

54
Q

Folate deficiency gives a _______ picture?

A

Macrocytic

55
Q

B12 deficiency gives a _______ picture?

A

Macrocytic

56
Q

Give an example of an Inherited Haemolytic anaemia?

A

Sickle cell disease

57
Q

Give 2 examples of Acquired Haemolytic anaemia’s?

A
  1. Immune- drugs, transfusion reaction, haemolytic disease of the newborn
  2. Non immune- Mechanical, Toxic, Infective
58
Q

Red cell destruction overloads the pathways for haemoglobin breakdown with a resultant rise in what 4 things?

A
  1. Unconjugated bilirubin in the blood and consequently jaundice
  2. Urinary urobilinogen (product of bilirubin breakdown)
  3. LDH in blood (lactate dehydrogenase released from the cells)
  4. Reticulocytosis (due to bone marrow compensation)
59
Q

Why does haemolytic give a macrocytic blood picture?

A

Increase in demand for red cells and therefore large immature cells are released into the blood

60
Q

Give 5 examples of chronic systems diseases which can cause anaemia?

A
  1. Chronic infection
  2. Chronic inflammation
  3. Neoplasia
  4. Liver disease
  5. Thyroid disease
61
Q

Describe the type of anaemia typically seen in chronic diseases?

A
  • Normocytic normochromic anaemia and ferritin levels are normal or high, but serum iron is often low
  • Hepcidin levels are high
62
Q

What is Hepcidin?

A
  • Regulatory protein, produced by the liver, which inhibits the export of iron into the blood
  • Iron remains trapped in storage sites in the form of ferritin
63
Q

Give 4 examples of what can cause Microcytic hypochromic anaemia?

A
  1. Iron deficiency
  2. Chronic bleeding
  3. Lead poisoning
  4. Thalassaemias
64
Q

Give 4 examples of what can cause Normocytic normochromic anaemia?

A
  1. Acute blood loss
  2. Sepsis
  3. Chronic disease
  4. Aplastic anaemia
65
Q

Give an example of what can cause Microcytic normochromic anaemia?

A

Erythropoietin deficiency in kidney failure

66
Q

Give 7 examples of what can cause Macrocytic normochromic anaemia?

A
  1. Folate deficiency
  2. Vitamin B12 deficiency
  3. Chemotherapy
  4. Marrow infiltration
  5. Hypothyroidism
  6. Haemolysis
  7. Alcohol
67
Q

What can cause Macrocytosis without anaemia?

A

Alcohol

68
Q

What is Anicytosis?

A

Any cells with different size/shapes

MD4003 (22 decks)

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