Anaemia Flashcards
1
Q
Define anaemia (words and lab results)
A
- Lack of red blood cells and/or haemoglobin
- this reduced the ability of blood to transfer oxygen to the tissues
Men <130g/L
Women <120g/L
2
Q
Defining anaemia into 3 categories and subcategories
A
- Microcytic = hypo/normo/hyperchromic
- Normocytic = hypo/hyperproliferative
- Macrocytic = megaloblastic/nonmegaloblastic
3
Q
Define microcytic anaemia
A
MCV <80fL
4
Q
Define normocytic anaemia
A
MCV 80-100fL
5
Q
Define macrocytic anaemia
A
MCV >100fL
6
Q
Causes of hypochromic microcytic anaemia
A
- Iron deficiency
- Thalassemia
- Siderblastic
7
Q
Cause of normocytic microcytic anaemia
A
Anaemia of chronic disease/inflammation
8
Q
Cause of hypochromic microcytic anaemia
A
Congenital spherocytic/hereditary sperocytosis
9
Q
Causes of megaloblastic macrocytic anaemia
A
- Vitamin B12 deficiency
- Folic acid deficiency
- Some medications - chemo, antiseizure, antiretrovirals
10
Q
Define megalobastic anaemia
A
- Errors in RBC DNA production
11
Q
Causes of non-megaloblastic macrocytic anaemia
A
- Alcoholism
- Liver disease
- Hypothyroidism
12
Q
Haemolytic anaemia - subtype of anaemia
A
Normo/micro/macro
13
Q
Signs and symptoms - 2 groups
A
- Decreased O2 delivery
- Hypovolaemia
14
Q
Signs and symptoms of anaemia
A
- Exertional and rest dyspnoea
- Fatigue
- Bounding pulse
- Palpitations
- Lethargy
- Confusion
- Congestion failure
- Angina
- Arrhythmia
- MI
- Lassitude (lack energy)
- Muscle cramps
- Postural dizziness
- Syncope
- Hypotension
- Shock - death
15
Q
Features on an exam - anaemia
A
- Pallor
- Jaundice
- Lymphadenopathy
- Hepatosplenomegaly
- Bone tenderness
- Petechiae
16
Q
Anaemia risk factors
A
- Diet lacking vitamins/iron
- Intestinal disorders
- Menstruation
- Pregnancy
- Chronic conditions = cancer, kidney
- Family history
- Certain infections
- Autoimmune disorders
- Alcoholism
- Age >65
17
Q
Broad categories - aetiology of anaemia
A
- Blood loss
- Nutrient deficiency and depletion
- Acquired bone marrow disease
- Toxin exposure
- Chronic systemic disease
- Immune reactions
- Infections
- Genetic disorders
- Microvascular disease
- Other
18
Q
Nutrient deficiencies causing anaemia
A
- Iron deficiency
- Vitamin B12 deficiency
- Folate deficiency
19
Q
What is haemoglobinuria?
A
- Iron loss in urine (rare)
20
Q
What are the consequences of vitamin B12 deficiency
A
- Megaloblastic macrocytic anaemia
- Neurological disorders
21
Q
What are vitamin B12 and folate important for?
A
- Co-factors in the synthesis of DNA
22
Q
What is pernicious anaemia?
A
- Lack intrinsic factor = impaired uptake of vitamin B12
23
Q
Who/when do folate requirements increase?
A
- Infants
- Pregnancy
- Lactation
- Malignancy
24
Q
Relationship between alcohol and folate
A
Alcohol = excess biliary folate excretion
25
Acquired bone marrow diseases causing anaemia
- Myeloblastic syndromes
- Leukaemias
- Infiltration of bone marrow by secondary malignancy
- Aplastic anaemia
- Pure RBC aplasia
26
What is myeloblastic syndrome
- Uncontrolled proliferation of neoplastic multipotential haem cells - compromises normal cells
27
Causes of myeloblastic syndromes
- Chromosomal abnormality
- Chemotherapy
- Radiotherapy
28
Type of anaemia caused by myeloblastic syndrome
- non-megaloblastic macrocytic anaemia
29
Describe aplastic anaemia
- Stem cell failure
- Pancytopaenia with no splenomegaly
- Inherited or acquired
- Typically present with recurrent infection
- Toxic causes
- Diagnosis - BM aspiration and biopsy
30
What does bone marrow look like in aplastic anaemia
Hypocellular
31
Describe pure RBC aplasia
- Congenital or acquired impairment of erythroid progenitor cells
- Infections and medications cause a self-limiting illness
- Autoimmune = chronic condition
32
Drugs and anaemia
- Can cause a direct or immune mediated RBC haemolysis
| - Can interfere with DNA synthesis
33
Radiation exposure causes what type of blood condition
Pancytopaenia
34
Lead toxicity and anaemia
- Lead competes with zinc = zonc needed as co-factor in haem synthesis
35
How dos alcohol cause anaemia
Suppress bone marrow
36
What kind of anaemia is caused by chronic disease
Can range from mild hypoproliferative normocytic to microcytic (co-exist with Fe def)
37
Type of anaemia with chronic kidney disease
Normocytic or microcytic
38
Type of anaemia with chronic liver disease
Non-megaloblastic macrocytic
39
Type of anaemia caused by hypothyroidism
Hypoproliferative normocytic (due to the loss of stimulatory effect of thyroid hormones of erythropoiesis)
40
2 types of immune reactions causing anaemia
- Autoimmune haemolytic anaemia (autoantibodies)
| - Alloimmune haemolytic anaemia (ABO incompatibility)
41
Infections that can cause anaemia
- CMV
- Infectious mononucleosis
- Malaria
- Parvovirus B19
- Mumps
42
Genetic disorders that can cause anaemia
- Thalassemias (alpha and beta) - AR
- Sickle cell (beta chain defect) - AR
- Hereditary spherocytosis - AD
- G6PD - X linked
- Fanconi (congenital bone marrow failure - AR/X-linked
43
Microvascular diseases causing anaemia
- Haemolytic uraemic syndrome
- Disseminated intravascular coagulation
- Thrombotic thrombocytopenic purpure
- Haemangiomas
- Malignant hypertension
- Prosthetic valves and surfaces
44
Haemolytic uraemic syndrome
- Damage to endothelium of glomerular - causes fragmentation and shearing of RBC
- Also causes thrombocytopenia and nephropathy
45
Haemangioma
- Vascular tumours - abnormal angiogenesis and over-proliferation of blood vessels
46
Other causes of anaemia (don't fall into other categories)
- Pregnancy (dilution effect)
- Thermal burns
- Hospital acquired anaemia (increased phlebotomy and iatrogenic blood loss)
47
Anaemia epidemiology
- Globally affects 24.8% of people
| - Most common cause - iron deficiency - most common in premenopausal women
48
Describe hypoproliferation normocytic anaemia
- Reticulocyte count of <2%
| - Leukaemia, aplastic, bone marrow failure
49
Describe hyperprolferative normocytic anaemia
- Reticulocyte count of >2%
| - Haemorrhage and haemolysis
50
Treatments for anaemia
DEPENDS ON CAUSE
- Vitamin/iron sup
- Iron injections
- Vitamin B12 injections
- Antibiotics (if infectious cause)
- Blood transfusion
- Oxygen therapy
- Surgery (abnormal bleeding)
- Splenectomy (severe haemolytic anaemia)
