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Y3 HAEMATOLOGY > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

“without blood”

Reduced red blood cells

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2
Q

State the parameters for defining anaemia in an adult male

A

Hb less than 130g/L

Hct 0.38-0.52

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3
Q

State the parameters for defining anaemia in an adult female

A

Hb less than 120g/L

Hct 0.37-0.47

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4
Q

What is haematocrit?

A

Ratio/percentage of whole blood that is made up of red cells if the sample was left to settle

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5
Q

What cells represent circulatory red cells that have just left the bone marrow?

A

Reticulocytes

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6
Q

How does the blood film of reticulocytes appear?

A

Polychromatic
Purple/deep red stain (contain some leftover RNA)
Larger than average red cell

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7
Q

How is anaemia classified by pathophysiology?

A

Decreased production of red cells (reduced or ineffective erythropoiesis) [low reticulocyte count]

Increased destruction of red cells (haemolysis, bleeding) [high reticulocyte count)

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8
Q

What morphological characteristic can be used to classify anaemia?

A

Mean cell volume

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9
Q

How can mean cell volume be used to distinguish between cytoplasmic and nuclear defects in erythropoiesis?

A

Low MCV suggests problems with haemoglobinisation in the cytoplasm
High MCV suggests problems with red cell maturation

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10
Q

Deficiency in haemoglobin production results in what type of anaemia? This suggests a defect in what part of the cell?

A

Microcytic anaemia - cells are small (low MCV) and hypochromic (lack colour)
Cytoplasm

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11
Q

List some causes of microcytic anaemia

A 
CYTOPLASMIC MATURATION DEFECTS
Haem deficiency (low body iron (deficiency), low available iron (chronic disease), problem with porphyrin synthesis)
Globin deficiency (thalassaemia)
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12
Q

Circulating iron is bound to what?

A

Transferrin

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13
Q

Iron is stored as ferritin where in the body?

A

Liver

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14
Q

How can iron deficiency be confirmed?

A 
Anaemia (less functional iron)
Low ferritin (less stored iron)
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15
Q

List some causes of iron deficiency

A

Dietary insufficiency
(Relative in woman of child bearing age or children) (Absolute in vegetarians)
Blood loss (GI, malignancy, menorrhagia, haematuria)
Malabsorption (coeliac disease)
Pregnancy

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16
Q

High mean cell volume is associated with which type of anaemia?

A

Macrocytic anaemia - cells are big

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17
Q

What is the difference between macrocytosis and macrocytic anaemia?

A

Macrocytosis: raised MCV, normal RBC count

Macrocytic anaemia: raised MCV, low RBC count

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18
Q

List causes of macrocytosis

A

GENUINE (TRUE)
Megaloblastic
Non-megaloblastic
SPURIOUS (FALSE)

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19
Q

What unit is MCV measured in?

A

Femtolitres (fl)

1 femtolitre = 10^-15 litres

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20
Q

What is the range for a normal MCV?

A

80-100 fl

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21
Q

What is a megaloblast? What is a macrocyte?

A

Abnormally large red cell precursor with an immature nucleus - nucleus looks hypersegmented on film
Large red cell but has no nucleus

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22
Q

What biochemical defect is megaloblastic anaemia characterised by?

A

Defect in DNA synthesis and nuclear maturation but RNA and haemoglobin synthesis preserved

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23
Q

What is the consequence of a megaloblastic cell?

A

Cytoplasm and haem synthesis is fully developed even though nucleus is immature; cell senses it has enough Hb and doesn’t divide anymore, leading to macrocytosis (BIGGER CELLS) and anaemia (LESS CELLS)

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24
Q

List some causes of megaloblastic anaemia

A 
NUCLEAR MATURATION DEFECTS
B12 deficiency
Folate deficiency
Drugs
Inherited conditions
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25
Q

Why does lack of B12 and folate cause megaloblastic anaemia?

A

B12 and folate are essential cofactors for nuclear maturation - enable reactions for DNA synthesis and gene activity
Thus deficiency leads to DNA defects

26
Q

Which 2 biochemical cycles involving folate and B12 are involved in DNA synthesis?

A

Methionine cycle

Folate cycle

27
Q

Where in the body does B12 bind to intrinsic factor?

A

Ileum

28
Q

List some causes of B12 deficiency

A 
Dietary insufficiency (vegans)
Pernicious anaemia
Atrophic gastritis
Gastrectomy
Pancreatitis
Small bowel resection
Crohn's disease
Malabsorption (Coeliac, IBD)
29
Q

Where in the body is dietary folate absorbed?

A

Duodenum and jejunum

30
Q

How long does the body store B12 and folate respectively?

A

B12: 2-4 years
Folate: 4 months

31
Q

State the daily requirements of B12 and folate

A

B12: 1-3 micrograms/day
Folate: 100 micrograms/day

32
Q

List some causes of folate deficiency

A

Dietary insufficiency (esp. alcoholics)
Malabsorption (coeliac, crohns)
Excess utilisation (haemolysis, pregnancy, malignancy)
Drugs (anticonvulsants)

33
Q

List clinical features of B12 and folate deficiency

A 
Signs of anaemia
Weight loss
Diarrhoea
Infertility
Sore tongue
Jaundice
Developmental problems
34
Q

B12 deficiency can cause issues with the myelin sheath. What neurological problems may result?

A 
Dorsal column abnormality
Lateral tract degeneration
Neuropathy
Dementia
Psychiatric manifestations
35
Q

What is pernicious anaemia?

A

Autoimmune condition where gastric parietal cells are destroyed, causing decreased intrinsic factor and thus B12 deficiency
Common in women who have an autoimmune history

36
Q

How is macrocytic anaemia diagnosed in the lab?

A

Blood count (RBC low)
Blood film: macrovalocytes and hypersegmented neutrophils (more than 5 segments)
Reticulocyte count (rule out reticulocytosis)
B12 and folate serum assay
Antibodies: parietal-cell, intrinsic factor

37
Q

List treatment for megaloblastic anaemia

A

Treat cause
B12 injections every 3 months
Folic acid tablets (5mg daily)
Red cell transfusion if life-threatening

38
Q

List some causes of non-megaloblastic anaemia

A

Alcoholism
Liver disease
Hypothyroidism
Marrow failure (myelodysplasia, myeloma, aplastic anaemia)

39
Q

What is spurious macrocytosis?

A

The size of the red cell is normal but the MCV is high

40
Q

What causes a spurious macrocytosis?

A
  1. Reticulocytosis

2. Cold-agglutins

41
Q

How does reticulocytosis result in spurious macrocytosis?

A

Acute blood loss/haemolysis response: increase in reticulocytes, which are bigger than red cells, which are analysed as part of MCV

42
Q

What are cold agglutins?

A

Abnormal proteins which cause clumping of red blood cells

43
Q

What condition can complicate severe megalobastic anaemia?

A

Pancytopaenia (red blood cells, white blood cells and platelets are low)

44
Q

List treatment options for anaemia

A

Iron supplements three times a day
Modified diet
IV iron if severe

45
Q

Reticulocytosis is a marker of what?

A

Red cell production

46
Q

List tools used in the diagnosis of anaemia

A 
History/exam
Full blood count
Reticulocyte count
Blood film features
Haematinics (ferritin/B12/folate)
Bone marrow biopsy
Special tests (Hb electrophoresis, HLPC)
47
Q

An increased reticulocyte response or reticulocytosis in anaemia is typically suggestive of…

A 
Haemolysis (increased red cell turnover)
Blood loss (red cells gone)
48
Q

A reduced reticulocyte response in anaemia is typically suggestive of…

A 
Maturation abnormality (ineffective erythropoesis) 
Hypoproliferative (reduced erythropoeisis)
49
Q

A patient has an anaemia with a high reticulocyte count. How do you differentiate between the differentials?

A

Haemolysis would present with increased products of red cell destruction (increaed unconjugated serum billirubin, increased urinary urobilinogen)

50
Q

What compound is a product of red cell breakdown that causes pale urine?

A

Urobilinogen

51
Q

What is the commonest cause of hypochromic microcytic anaemia?

A

Iron deficiency

52
Q

List aetiology of anaemia

A 
Iron deficiency
Heme defects (lead poisoning, sideroblastic anaemia)
Globin defects (thalasaemia)
Nuclear maturation (megaloblastic anaemia, MDP)
Apparent (agglutination in reticulocytosis)
53
Q

List aetiology of macrocytosis without anaemia. What do the cells look like on film?

A

Alcohol
Liver disease
Hypothyroidism
UNIFORM MACROCYTOSIS

54
Q

Normochromic normocytic cells is typically indicative of…

A

Hypoproliferative anaemia

Marrow fails to appropriately respond to anaemia, but cells produced are usually normal

55
Q

List causes of hypoproliferative anaemia

A 
Marrow failure (drugs, aplastic anaemia)
Hypometabolic 
Marrow infiltration (mets, fibrosis)
Renal impairment
Chronic disease (infective, inflammatory, malignant)
56
Q

What is renal anaemia?

A

Anaemia of chronic disease due to failure of epo production

57
Q

Anaemia of chronic disease is common. True/ False?

A

True

Second most common cause of anaemia after iron deficiency

58
Q

There is always a low MCV in microcytosis. True/ False?

A

False

Microcytic anaemia is relative to the individual, not always absolute

59
Q

What is the best blood test to differentiate between iron deficiency and anaemia of chronic disease?

A

Serum ferritin
Reduced in iron deficiency
Normal or increased in chronic disease

60
Q

What is the main mechanism behind anaemia of chronic disease?

A

Inflammation produces an elevation of IL-6 which stimulates hepcidin production and release from the liver, reducing the iron carrier protein ferroportin so that access of iron to the circulation is reduced

61
Q

What is the first and second line investigation for an older person who is anaemic?

A

Sigmoid colonoscopy

Endoscopy for chronic bleed

Y3 HAEMATOLOGY (16 decks)

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