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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is the definition of anaemia?

A

A reduced total red blood cell mass

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2
Q

What is the main marker used for anaemia?

A

Haemoglobin concentration

Haematocrit also used

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3
Q

What haemoglobin concentration indicates anaemia in men and women?

A

Men <130g/l

Women <120g/l

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4
Q

What method is used to measure haemoglobin concentration?

A

Spectrophotometric

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5
Q

What is haematocrit?

A

The concentration of whole blood that is red cells

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6
Q

When might haemoglobin concentration not be a good marker of anaemia?

A

Massive haemorrhage

Haemodilution

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7
Q

What is the body’s natural response to anaemia?

A

Reticulocytosis - increase red cell production

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8
Q

How will blood film appear in patients undergoing reticulocytosis?

A

Polychromatic

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9
Q

What aspects of red blood cells are measured?

A

Haemoglobin concentration
Number of red cells
Size of red cells

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10
Q

What are the two main pathophysiological causes of anaemia?

A

Decreased production

Increased loss/destruction of red cells

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11
Q

If there is decreased production of red cells, will reticulocyte count be low or high?

A

Low

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12
Q

What are the two main types of decreased production of red cells?

A

Hypoproliferative (reduced amount)

Maturation abnormality

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13
Q

What can cause increased loss/destruction of red cells?

A

Bleeding

Haemolysis

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14
Q

Where are the sites of defect in a maturation abnormality?

A

Cytoplasm

Nucleus

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15
Q

A cytoplasmic defect results in impaired what?

A

Haemoglobinisation

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16
Q

A nucleus defect results in impaired what?

A

Cell division

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17
Q

If mean cell volume is low, there are problems with what?

A

Haemoglobinisation

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18
Q

Problems with cell division results in a low/high/normal MCV

A

High

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19
Q

In cells where there is a problem with haemoglobin, how will the cells appear?

A

Microcytic (small)

Hypochromic (lacking in colour)

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20
Q

What are the two main causes of microcytic anaemias?

A

Heme deficiency

Globin deficiency

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21
Q

Give some causes of heme deficiency

A

Iron deficiency

Problems with porphyrin synthesis

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22
Q

What is it called when you cannot make globin chains?

A

Thalassaemia

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23
Q

What carries iron in the blood?

A

Transferrin

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24
Q

What is iron stored as in the body? Where is it mainly stored?

A

Ferritin

Liver

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25
Q

A combination of what confirms iron deficiency?

A

Anaemia

Low serum ferritin

26
Q

Give some causes of iron deficiency

A

Diet
Blood loss
Malabsorption

27
Q

What is macrocytic anaemia?

A

An anaemia where the red cells have a larger than normal volume

28
Q

On a blood film, the size of a red blood cell should be the same size as what?

A

Nucleus of a mature small lymphocyte

29
Q

What are the two main groups of causes of macrocytosis?

A

Megaloblastic

Non-megaloblastic

30
Q

What is a megaloblast?

A

An abnormally large nucleated red cell precursor with an immature nucleus

31
Q

Megaloblastic anaemias are characterised by defects in what?

A

DNA synthesis

Nuclear maturation

32
Q

In megaloblasts, cytoplasmic development and haemoglobin accumulation is normal. True/false?

A

True

33
Q

Why does anaemia occur even though the red cells are bigger than normal?

A

Because many more of the red cell precursors undergo apoptosis

34
Q

What are the main causes of megaloblastic anaemia?

A

Vitamin B12 deficiency

Folate deficiency

35
Q

Why does B12/folate deficiency result in megaloblastic anaemia?

A

As they are essential co-factors in nuclear maturation

36
Q

The folate cycle is important in what?

A

Nucleoside synthesis

37
Q

What nucleoside synthesis is the folate cycle particularly important in?

A

Uridine to thymidine

38
Q

Vitamin B12 is an important part of which cycle?

A

Methionine cycle

39
Q

Once vitamin B12 enters the stomach in food, it is bound to what?

A

R-protein

40
Q

What hormone is released by gastric parietal cells?

A

Intrinsic factor

41
Q

Where does vitamin B12 bind to intrinsic factor?

A

Duodenum

42
Q

The intrinsic factor-B12 complex binds to which receptors in the ileum?

A

Cubulin

43
Q

Give some causes of vitamin B12 deficiency

A 
Veganism
Pernicious anaemia
Atrophic gastritis
Achlorhydia
Coeliac disease
Crohn's disease
44
Q

What is pernicious anaemia?

A

An autoimmune condition with destruction of gastric parietal cells

45
Q

Where is folate absorbed?

A

Jejunum

46
Q

Give some causes of folate deficiency

A

Inadequate intake
Malabsorption
Haemolysis
Pregnancy

47
Q

What group of people are particularly prone to getting folate deficiency?

A

Alcoholics

48
Q

Which drug is known to cause folate deficiency?

A

Phenytoin

49
Q

Give some clinical features of B12/folate deficiency

A 
Fatigue
Shortness of breath
Weight loss/diarrhoea
Glossitis
Jaundice
Developmental problems
50
Q

What system tends to be more affected by a deficiency in B12?

A

Neurological

51
Q

A vitamin B12 deficiency will commonly affect which part of the spinal cord?

A

Dorsal column

52
Q

What does the blood film of a macrocytic anaemia show?

A

Hypersegmented neutrophils

Macrovalocytes

53
Q

What antibodies can be measured to diagnose macrocytic anaemia?

A

Anti-intrinsic factor

Anti-gastric parietal cell

54
Q

What are the main flaws of using auto-antibodies to diagnose macrocytic anaemia?

A

Anti-GPC has poor specificity

Anti-IF has poor sensitivity

55
Q

How is pernicious anaemia treated?

A

Vitamin B12 injections for life

56
Q

How is folate deficiency treated?

A

Folic acid tablets 5mg per day

57
Q

Give some causes of non-megaloblastic macrocytosis

A

Alcohol
Liver disease
Hypothyroidism
Marrow failure

58
Q

What occurs in spurious macrocytosis?

A

Volume of mature red cell is normal but MCV is high

59
Q

What are the two main causes of spurious macrocytosis?

A

Reticulocytosis

Cold-agglutinins

60
Q

How does increased reticulocytosis cause spurious macrocytosis?

A

As reticulocytes are bigger than mature red cells and are analysed as well for MCV

Haematology (19 decks)

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