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HAEMATOLOGY > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is the definition of anaemia?

A

Reduced total red cell mass (not easy to measure so Hb concentration is used as a surrogate marker)

Reduction in Hb concentration below that which is optimum for that patient or below 95% of the average range for the population

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2
Q

What are the two most common causes of anaemia worldwide?

A

Iron deficiency anaemia

Anaemia of chronic disease

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3
Q

Below what Hb concentration is anaemia likely to present in adult males and adult females?

A

Adult males <130g/l

Adult females <120 g/l

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4
Q

Below what Hb concentration is anaemia likely to present in pregnancy?

A

<110 g/l

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5
Q

What are reticulocytes?

A

Red cells that have just left the bone marrow - they are immature and larger than normal red blood cells. They still have remnants of RNA.

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6
Q

What colour do reticulocytes stain?

A

Reticulocytes stain purple/ deep red because they still have remnants of RNA

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7
Q

When is reticulocyte count increased?

A

In anaemic patients whose bone marrow is functioning normally

There is increased loss or destruction of cells

E.g haemolysis and blood loss

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8
Q

When is reticulocyte count decreased?

A

In patients with anaemia involving hypoproliferation or abnormal maturation

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9
Q

Different investigations can be done to investigate for; functional, storage and transport iron. What investigations are these?

A

Functional iron
- Hb concentration

Storage iron
- Serum ferritin

Transport iron
- Serum transferrin

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10
Q

What investigations can be done for anaemia?

A

Investigations for iron
(Hb concentration, serum ferritin, serum transferrin)

Reticulocyte count
(to assess marrow response)

Haematinics - folate and vitamin B12

MCV

Faecal occult blood testing

GI investigations

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11
Q

What is the problem in microcytic anaemia?

A

Defects in haemoglobin synthesis = cytoplasmic defect

haemoglobin synthesis occurs in the cytoplasm

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12
Q

What is the problem in macrocytic anaemia?

A

Defects in DNA synthesis

Cell division is reduced and apoptosis occurs. This means that the cells will be larger (because they do not divide because of the abnormal nucleus) but there will be less of them (since they undergo apoptosis) which is what causes the anaemia.

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13
Q

What two things are needed to make haemoglobin?

A

Porphyrin ring and iron(Fe2+)

*Shortages in these result in microcytic anaemia

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14
Q

What are the causes of hypochromic microcytic anaemia?

A

Haem deficiencies

  • Iron deficiency
  • Chronic disease
  • Lead poisoning
  • Pyridoxine responsive anaemias
  • Congenital sideroblastic anaemia

Globin deficiency
- Thalassaemia

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15
Q

Problems with porphyrin synthesis can rarely cause microcytic anaemia. What are possible causes of this?

A

Lead poisoning

Pyridoxine responsive anaemias

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16
Q

What is circulating iron bound to and what is it stored as?

A

Circulating iron is bound to transferrin

Iron is stored in ferritin mainly in the liver

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17
Q

What are some of the possible causes of iron deficiency?

A

Low consumption

Malabsorption

Blood loss

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18
Q

Why might achlorhydria result in anaemia?

A

Acid is needed for the absorption of iron

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19
Q

Where is iron absorbed from in the GI tract?

A

Iron is absorbed from the jejunum (proximal bowel)

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20
Q

How is iron deficiency anaemia managed?

A

Ferrous iron (Fe2+) supplements

Vitamin C
(helps with the absorption of iron)

Management of the cause

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21
Q

What increase in reticulocytes would you expect per week when a patient is being treated for iron deficiency anaemia?

A

10g/L/week

Low reticulocytes might suggest poor compliance with iron supplements

22
Q

How should a patient be managed if they are not compliant with iron supplements?

A

Try a lower dose and consider adding a laxative for GI symptoms

Can consider IV iron if necessary

23
Q

What are some of the possible causes of normochromic normocytic anaemia?

A

Chronic diseases

Renal failure

Hypometabolic states e.g hypothyroidism

Marrow failure

24
Q

What is the problem in microcytic anaemia?

A

There are defects in DNA synthesis

Cell division is reduced and apoptosis occurs, this means that the cells will be larger (because they don’t divide) but there will be less of them (since they undergo apoptosis).

25
Q

What would be the expected lab findings in macrocytic anaemia?

A

Low RBCs and Hb

High MCV

26
Q

What units are used for macrocytosis and what is the cut off?

A

MCV stands for mean corpuscular (cellular) volume

> 100 fl (femtolitres) is macrocytic

27
Q

What is a megaloblast?

A

An abnormally large nucleated red cell precursor with an immature nucleus

28
Q

What is an erythroblast?

A

A normal red cell precursor with a nucleus

29
Q

What are the causes of megaloblastic macrocytic anaemia?

A

B12 or folate deficiency

Drugs

Inherited abnormalities

30
Q

Where is B12 absorbed fro in the GI tract?

A

B12 is absorbed from the distal small bowel (ileum)

31
Q

What are some of the potential causes of B12 deficiency?

A

Vegan diet

Atrophic gastritis/ PPIs

Chronic pancreatitis

Crohn’s disease

Coeliac disease

32
Q

What is pernicious anaemia?

A

Autoimmune condition which results in a deficiency of vitamin B12

Antibodies against IF which is responsible for the transportation of B12

33
Q

How is pernicious anaemia managed?

A

Lifelong B12 injections

34
Q

What other conditions is pernicious anaemia associated with?

A

Hypothyroidism

Vitiligo

Addison’s

35
Q

Where is folate absorbed in the GI tract?

A

Absorbed in the jejunum

36
Q

What are some of the possible causes of folate deficiency?

A

Inadequate intake (e.g alcoholics have a poor diet)

Malabsorption

Excessive utilisation (e.g haemolysis, dermatitis, pregnancy and malignancy)

Drugs - anticonvulsants

37
Q

What are some of the clinical features of B12/ folate deficiency?

A

Symptoms and signs of anaemia

Jaundice

Neurological problems

38
Q

Neurological problems are more associated with B12 or folate deficiency?

A

B12

Posterior/ dorsal column abnormalities, neuropathy, dementia and psychiatric manifestations

39
Q

How is folate deficiency managed?

A

Folic acid 5mg daily

40
Q

What auto-antibodies are associated with pernicious anaemia?

A

Anti-IF (specific but not sensitive)

Anti-GPC (sensitive but not specific)

41
Q

What are some of the causes of non-megaloblastic macrocytosis?

A

Alcohol

Liver disease

Hypothyroidism

Marrow failure

42
Q

What is meant by spurious macrocytosis?

A

The volume of the red cell is normal but the MCV is measured as high

43
Q

What are the possible causes of spurious macrocytosis?

A

Reticulocytosis

Cold-agglutinins

44
Q

Why does reticulocytosis cause a spurious macrocytosis?

A

Reticulocytes are bigger than mature red cells and are analysed along with these for the MCV measurement - they thus cause a false macrocytosis

45
Q

How do cold-agglutinins cause a spurious macrocytosis?

A

Clumps of agglutinated red cells are registered as 1 giant cell

46
Q

Does aplastic anaemia present with; micro, normo or macrocytic anaemia?

A

Aplastic anaemia presents with normocytic anaemia

47
Q

Does liver disease present with micro, normo or macrocytic anaemia?

A

Macrocytic anaemia

48
Q

What kind of anaemia do hypothyroidism and myelodysplasia present with?

A

Normoblastic macrocytic anaemia

49
Q

Red cells that have lost their central pallor are referred to as spherocytes. An excess of these in a patient with a FH of haemolytic anaemia makes what diagnosis likely?

A

Hereditary spherocytosis

50
Q

How is autoimmune haemolytic anaemia managed?

A

Steroids (to suppress the autoimmune process)

Folic acid (to prevent deficiency which can occur when red cell turnover is high)

HAEMATOLOGY (10 decks)

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