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Anaemia Flashcards

1
Q

What Hb is anaemia in:

  • adult male
  • adult female
  • pregnant female
  • age 6-14
  • 6mth to 6y.o.
A
  • adult male 130
  • adult female 120
  • pregnant female 110
  • age 6-14 120
  • 6mth to 6y.o. 110
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2
Q

What test distinguishes anaemia based on size?

A

Macrocytic MCV more than 100

Microcytic MCV less than 80

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3
Q

What tests are haematinics?

A

Ferritin, B12, folate

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4
Q

What infection causes stop erythropoiesis for 2 weeks?

A

Parvovirus B19 slapped cheek

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5
Q

What is another way of classifying anaemia other than by cell size?

A

Decreased production
Increased destruction
Increased loss

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6
Q

What are the 2 causes of decreased production anaemia?

A

Hypoproliferative marrow (less erythropoiesis)
Or
Ineffective maturation

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7
Q

A erythrocyte maturation defect can be in which 2 places in the cell?

A

Cytoplasmic or nuclear

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8
Q

A cytoplasmic erythrocyte maturation problem often causes what size of anaemia?

A

Microcytic

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9
Q

A nuclear erythrocyte maturation problem often causes what size of anaemia?

A

Macrocytic

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10
Q

Name 6 causes of anaemia with decreased red cell production?

A 
Iron deficiency
B12/PA 
Folate deficient
Aplastic anaemia
CKD
Anaemia of chronic disease
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11
Q

Name some causes of iron deficiency?

A

Intake
Absorption
Increased requirement
Chronic blood loss

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12
Q

What is the commonest cause of anaemia?

A

Iron deficiency

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13
Q

What additional S+S can iron deficiency anaemia cause?

A

Glossitis, angular stomatitis, koilonychia

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14
Q

What happens in iron deficiency before the patient become clinically anaemia?

A

Exhaust their iron stores

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15
Q

What blood results are seen in iron deficiency anaemia

A

Low Hb
Low MCV / MCH
Low ferritin
+- Raised platelets

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16
Q

What is the Mx of Fe deficiency anaemia?

A

PO Fe2+ ferrous fumarate 3X day

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17
Q

What are the main side effects of ferrous fumarate?

A

GI upset - constipation

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18
Q

What is the commonest cause of failure to respond to ferrous fumarate in iron deficiency anaemia?

A

Poor compliance

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19
Q

How quickly do you expect a rise in Hb following ferrous fumarate Tx in Fe deficiency anaemia?

A

Raise 10g / week

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20
Q

What blood test can you do to look for a response to Tx in Fe deficiency anaemia?

A 
Hb
Reticulocytes (should raise in 1st week)
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21
Q

What additional management should you do in iron deficiency anaemia other than replace iron?

A

Investigate cause eg why menorrhagia?

consider endoscopy or colonoscopy if older

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22
Q

How long does it take to deplete folate and B12 stores in deficiency?

A

B12 2-4 years

Folate 4 months

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23
Q

What additional S+S can B12 deficiency cause?

A 
Peripheral neuropathy
Subacute combined SC degeneration
Dementia
Weight loss
Psychiatric

(others)

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24
Q

What is the function of B12 and folate in erythrocytes?

A

Co-factor for nuclear maturations enabling DNA synthesis

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25
Q

What is the aetiology of B12 deficiency?

A

Intake
Absorption
PA
Drugs (PPI)

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26
Q

Where is folate absorbed?

A

Jejunum + duodenum

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27
Q

What is folate converted to in the body?

A

Monoglutamate

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28
Q

What is the stereotypical cause of folate deficiency?

A

Alcoholic

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29
Q

What is the Mx of folate deficiency?

A

5mg PO folate 1X day

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30
Q

What is the pathology of pernicious anaemia?

A

Ab to gastric parietal cells intrinsic or IF needed to absorb B12

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31
Q

Where is B12 absorbed?

A

Terminal ileum

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32
Q

What conditions is pernicious anaemia associated with?

Also associated with increased age, FH and atrophic gastritis

A

Other autoimmune conditions eg hypothyroid, Addison’s, vitiligo etc.

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33
Q

What investigations are done for pernicious anaemia?

A

Serum B12 inaccurate
anti-IF
anti-gastric parietal cell

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34
Q

What is the Mx of pernicious anaemia?

A

Lifelong B12 IJ every 3 mth

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35
Q

What cause of anaemia also shows reduced platelets and WBCs?

A

Aplastic anaemia

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36
Q

What are the causes of anaemia of chronic disease?

A

Chronic inflammation eg cancer, autoimmunity (RA), infections

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37
Q

What is the mechanism of anaemia of chronic disease?

A

Macrophages release cytokines that inhibit Epo

Decreased RBC lifespan

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38
Q

What effect does anaemia of chronic disease have on

  • Ferritin
  • Serum Fe
  • MCV
A

Increased ferritin
Decreased Fe
Normal or decreased MCV

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39
Q

In anaemia of chronic disease the cytokine ____ causes hepatocytes to release _____ which causes macrophages to release _____ and increases Fe absorption

A

In anaemia of chronic disease the cytokine IL6 causes hepatocytes to release HEPCIDIN which causes macrophages to release FE

40
Q

What congenital cause of anaemia is due to an abnormality in the Hb protoporphyrin ring? It causes decreased production of RBCs

A

Sideroblastic anaemia

41
Q

What is the definition of haemolysis

A

Premature RBC destruction

42
Q

What system is responsible for RBC removal?

A

Reticulo-endothelial system

Predominantly liver and spleen

43
Q

What effect does haemolysis have on erythroid marrow?

A

Erythroid hyperplasia and reticulocytosis

44
Q

Haemoylsis directly causes increased ……

A

RBC breakdown products

45
Q

What effect does haemolysis have on haptoglobin? Why?

A

Decreased serum haptoglobin

It binds free Hb

46
Q

What RBC breakdown products are found in the blood in haemolysis?

A

LDH, bilirubin

47
Q

What is the classification of haemolytic anaemia? Which form is more common?

A

Intra or extravascular

Extravascular commoner

48
Q

Name 4 causes of extravascular haemolysis

A

Sickle cell
Haemolytic disease of the newborn
Spherocytosis
Warm AIHA

49
Q

Name 6 causes of intravascular haemolysis

A 
MAHA
Malaria
Cold AIHA
PNH
G6PD deficient
ABO reaction
50
Q

Name 4 causes of MAHA intravascular haemolysis

A

Mechanical valve
March haemoglobulinuria
TTP
HUS

51
Q

What is the commonest cause of warm AIHA?

A

Idiopathic

52
Q

Is warm AIHA IgG or IgM mediated?

53
Q

Is cold AIHA IgG or IgM mediated?

54
Q

What is the other name for malaria causing intravascular haemolysis?

A

Blackwater fever

55
Q

What are the consequences of hyperbilirubinaemia in haemlysis?

A

Prehepatic jaundice

Gallstones

56
Q

What is LDH an indicator of?

A

Non-specific indicator of increased cell turnover

57
Q

Extravascular haemolysis causes increased [normal/ abnormal] products.
Intravascular haemolysis causes increased [normal/ abnormal] products.

A

Extravascular haemolysis causes increased NORMLA products.

Intravascular haemolysis causes increased ABNORMAL products.

58
Q

Haemoglobinaemia, methaemalbuminaemia, haemoglobinuria and haemosiderinuria are all examples of _______ which is seen in _______

A

abnormal products

intravascular haemolysis

59
Q

What investigations help differentiate the cause of haemolysis?

A

FBC, blood film, reticulocytes, unconjugated bilirubin, haptoglobins, urine urobilinogen

60
Q

What cause of intravascular haemolysis has irregularly contracted cells and Heinz bodies on blood film?

A

G6PD deficiency

61
Q

What is the inheritance pattern of G6PD deficiency?

62
Q

What is the inheritance pattern of hereditary spherocytosis?

63
Q

What effect does G6PD deficiency have on:

  • Epo
  • Reticulocytes
  • RBC lifespan
  • The spleen
  • Fe
A
  • Raised Epo
  • Raised reticulocytes
  • Decreased lifespan
  • Splenomegaly
  • Normal Fe
64
Q

What effect does hereditary spherocytosis have on:

  • MCV
  • Platelets
  • WCC
  • RBC lifespan
  • Spleen
A
  • Normal MCV
  • Normal WCC
  • Raised platelets
  • Reduced RBC lifespan
  • Splenomegaly
65
Q

What is a spherocyte

A

Spherical not bi-concave shape RBC

66
Q

What part of the RBC is effect in hereditary spherocytosis?

67
Q

How does hereditary spherocytosis present?

A

Young, jaundice/fatigue after illness, splenomegaly

68
Q

How does G6PD deficiency present?

A

Compensate day-day, episodic haemolytic anaemic in oxidative stress (ill/ drug)

69
Q

What supplement is given in hereditary spherocytosis and G6PD deficiency?

70
Q

ABO transfusion reactions and haemolytic disease of the newborn are both examples of what cause of haemolysis?

A

Alloimmune

71
Q

What is seen on blood film in mechanical intravascular haemolysis?

A

RBC fragments

72
Q

What colour is urine in malaria haemolysis?

A

black (blackwater fever)

73
Q

What colour is the urine in PNH

A

Red (in the mornings)

74
Q

What is the name of the condition that causes haemolytic anaemia and hyperlipidaemia due to alcoholic liver disease?

A

Zieve’s syndrome

75
Q

What is compensated haemolysis?

A

Increased production matches increased destruction so not clinically anaemic

(but haemolysis markers are present)

76
Q

Name 3 causes of chronic blood loss anaemia

A

PUD (RF NSAID)
Menorrhagia
GIT malignancy

77
Q

Is anaemia in acute blood loss is normocytic, macrocytic or microcytic?
Is anaemia in chronic blood loss is normocytic, macrocytic or microcytic?

A

Acute normocytic

Chronic microcytic

78
Q

In acute blood loss, what hormone responds? What effect does this have and over what time frame?

A

Increased Epo
Release reticulocytes
Takes 6-12 hours

79
Q

What is the commonest cause of microcytic anaemia?

Name 3 other causes

A 
Fe deficiency commonest
Also: 
Anaemia of chronic disease
Thalassaemia
Sideroblastic anaemia
80
Q

How does microcytic anaemia appear on blood film?

A

Hypochromic (lack colour)

81
Q

What investigation is most useful for finding the cause of microcytic anaemia

A

Serum ferritin

82
Q

What are the 3 categories of macrocytic anaemia?

A

Megaloblastic
Non-megaloblastic
Spurious

83
Q

Name 2 causes of spurious aka false macrocytosis

A

Cold agglutinins

Reticulocytosis a few days after acute blood loss

84
Q

Macrocytosis always happens in the context of anaemia. T or F

A

False - spurious

85
Q

What is cold agglutinins associated with?

Red cells clumps registered as 1 giant cell

A

Lymphoma and infection

86
Q

What is a megaloblast?

A

Abnormally large nucleated RBC precursor with an immature nucleus

87
Q

What is seen on blood film in megaloblastic anaemia?

A

Oval macrovalocytes + hypersegmented neutrophils

Normally 3-5 nuclear segments

88
Q

Name the 2 commonest causes of megaloblastic macrocytic anaemia?

A

B12 or folate deficiency

89
Q

What effect for megaloblastic anaemia have on overall RBC apoptosis?

A

Increased apoptosis since macrophages register cells as abnormal

90
Q

How is haemoglobin synthesis effected in megaloblastic anaemia?

91
Q

There are increased red cell division in megaloblastic macrocytosis. T or F

A

False, fewer divisions = failure to become smaller

92
Q

Myelodysplasia, aplastic anaemia, alcohol, liver and hypothyroidism can all cause what type of anaemia?

A

Non-megaloblastic macrocytic

93
Q

What is the main way of classifying normocytic anaemia?

A

Increased or decreased reticulocytes

94
Q

What causes a normocytic anaemia with a low reticulocyte count?

A

Hypoproliferative marrow

E.g. CKD, hypothyroid, marrow failure, marrow fibrosis, aplastic anaemia, anaemia of chronic disease

95
Q

What causes a normocytic anaemia with a raised reticulocyte count?

A

Haemolysis or acute blood loss

96
Q

If you suspect haemoylsis, what is the next most important test?

A

Reticulocyte count

97
Q

In pernicious anaemia there is premature RBC destruction in the _______ causing excess bilirubin production

A

Bone marrow

Large abnormal cells may be mechanically destroyed whilst leaving the marrow

Y3 Haematology (15 decks)

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