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
2
Q
What test distinguishes anaemia based on size?
A
Macrocytic MCV more than 100
Microcytic MCV less than 80
3
Q
What tests are haematinics?
A
Ferritin, B12, folate
4
Q
What infection causes stop erythropoiesis for 2 weeks?
A
Parvovirus B19 slapped cheek
5
Q
What is another way of classifying anaemia other than by cell size?
A
Decreased production
Increased destruction
Increased loss
6
Q
What are the 2 causes of decreased production anaemia?
A
Hypoproliferative marrow (less erythropoiesis)
Or
Ineffective maturation
7
Q
A erythrocyte maturation defect can be in which 2 places in the cell?
A
Cytoplasmic or nuclear
8
Q
A cytoplasmic erythrocyte maturation problem often causes what size of anaemia?
A
Microcytic
9
Q
A nuclear erythrocyte maturation problem often causes what size of anaemia?
A
Macrocytic
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
11
Q
Name some causes of iron deficiency?
A
Intake
Absorption
Increased requirement
Chronic blood loss
12
Q
What is the commonest cause of anaemia?
A
Iron deficiency
13
Q
What additional S+S can iron deficiency anaemia cause?
A
Glossitis, angular stomatitis, koilonychia
14
Q
What happens in iron deficiency before the patient become clinically anaemia?
A
Exhaust their iron stores
15
Q
What blood results are seen in iron deficiency anaemia
A
Low Hb
Low MCV / MCH
Low ferritin
+- Raised platelets
16
Q
What is the Mx of Fe deficiency anaemia?
A
PO Fe2+ ferrous fumarate 3X day
17
Q
What are the main side effects of ferrous fumarate?
A
GI upset - constipation
18
Q
What is the commonest cause of failure to respond to ferrous fumarate in iron deficiency anaemia?
A
Poor compliance
19
Q
How quickly do you expect a rise in Hb following ferrous fumarate Tx in Fe deficiency anaemia?
A
Raise 10g / week
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)
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
22
Q
How long does it take to deplete folate and B12 stores in deficiency?
A
B12 2-4 years
Folate 4 months
23
Q
What additional S+S can B12 deficiency cause?
A
Peripheral neuropathy Subacute combined SC degeneration Dementia Weight loss Psychiatric
(others)
24
Q
What is the function of B12 and folate in erythrocytes?
A
Co-factor for nuclear maturations enabling DNA synthesis
25
What is the aetiology of B12 deficiency?
Intake
Absorption
PA
Drugs (PPI)
26
Where is folate absorbed?
Jejunum + duodenum
27
What is folate converted to in the body?
Monoglutamate
28
What is the stereotypical cause of folate deficiency?
Alcoholic
29
What is the Mx of folate deficiency?
5mg PO folate 1X day
30
What is the pathology of pernicious anaemia?
Ab to gastric parietal cells intrinsic or IF needed to absorb B12
31
Where is B12 absorbed?
Terminal ileum
32
What conditions is pernicious anaemia associated with?
Also associated with increased age, FH and atrophic gastritis
Other autoimmune conditions eg hypothyroid, Addison's, vitiligo etc.
33
What investigations are done for pernicious anaemia?
Serum B12 inaccurate
anti-IF
anti-gastric parietal cell
34
What is the Mx of pernicious anaemia?
Lifelong B12 IJ every 3 mth
35
What cause of anaemia also shows reduced platelets and WBCs?
Aplastic anaemia
36
What are the causes of anaemia of chronic disease?
Chronic inflammation eg cancer, autoimmunity (RA), infections
37
What is the mechanism of anaemia of chronic disease?
Macrophages release cytokines that inhibit Epo
| Decreased RBC lifespan
38
What effect does anaemia of chronic disease have on
- Ferritin
- Serum Fe
- MCV
Increased ferritin
Decreased Fe
Normal or decreased MCV
39
In anaemia of chronic disease the cytokine ____ causes hepatocytes to release _____ which causes macrophages to release _____ and increases Fe absorption
In anaemia of chronic disease the cytokine IL6 causes hepatocytes to release HEPCIDIN which causes macrophages to release FE
40
What congenital cause of anaemia is due to an abnormality in the Hb protoporphyrin ring? It causes decreased production of RBCs
Sideroblastic anaemia
41
What is the definition of haemolysis
Premature RBC destruction
42
What system is responsible for RBC removal?
Reticulo-endothelial system
| Predominantly liver and spleen
43
What effect does haemolysis have on erythroid marrow?
Erythroid hyperplasia and reticulocytosis
44
Haemoylsis directly causes increased ......
RBC breakdown products
45
What effect does haemolysis have on haptoglobin? Why?
Decreased serum haptoglobin
| It binds free Hb
46
What RBC breakdown products are found in the blood in haemolysis?
LDH, bilirubin
47
What is the classification of haemolytic anaemia? Which form is more common?
Intra or extravascular
Extravascular commoner
48
Name 4 causes of extravascular haemolysis
Sickle cell
Haemolytic disease of the newborn
Spherocytosis
Warm AIHA
49
Name 6 causes of intravascular haemolysis
```
MAHA
Malaria
Cold AIHA
PNH
G6PD deficient
ABO reaction
```
50
Name 4 causes of MAHA intravascular haemolysis
Mechanical valve
March haemoglobulinuria
TTP
HUS
51
What is the commonest cause of warm AIHA?
Idiopathic
52
Is warm AIHA IgG or IgM mediated?
IgG
53
Is cold AIHA IgG or IgM mediated?
IgM
54
What is the other name for malaria causing intravascular haemolysis?
Blackwater fever
55
What are the consequences of hyperbilirubinaemia in haemlysis?
Prehepatic jaundice
| Gallstones
56
What is LDH an indicator of?
Non-specific indicator of increased cell turnover
57
Extravascular haemolysis causes increased [normal/ abnormal] products.
Intravascular haemolysis causes increased [normal/ abnormal] products.
Extravascular haemolysis causes increased NORMLA products.
| Intravascular haemolysis causes increased ABNORMAL products.
58
Haemoglobinaemia, methaemalbuminaemia, haemoglobinuria and haemosiderinuria are all examples of _______ which is seen in _______
abnormal products
intravascular haemolysis
59
What investigations help differentiate the cause of haemolysis?
FBC, blood film, reticulocytes, unconjugated bilirubin, haptoglobins, urine urobilinogen
60
What cause of intravascular haemolysis has irregularly contracted cells and Heinz bodies on blood film?
G6PD deficiency
61
What is the inheritance pattern of G6PD deficiency?
X linked
62
What is the inheritance pattern of hereditary spherocytosis?
AD
63
What effect does G6PD deficiency have on:
- Epo
- Reticulocytes
- RBC lifespan
- The spleen
- Fe
- Raised Epo
- Raised reticulocytes
- Decreased lifespan
- Splenomegaly
- Normal Fe
64
What effect does hereditary spherocytosis have on:
- MCV
- Platelets
- WCC
- RBC lifespan
- Spleen
- Normal MCV
- Normal WCC
- Raised platelets
- Reduced RBC lifespan
- Splenomegaly
65
What is a spherocyte
Spherical not bi-concave shape RBC
66
What part of the RBC is effect in hereditary spherocytosis?
Membrane
67
How does hereditary spherocytosis present?
Young, jaundice/fatigue after illness, splenomegaly
68
How does G6PD deficiency present?
Compensate day-day, episodic haemolytic anaemic in oxidative stress (ill/ drug)
69
What supplement is given in hereditary spherocytosis and G6PD deficiency?
Folate
70
ABO transfusion reactions and haemolytic disease of the newborn are both examples of what cause of haemolysis?
Alloimmune
71
What is seen on blood film in mechanical intravascular haemolysis?
RBC fragments
72
What colour is urine in malaria haemolysis?
black (blackwater fever)
73
What colour is the urine in PNH
Red (in the mornings)
74
What is the name of the condition that causes haemolytic anaemia and hyperlipidaemia due to alcoholic liver disease?
Zieve's syndrome
75
What is compensated haemolysis?
Increased production matches increased destruction so not clinically anaemic
(but haemolysis markers are present)
76
Name 3 causes of chronic blood loss anaemia
PUD (RF NSAID)
Menorrhagia
GIT malignancy
77
Is anaemia in acute blood loss is normocytic, macrocytic or microcytic?
Is anaemia in chronic blood loss is normocytic, macrocytic or microcytic?
Acute normocytic
| Chronic microcytic
78
In acute blood loss, what hormone responds? What effect does this have and over what time frame?
Increased Epo
Release reticulocytes
Takes 6-12 hours
79
What is the commonest cause of microcytic anaemia?
| Name 3 other causes
```
Fe deficiency commonest
Also:
Anaemia of chronic disease
Thalassaemia
Sideroblastic anaemia
```
80
How does microcytic anaemia appear on blood film?
Hypochromic (lack colour)
81
What investigation is most useful for finding the cause of microcytic anaemia
Serum ferritin
82
What are the 3 categories of macrocytic anaemia?
Megaloblastic
Non-megaloblastic
Spurious
83
Name 2 causes of spurious aka false macrocytosis
Cold agglutinins
| Reticulocytosis a few days after acute blood loss
84
Macrocytosis always happens in the context of anaemia. T or F
False - spurious
85
What is cold agglutinins associated with?
| Red cells clumps registered as 1 giant cell
Lymphoma and infection
86
What is a megaloblast?
Abnormally large nucleated RBC precursor with an immature nucleus
87
What is seen on blood film in megaloblastic anaemia?
Oval macrovalocytes + hypersegmented neutrophils
| Normally 3-5 nuclear segments
88
Name the 2 commonest causes of megaloblastic macrocytic anaemia?
B12 or folate deficiency
89
What effect for megaloblastic anaemia have on overall RBC apoptosis?
Increased apoptosis since macrophages register cells as abnormal
90
How is haemoglobin synthesis effected in megaloblastic anaemia?
Normal
91
There are increased red cell division in megaloblastic macrocytosis. T or F
False, fewer divisions = failure to become smaller
92
Myelodysplasia, aplastic anaemia, alcohol, liver and hypothyroidism can all cause what type of anaemia?
Non-megaloblastic macrocytic
93
What is the main way of classifying normocytic anaemia?
Increased or decreased reticulocytes
94
What causes a normocytic anaemia with a low reticulocyte count?
Hypoproliferative marrow
| E.g. CKD, hypothyroid, marrow failure, marrow fibrosis, aplastic anaemia, anaemia of chronic disease
95
What causes a normocytic anaemia with a raised reticulocyte count?
Haemolysis or acute blood loss
96
If you suspect haemoylsis, what is the next most important test?
Reticulocyte count
97
In pernicious anaemia there is premature RBC destruction in the _______ causing excess bilirubin production
Bone marrow
| Large abnormal cells may be mechanically destroyed whilst leaving the marrow
