Anaemia Flashcards
Warm AIHA
IgG mediated
Phagocytosis - no complement - occurs in spleen - steroids effective
Lymphoproliferative disease, drugs (penicillin), AI disease (SLE, Crohn’s, RA, UC)
Cold AIHA
IgM mediated
Opsonisation - complement - occurs in liver Kupffer cells - steroids ineffective
Mycoplasma, EBV infections, mono
Schistocytes
Jaundice, uraemia, thrombocytopenia
MAHA
Abdominal pain
Dactylitis
Sickle cell anaemia
Fava beans
Heinz bodies
Bite cells
Think ‘Heinz beans’
G6PD deficiency
ROS = denatured Hb inclusion bodies (Heinz bodies). Bite cells = bites out of RBC where spleen tries to remove Heinz
DAAT positive
AI haemolytic anaemia
Microcytic anaemia
RA
Anaemia of chronic disease
Mediterranean
Microcytic anaemia
B-thalassaemia
Microcytic anaemia
Anisocytosis
Low serum iron + ferritin, high TIBC
Iron deficiency anaemia
Macrocytic anaemia
Pancytopenia + hypocellular BM (ptechiae, high reticulocytes, low WBCs and platelets)
Aplastic anaemia
Failure of BM - macrocytosis as release of fetal Hb to make up for anaemia
Hyper-segmented neutrophils
Cabot rings
Megaloblastic anaemia (folate / B12)
Anisocytosis
Variation in RBC size
Usually due to ID
Donath Landsteiner test
Cold AIHA
Paroxysmal cold haemoglobinuria
Warm vs. cold AIHA
DAAT performed at low and high temperatures - when antibodies bind
Osmotic fragility test
Hereditary spherocytosis
Kleihauer test
Rhesus disease
Looks for fetal Hb containg cells
Teardrop poikilocytes (dacrocytes)
Hypocellular BM
Dry tap
Myelofibrosis
Hamm’s test
Paroxysmal nocturnal haemoglobinuria
Mild acid - RBCs have increased fragility
IDA + Post-cricoid webs
Difficulty swallowing
Plummer-Vinson syndrome
Pencil cells, anisocytosis, hypochromia, poikilocytosis
IDA
How does chronic disease cause anaemia?
- Inflammatory markers reduce EPO receptor production by kidneys (or in renal disease there is just EPO deficiency)
- Dysregulated iron metabolism - IL6 + LPS stimulate liver to make hepcidin - decreases iron absorption from gut
Ring sideroblasts
Alcohol excess
Sideroblastic anaemia (Pyridoxine (vitamin B6) given to promote RBC production)
Megaloblastic macrocytic anaemia
B12 / folate deficiency
Cytotoxic drugs
Non-megaloblastic macrocytic anaemia
Alcohol, reticulocytosis (e.g. in haemolysis), hypothyroidism, pregnancy
Hypersegmented neutrophils
Megaloblastic anaemia
Meat + dairy products (vegans)
Malabsorption (PA or ileal resection)
Glossitis, angular cheilosis, neuropathy
B12 deficiency (Replenish with IM B12)
Diagnostic test pernicious anaemia
Parietal cell antibodies (IF less specific, Schilling test outdated)
Green vegetables
Pregnancy
Folate deficiency
