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Anaemia Flashcards

1
Q

What does MCV mean?

A

The mean volume of RBC

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2
Q

What does RCC mean?

A

Concentration of RBC in blood

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3
Q

What does HCT mean?

A

Haematocrit

Volume percentage of erythrocytes in blood

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4
Q

What does MCH mean?

A

Mean corpuscular haemoglobin.

Mean Hb quantity within blood calls

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5
Q

What does RDW mean?

A

Red blood cell distribution width

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6
Q

What is transferrin?

A

Protein that attaches iron molecules and transports iron in blood plasma.

Made in liver.

Levels are increased in hemochromatosis, iron deficiency and electrolyte transfusions.

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7
Q

What is transferrin saturation?

A

How much of iron-binding sites of transferrin are being occupied by iron

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8
Q

What is Ferritin?

A

Protein that stores iron and releases iron when it’s needed.

It is an acute phase protein so can be raised in inflammatory conditions.
Best indicator of iron deficiency

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9
Q

How is Iron absorbed in the body?

A

Absorbed in duodenum with transferrin.

Iron must be converted into the ferrous Fe2+ state via ferric reductase enzymes on the brush border of erythrocytes.

Transferrin is then transported to liver and converted to ferritin (storage form of iron). Iron is then stored in bone marrow, liver and spleen

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10
Q

Examples of microcytic anaemias:

A

Iron deficiency
Sideroblastic
Thalassaemia

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11
Q

Examples of normocytic anaemias:

A

Haemolytic anaemia
Blood loss
Sickle cell

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12
Q

Examples of macrocytic anaemias:

A

Megaloblastic anaemia
Reticulocytosis
Alcohol and pregnancy

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13
Q

When would we get low Hb and low MCV?

A

Iron deficiency
Thalassaemia
Sideroblastic anaemia

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14
Q

When would we get low Hb but unchanged MCV?

A 
Anaemia of chronic disease
Acute blood loss 
Aplastic anaemia 
Haemolysis
Marrow infiltration
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15
Q

When would we get low Hb but raised MCV?

A 
B12/folate deficiency 
Alcohol
Myelodysplastic syndrome 
Marrow infiltration 
Haemolysis
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16
Q

When would you get low ferritin, low iron, high transferrin and low transferrin saturation?

A

Iron deficiency

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17
Q

When would you get high ferritin, high iron, low transferrin and high saturation?

A

Haemochromatosis

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18
Q

When would you get normal/high ferritin, low iron, low transferrin and low saturation?

A

Anaemia of chronic disease

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19
Q

When would you get high ferritin, high iron, normal/low transferrin and high saturation?

A

Haemolytic anaemia

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20
Q

What is the normal Hb range?

A

Female (120-160 g/dL) and Males (135-175 g/dL)

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21
Q

Why is using serum ferritin preferred over serum iron levels?

A

Serum ferritin reflects true iron stores in uncomplicated iron deficiency and fluctuates less due to short-term variations than serum iron levels and total iron binding capacity (TIBC)

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22
Q

When can ferritin be raised other than anaemia?

A

Ferritin is also an acute phase protein and can be raised by inflammation, infection, chronic disease and malignancy.
Ferritin is stored in the liver, so liver disease or inflammation may also result in elevated levels

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23
Q

What does a raised reticulocyte count suggest?

A

Blood loss or haemolytic anaemia

24
Q

What is pernicious anaemia?

A

Autoimmune destruction of gastric parietal cells. Anti-parietal cell antibodies or intrinsic factor antibodies

Low vitamin B12

25
Q

What is iron deficiency anaemia?

A
  • Microcytic, hypochromic anaemia
    • Causes: blood loss, sideroblastic anaemia and thalassaemia
    • Low MCV, MCH and high RDW
    • Low reticulocyte count
    • Treatment:
      • Contraceptives if menstruation is cause for anaemia
        Iron supplementation taken on an empty stomach
26
Q

What is Thalassaemia?

A
  • Genetic disorder
    • Hypochromic microcytic cells and ineffective erythropoiesis
    • Imbalance of alpha and beta globin chains
27
Q

What is the treatment for thalassaemia?

A
  • Treatment:
    - Blood transfusion
    - Iron chelation treatment to reduce iron toxicity.
    - Allogenic bone marrow transplantation has been used recently to treat the condition.
    - Genetic counselling
28
Q

What is Anaemia of chronic disease?

A
  • Normocytic normochromic anaemia
    • Inflammatory cytokines inhibit iron transporter by blocking iron from leaving macrophages and other cells. This results in functional iron deficiency. They also suppress erythropoietin secretion.
    • 20% of anaemias over age 65
    • Non-progressive anaemia

Investigations:

	- Low Hb, low/normal MCV
	- Iron, transferrin, transferrin saturation low
	- High ferritin levels
29
Q

What is the treatment for anaemia of chronic disease?

A

IV erythropoietin stimulating agent. Oral iron wont work and as there is a defect in iron incorporation into erythrocyte which is independent of serum iron levels.

30
Q

What are the lab tests done to diagnose megaloblastic anaemia?

A

Low Hb and haematocrit. Raised MCV and MCH
Serum B12 and folate - low
Blood smear - hyper-segmented neutrophils and anisocytosis (high RDW)
Reticulocyte count - low
Lactate dehydrogenase - raised due to ineffective erythropoiesis
Unconjugated bilirubin - raised
Plasma methylalonic acid -only raised in B12 deficiency
Bone marrow aspiration - megaloblastic changes, erythroid hyperplasia
Antibody screening - parietal cells antibodies
Schilling test

31
Q

What is the Schilling test

A

IM B12 load to saturate body stores -> give radioactive b12 with intrinsic factor and look at the difference in urinary excretion on the labelled form

32
Q

What medications can cause macrocytic anaemia?

A 
Methotrexate
Trimethoprim
Oral contraceptive medicine
Phenytoin
Metformin
Hydroxyurea
33
Q

What are the causes of haemolytic anaemia?

A

Inherited:

  • spherocytosis or elliptocytosis
  • Haemoglobin abnormalities like thalassaemia or sickle cell
  • Metabolic defects like glucose-6-phosphate dehydrogenase deficiency or pyruvate kinase deficiency

Acquired:

  • Immune: autoimmune, alloimmune, drug reaction
  • Non immune: Paroxysmal nocturnal haemoglobinuria, fragmentation anaemias, microangiopathic anaemias

Infections, hypersplenism, burns, drugs causing oxidative haemolysis

34
Q

What is Paroxysmal nocturnal haemoglobinuria?

A

What is Paroxysmal nocturnal haemoglobinuria? Rare acquired, life-threatening disease of the blood. The disease is characterized by haemolysis, thrombosis and decreased haematopoiesis.

35
Q

What is Microangiopathic haemolytic anaemia?

A

Production of fragmented RBS (schistocytes) caused due to defective prosthetic cardiac valves, intravascular coagulation, HUS.

36
Q

What is the treatment for megaloblastic anaemias?

A

Hydroxocobalamin injections

Folic acid given parenterally

37
Q

What are the acute complications of Sickle Cell Anaemia?

A

Vaso-occlusive crisis: dactylitis triggered by stress/infection/cold, priapism
Acute chest syndrome: pain in ribs, SOB, hypoxia
Leg ulcers - due to vaso-occlusion of small vessels
Stroke - stenosis on internal carotid artery
Sepsis (frequent infections) - hyposplenism causes immune dysfunction
Delayed growth
Vision problems
DVT

38
Q

What are the ways to manage the acute complications of sickle cell anaemia?

A

Vaso-occlusive crisis: Rest, hydration, analgesia
ACS: Hydroxyurea, meds to treat infection, blood transfusion
Ulcers - cream/ointments
Stroke - hypertransfusion
Sepsis (frequent infections) - prophylactic penicillin
Spleen sequestration - splenectomy, blood transfusion
Vision problems - yearly eye check ups

39
Q

Commonest cause of iron-deficiency anaemia in asian-african countries

A

Hookworms (found in soil when faeces gets mixed and can enter body after people walk barefoot)

40
Q

Where is excess iron commonly deposited

A

Liver, pancreas (tissue damage and diabetes), joints, skin (bronzed colour), heart

41
Q

What is subacute combined degeneration?

A

Patchy loss of myelin in posterior and lateral columns

Weakness, vision disturbances, mental disturbances, bilateral spastic paresis

Glove and stocking paresthesia

42
Q

What is the Plummer Vinson syndrome?

A

Symptom of iron deficiency anaemia

Difficulty swallowing, glossitis, cheilosis and oesophageal webs

43
Q

Where is red bone marrow found in adults and in foetus?

A

Adults - flat bones (e.g. pelvis, ribs, vertebrae)

Foetus - yolk sac

44
Q

What is G6PD deficiency?

A

Commonest red blood cell enzyme defect
More in Mediterranean and African people. X-linked inherited

Drugs can lead to haemolysis in these patients - ciprofloxacin, anti-malarials, sulph group drugs

Features: Heinz bodies on blood films, neonatal jaundice, gallstones, haemolysis, splenomegaly

45
Q

What is hereditary spherocytosis?

Presentation

A

Most common haemolytic anaemia in northern european descent
Autosomal dominant defect of RBC cytoskeleton

FTT, jaundice, gallstones, splenomegaly, aplastic crisis precipitated by parovirus, MCHC elevated

46
Q

What tests are done to diagnose hereditary spherocytosis?

A

Usually a typical family history and lab tests
EMA binding test
Electrophoresis

47
Q

Blood results in patients with Sickle cell

A

Low Hb
Normal MCV
Raised reticulocytes (due to haemolysis)

48
Q

In HbS homozygous individuals, how long does it take for symptoms to develop?

A

4-6 months

Due to abnormal HbSS taking over from fetal hemoglobin

49
Q

What should all patients over the age of 6- with iron deficiency anaemia be investigated for?

A

Colorectal cancer using colonoscopy

50
Q

What would a raised LDH on bloods suggest in context of anaemias?

A

Cell lysis - haemolytic anaemia

51
Q

SLE is a known cause for what kind of anaemia?

A

Autoimmune haemolytic anaemia

52
Q

What is thrombotic crisis in sickle cell?

A

Painful or vaso-occlusive crisis
Precipitates by infection, dehydration, deoxygenation
Infarct occurs in various organs

53
Q

What is sequestration crisis in sickle cell?

A

Sickling within organs such as spleen on lungs causes pooling of blood worsening the anaemia

54
Q

What is Acute chest syndrome in sickle cell?

A

Dyspnoea, cheat pain, low pO2, pulmonary infiltrates

Most common cause of death after childhood

55
Q

What is aplastic crisis in sickle cell?

A

Caused by parovirus infection

Sudden fall in Hb

56
Q

What is haemolytic crisis in sickle cell?

A

Rare

Fall in Hb due to increased rate of haemolysis

57
Q

What should be offered to patients who have iron deficiency anaemia pre-surgery but can’t take oral iron

A

IV Iron

Met (7 decks)

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