Anaemia Flashcards
Define anaemia
Number of red cells or the oxygen carrying capacity of the red cells are insufficient in meeting the physiological needs
How many people are affected by anaemia?
1.6 billion people
Requirements for RBC production?
Myeloid progenitor cells in bone marrow
Permissive BM mico-environment
Adequate iron, B12, folate
EPO
erythropoietin controls RBC production
Peritubular fibroblasts in renal cortex synthesise EPO
EPO = more reduces oxygen tension
How can anaemia be classified on the underlying mechanism?
1) Bone marrow aplasia/infiltrate
2) Ineffective haematopoiesis (HIV)
3) Substrate deficiency
4) EPO insufficiency
How can anaemia be classified by peripheral loss/destruction?
1) Bleeding
2) Sequestration
3) Haemolysis
General anaemia symptoms
Increased fatigue/tiredness
Dyspnea
Decreased effort to tolerance
What do the severity of anaemia symptoms depend on?
Degree of anaemia
Rate of Hb decrease
What to cover in an anaemia history?
PC Duration of problem Transfusion history Dietary history Cravings for unusual foods (associated with iron deficiency) Travel history Change in bowel habits Bleeding Drug history (anticoagulants, antiplatelets, reno toxic agents) Chronic disease (HIV, TB) Surgery Pregnancy (recent or current) FH
Skin and mucous membrane clinical exam signs
Pallor cardinal sign Angular stomatitis Glossitis Koilonychia (spoon nails) Premature greying Scleral icterus
Neuromuscular clinical exam signs
Muscle weakness
Headache, lack of concentration, drowsiness
Tinnitus
Paraesthesias, peripheral neuropathy, ataxia, loss of vibration sense
CV clinical exam signs
Hyperdynamic circulation with flow murmurs
Cardiac failure
Hepatosplenomegaly
Lymphadenopathy
Bleeding manifestations (petechiae, purpura)
Lab test for anaemia
FBC
Reticulocyte counts
Microscopic blood smear
Normal male Hb
13.8-17.9
Normal female Hb
12.4-15.5
Pregnancy normal Hb
<11
Define Hct
Volume percentage of RBC in blood
Adult male Hct normal
42-54%
Adult women Hct normal
38-46%
Define MCV
Mean cell volume
Hct/RBC concentration
Normal value of MCV
77-93
85 is normal
MCH Define
Mean corpuscular Hb
Average mass of Hb per RBC
= Hb total mass/RBC number
Causes of microcytic anaemia with low or now RBC
Iron deficiency
Lead poisoning
Anaemic of chronic inflammation
Sideroblastic anaemia
Causes of microcytic anaemia with high FBC
Thalassemias
Causes of normocytic anaemia
Haemolytic Bone marrow disorders Hypersplenism Acute blood loss Anaemias of chronic disease
Causes of macrocytic anaemia
B12 deficiency Folate deficiency Liver disease Hypothyroidism Reticulocytosis
