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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Reduced red cell mass (with/without reduced haemoglobin concentration)

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2
Q

What is the normal range of haemoglobin for men?

A

131-166g/L

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3
Q

What is the normal range of haemoglobin for women?

A

110-147g/L

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4
Q

What is the normal range of mean cell volume for men?

A

81.8-96.3 fl

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5
Q

What is the normal range of mean cell volume for women?

A

80.0 – 98.1 fl

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6
Q

Give an example of when there may be reduced Hb but increased RBC count

A

3rd trimester of pregnancy

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7
Q

What is the relevance of plasma volume to anaemia?

A

Hb is a relative marker in terms of plasma volume. Increased plasma volume (dilution) makes Hb and RBC appear low

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8
Q

What is the Mean Corpuscular Volume (MCV)?

A

Average volume of RBCs/average RBC size

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9
Q

Give 3 causes of microcytic anaemia

A
  1. Iron deficiency
  2. Chronic disease
  3. Thalassaemia
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10
Q

Give 3 causes of normocytic anaemia

A
  1. Acute blood loss
  2. Anaemia of chronic disease
  3. Combined haematinic deficiency
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11
Q

What are the causes of macrocytic anaemia?

A
  • Folate deficiency
  • Alcohol use
  • Thyroid deficiency (hypothyroid)
  • Reticulocytosis (increased)
  • B12 deficiency
  • Cirrhosis (liver disease)
  • Myelodysplasia
  • Drugs e.g. AZT
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12
Q

What are the 2 main consequences of anaemia?

A
  • Reduced O2 transport

* Tissue hypoxia

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13
Q

Give 3 physiological compensatory changes of anaemia

A
  1. Increased tissue perfusion
  2. Increased O2 transfer to tissues
  3. Increased RBC production
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14
Q

Give 5 potential pathological consequences of anaemia

A
  1. Myocardial fatty change
  2. Fatty change in liver
  3. Aggravates angina/claudication
  4. Skin and nail atrophic changes
  5. CNS cell death (cortex and basal ganglia)
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15
Q

State the main clinical symptoms of anaemia

A
  • Fatigue, headaches and faintness
  • Dyspnoea and breathlessness
  • Angina if there is pre-existing coronary disease
  • Anorexia
  • Intermittent claudication
  • Palpitations
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16
Q

What a possible clincal signs of anaemia?

A
  • Pallor
  • Tachycardia
  • Systolic flow murmur
  • Cardiac failure
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17
Q

What are the key investigations of anaemia?

A
  • Thorough history and examination
  • FBC and blood film
  • Reticulocyte count
  • U+Es, LFTs, TSH
  • B12, folate and ferritin levels (to check for malabsorption)
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18
Q

Why does iron deficiency lead to smaller RBCs?

A

Iron is required for haem formation but a decrease means there is less Hb so RBCs are smaller

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19
Q

What is the average daily intake of iron?

A

15-20mg

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20
Q

What percentage of iron intake is absorbed?

A

10%

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21
Q

Where is dietary iron absorbed?

A

The duodenum

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22
Q

What happens to absorbed iron?

A
  • Bound to ferritin and stored intracellularly

* Bound to transferrin and circulates in the blood

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23
Q

What is the most common cause of anaemia in the world?

A

Iron deficiency anaemia

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24
Q

What are some causes of iron deficiency anaemia?

A
  • Blood loss e.g. menorrhagia, GI bleeding, hookworm
  • Poor diet
  • Malabsorption e.g. poor intake, coeliac disease
  • Increased demands e.g. in growth and pregnancy
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25
Q

What are the clinical presentations of iron deficiency anaemia?

A
  • General anaemia symptoms e.g. fatigue, faintness, palpitations, breathlessness
  • Brittle nails and hair
  • Spoon-shaped nails (koilonychias)
  • Atrophy of the papillae of the tongue (atrophic glossitis)
  • Angular stomatitis/cheilosis – ulceration of the corners of the mouth
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26
Q

Give 3 differential diagnoses of iron deficiency anaemia

A
  • Thalassaemia
  • Sideroblastic anaemia
  • Anaemia of chronic disease
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27
Q

What would you use to diagnose iron deficiency anaemia?

A
  • Blood count and film
  • Serum ferritin
  • Serum iron
  • Serum soluble transferrin receptors
  • Reticulocyte count
  • Further investigations into cause of blood loss
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28
Q

What would you see on the blood count and film in iron deficiency anaemia?

A
  • Microcytic and hypochromic RBCs
  • Variation in RBC shape and size
  • Low reticulocyte level
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29
Q

What is the use of serum ferritin in the diagnosis of iron deficiency anaemia?

A
  • Level of serum ferrite reflects the amount of stored iron
  • So low levels confirms diagnosis
  • It may be normal in malignancy or infection
30
Q

What is the use of serum iron in the diagnosis of iron deficiency anaemia?

A
  • Serum iron is low

* Total iron-binding capacity (TIBC) rises compared to normal

31
Q

How would you treat iron deficiency anaemia?

A
  • Find and treat cause
  • Oral iron e.g. ferrous sulphate
  • Parental iron e.g. IV or deep intramuscular in extreme cases such as severe malabsorption
32
Q

Give some side effects of ferrous sulphate

A
  • Nausea
  • Abdominal discomfort
  • Diarrhoea/constipation
  • Black stools
33
Q

If side effects of ferrous sulphate are bad, what might you give instead?

A

Ferrous gluconate

34
Q

What is the most common anaemia in hospitals?

A

Anaemia of chronic disease

35
Q

How does anaemia occur secondary to chronic disease?

A
  • Decreased iron release from bone marrow to developing erythroblasts (early RBCs, before reticulocytes)
  • An inadequate erythropoietin response to anaemia
  • Decreased RBC survival
36
Q

What are some clinical presentations of anaemia of chronic disease?

A
  • Fatigue
  • Headaches and faintness
  • Dyspnoea and breathlessness
  • Angina if there is pre-existing coronary disease
  • Anorexia
  • Intermittent claudication
37
Q

How would you diagnose anaemia of chronic disease?

A
  • Serum iron and Total iron-binding capacity (TIBC) are low
  • Serum ferritin is normal or raised due to the inflammatory process
  • Serum soluble transferrin receptor level is normal
  • Blood count & film
38
Q

What are the RBCs like in anaemia of chronic disease?

A

Normocytic or microcytic and hypochromic

39
Q

How would you treat anaemia of chronic disease?

A
  • Treat underlying chronic cause

* Erythropoietin

40
Q

What are some potential side effects of erythropoietin treatment?

A
  • Flu-like symptoms
  • Hypertension
  • Mild rise in the platelet count
  • Thromboembolism
41
Q

What is the MCV of normocytic anaemia?

A

Normal

42
Q

What are the main causes of normocytic anaemia?

A
  • Acute blood loss
  • Anaemia of Chronic Disease
  • Endocrine disorders e.g. hypopituitarism, hypothyroidism and hypoadrenalism
  • Renal failure
  • Pregnancy
43
Q

What are some clinical presentations of normocytic anaemia?

A
  • Fatigue, headaches and faintness
  • Dyspnoea and breathlessness
  • Angina if there is pre-existing coronary disease
  • Anorexia
  • Intermittent claudication
  • Palpitations
44
Q

How would you diagnose normocytic anaemia?

A
  • Normal B12 and folate
  • Raised reticulocytes
  • Hb down
  • Blood count
  • Normocytic RBCs of blood film
45
Q

How would you treat normocytic anaemia?

A
  • Treat underlying cause
  • Improve diet with plenty of vitamins
  • Erythropoietin injections
46
Q

What is the MCV of macrocytic anaemia?

A

High

47
Q

What are the 2 divisions of macrocytic anaemia?

A

Megaloblastic and non-megaloblastic

48
Q

What are the main causese of megaloblastic macrocytic anaemia?

A
  • Vitamin B12 deficiency

* Folate deficiency

49
Q

What are the main causese of non-megaloblastic macrocytic anaemia?

A
  • Alcohol
  • Liver disease
  • Hypothyroidism
  • Haemolysis
  • Bone marrow failure (aplastic anaemia)
  • Bone marrow infiltration
  • Antimetabolite therapy
  • Myeloma
50
Q

What type of anaemia is pernicious anaemia?

A

An autoimmune, megoloblastic anaemia

51
Q

What foods is B12 found in?

A

Meat, fish and diary products

52
Q

What is Vitamin B12 needed for?

A

For thymidine for DNA synthesis

53
Q

Give 3 causes of B12 deficiency

A
  1. Pernicious anaemia
  2. Diet e.g. vegan
  3. Malabsorption
54
Q

Give some risk factors for pernicious anaemia

A
  • Elderly
  • Female
  • Fair-haired, blue eyes
  • Thyroid and Addison’s disease
55
Q

How might B12 deficiency present clinically?

A
  • Insidious onset with progressively increasing symptoms of anaemia
  • May have lemon-coloured skin (pallor + mild jaundice)
  • Sore tongue
  • Ulceration of the corners of the mouth
  • Neurological features
56
Q

When do neurological features occur in B12 deficiency?

A

When B12 levels are very low

57
Q

Give some differential diagnoses of pernicious anaemia

A
  • Folate deficiency
  • Other causes of B12 deficiency
  • Disease of the terminal ileum/bacterial overgrowth of the small bowel
  • Gastrectomy
58
Q

How might you diagnose pernicious anaemia?

A
  • Blood count and film
  • Raised serum bilirubin
  • Low serum B12
  • Low Hb
  • Low reticulocyte count
  • Intrinsic factor antibodies - dianositic but not present in all cases
59
Q

How might you treat B12 deificiency?

A

• Treat cause if it isn’t pernicious anaemia
• Give B12 injections if cause is malabsorption
• Give oral B12 if cause is dietary
Replenish B12 stored with IM hydroxocobalamin

60
Q

What foods is folate found in?

A
  • Green veg (e.g. spinach, broccoli)
  • Nuts
  • Yeast
  • Liver
61
Q

What is folate needed for?

A

DNA synthesis and in foetal development

62
Q

Where is folate absorbed in the body?

A

The duodenum/proximal jejunum

63
Q

What is the main cause of folate deficiency?

A

Poor intake

64
Q

Give some causes of folate deficiency

A
  • Poor intake
  • Increased demand e.g. pregnancy
  • Increased cell turnover e.g. malignancy, inflammatory disease
  • Malabsorption
  • Anti-folate drugs e.g. methotrexate and trimethoprim
65
Q

Give some risk factors for folate deficiency

A
  • Elderly
  • Poverty
  • Alcoholic
  • Pregnant
  • Crohn’s or coeliac
66
Q

How might folate deficiency present clinically?

A
  • May be asymptomatic
  • May have symptoms of anaemia
  • Glossitis can occur
  • No neuropathy
67
Q

How might you diagnose folate deficiency?

A
  • Blood count and film
  • Low serum and RBC folate
  • GI investigation to exclude GI disease
  • Raised serum bilirubin
68
Q

How might you treat folate deficiency?

A
  • Treat underlying cause

* Give folic acid tablets daily for 4 months with B12 supplements

69
Q

What is haemolytic anaemia?

A

Anaemia caused by the premature breakdown of RBCs before their normal lifespan of 120 days

70
Q

Where can haemolytic anaemia occur?

A
  • The circulation(intravascular)
  • The reticuloendothelial system i.e. by macrophages of the liver and spleen (in particular)
  • The bone marrow (extravascular)
71
Q

What happens to liberated haemoglobin in haemolytic anaemia?

A
  1. Initially binds to haptoglobin until it is saturated
  2. Excess free plasma Hb is filtered by the renal glomerulus and enters the urine
  3. Hb broken down in renal tubular cells and is deposited as haemosiderin
72
Q

Give 4 causes of haemolytic anaemia

A

• RBC membrane defects e.g. Hereditary spherocytosis
• Enzyme defects
e.g. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Haemoglobinopathies
e.g. Thalassaemia, sickle cell disease
• Autoimmune haemolytic anaemia

Haematology (5 decks)

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