Anaemia Flashcards
what is the definitions of anaemia for men and women?
men < 13.5
women < 11.5
what are the symptoms of anaemia FFATHPAD
F - fatigue F - faintness A - anorexia T - tinnitus H - headaches P - palpitatins A - angina D - dysopnea
signs of anaemia?
conjuctive pallor
if severe anaemia (<8) then there are sings of hyperdynamic circulation -
- tachycardia
- flow murmurs
- cardiac hypertrophy
- retinal heamorrhage (rare)
- heart failure (later)
what are the 3 types of anaemias based on mean cell volume and MCH?
microcytic hypochromic anaemia = decreased MCV and decreased MCH
normocytic normochromic anaemia = normal MCV, normal MCH
macrocytic anaemia = increased MCV and decreased MCH
causes of low MCV (microcytic anaemia) (3)
Iron deficiency anaemia
Thallasaemia (low MCV high RCC)
sideroblastic anaemia
causes of normocytic anaemia (normal MCV)
acute blood loss anaemia of chronic disease (or dec MCV) renal failure hypothyroidism (or inc MCV) Haemolysis (or inc MCV) Pregnancy Bone marrow failure (if decreased WCC or decreased platelets suspect bone marrow)
causes of high MCV (macrocytic anaemia)?
B12 / folate deficiency alcohol excess or liver disease reticulocytosis cytotoxis myelodysplastic syndrome marrow infiltration Hypothyroidism antipholate drugs such as phenytoin
what can haemolytic anaemia be both of?
normocytic or macrocytic
what are the three main types of microcytic anaemia?
1) Haem synthesis defect - iron deficiency (most common)
2) Globin synthesis defect - Thallasaemia autosommal recessive disease, reduced rate of synthesis alpha and beta chains
3) sideroblastic anaemia - inability to incorporate iron into haemoglobin. X linked ineffective erythropoeisis.
what are rare causes of iron deficiency anaemia?
malnutrition in babies
malabsorption (such as coeliac disease causing refractory IDA)
in the tropics (hookworm causes GI bleeds)
Pregnancy
what are the signs in chronic iron deficiency anaemia?
1) koilonychia - spoon shaped nails - iron defiency
2) atrophic glossitis - papillae atrophy
3) angular stomatitis
4) oesophageal webs caused by dysphagia (Plummer-vinson syndrome, rare sign)
where is iron absorbed?
upper small intestine
what enhances iron absorption?
vitamin C
what protein made in the liver regulates iron absorption and circulation?
hepcidin
when is hepcidin released?
in iron excess in stores
inflammation
(it reduces ferroportin)
what does hepcidin do?
reduces iron absorption
and iron release from macrophages to transferring
what happens in iron deficiency?
transferrin receptors are increased and there is also an increase in iron receptor levels to maintain it in circulation.
ferritin syntehsis is decreased to maintain levels in circulation.
what does anisocytosis mean
RBCs of unequal size
what does poikilocytosis mean
RBCs of different/abnormal shapes
what do you see in a blood film for iron deficiency anaemia?
microcytic hypochromic anaemia with presence of anisocytosis and poikilocytosis and target cells.
what do you see in lab FBC findings for iron deficiency anaemia?
decreased:
- ferritin (diagnostic < 20)
- MCV
- MCH
- MCHC
- RCC
- Hb
also decreased serum iron + increased total iron-binding capacity
what do you see for ferritin in haemotinics (Fe study) in iron deficiency
it will be decreased as body wants to use as much iron in circulation as possible to compensate for iron deficiency
it is an acute phase protein that is increased in inflammtion e.g. infection
what do you see for transferrin in haemotinics (Fe study) in iron deficiency
its a transport protein that is increased in iron deficiency as body produces more to collect as much iron as possible.
serum transferrin receptors are increased in IDA but are less affected by inflammation
what is the total Fe binding capacity in haemotinics (Fe study) in iron deficiency?
very high
as you want to retain iron by transferrin in circulation
what other investigations can you do for GI blood loss?
- gastrocopy
- sigmoidoscopy
- barium enema
- stool microscopy for ova or hookworm
what is the management for iron deficiencyif there is history of menorrhagia and MCV is low?
give iron supplements with no further investigations
treat underlying cause
what are some common side effects of oral iron - ferrous sulphate?
- nausea
- abdominal discomfornt
- diarrhoea / constipation
- black stools
when do you give IV iron?
if oral route is ineffective
e.g. functional iron deficiency in chronic renal failure.
what type of anaemia is thallasaemia
microcytic hypochromic
what is thallasaemia?
genetic disease
impaired Hb synthesis resulting in underproduction or no production of a globin chain.
this causes precipitations of globin chains causing damage to RBCs in resulting in haemolysis in the marrow.
what can thallasaemia be classifed as?
alpha
beta
what do gene carriers have a degree of protection from?
falciform malaria
what type of anaemai is sideroblastic anaemia?
microcytic hypochromic
what is sideroblastic anaemia?
an anaemia with increased iron present as granules arranged in a ring around the nucleus of erythroblasts.
when do you consider sideroblastic anaemia?
if patient does not respond to iron therapy
what two things can sideroblastic anaemia be caused by?
an X linked condition or a myelodisplastic syndrome (ineffective production of myelin class cells)
what is the pathophysiology of sideroblastic anaemia?
ineffective erythropeisis
causing an increase in iron absorption
this causes iron overload in the bone marrow +/- haemosiderosis if iron is deposited and causes endocrine, liver or heart damage.
so there is an increase in iron and ferritin and normal total binding capacity
