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Haem > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia

A

Low Hb conc <135g/L for men and <115g/L women

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2
Q

Anaemia presentation

A

Fatigue
Dyspnoea
Pallor

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3
Q

Anaemia types

A

Microcytic
Normocytic (including haemolytic)
Macrocytic (can be haemolytic if immature RBCs)

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4
Q

Microcytic anaemia causes

A

Iron-deficient
Thalassaemia
Sideroblastic

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5
Q

Normocytic anaemia causes

A 
Acute blood loss
Anaemia of chronic disease
Bone marrow failure
Renal failure
Hypothyroidism
Haemolysis
Pregnancy
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6
Q

Macrocytic anaemia causes

A

B12/folate deficiency

Liver disease
Reticulocytosis
Myelodysplastic syndromes
Hypothyroidism

Antifolate drugs
Cytotoxics

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7
Q

Indication for transfusion in anaemia

A

Hb <70g/L in acute, chronic better tolerated

Severe anaemia with heart failure, give slowly with furosemide 10-40mg IV/PO

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8
Q

Iron deficiency anaemia causes

A

Bleeding e.g. menorrhagia
Poor diet
Malabsorption (e.g. coeliac)

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9
Q

Iron deficiency anaemia signs

A

Koilonychia
Atrophic glossitis
Angular cheilosis

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10
Q

Iron deficiency anaemia tests

A

Blood film is hypochromic + microcytic

Confirmed by decreased ferritin, serum iron and increased TIBC

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11
Q

Iron deficiency anaemia treatment

A

Ferrous sulfate 200mg/8h PO, Hb up by 10g/L/week
Treat cause e.g. GI bleed
2ww referral for upper + lower GI endoscopy if Male with Hb<110

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12
Q

Anaemia of chronic disease causes

A

Poor use of erythropoesis
Dec production /response to EPO

Cytokine induced life-shortening of RBCs

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13
Q

Anaemia of chronic disease tests

A

Ferritin normal/inc in mild normo/microcytic anaemia

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14
Q

Sideroblastic anaemia definition

A

Ineffective erythropoiesis so inc iron absorption, iron loading in marrow ± haemosiderosis (organ damage due to iron deposition)

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15
Q

Sideroblastic anaemia causes

A

Congenital
Idiopathic
Can follow chemo/ anti-TB/ irradiation/ alcohol

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16
Q

Sideroblastic anaemia tests

A

Inc ferritin
Hypochromic blood film
Sideroblasts in marrow

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17
Q

Sideroblastic anaemia treatment

A

Remove cause

Pyridoxine ± transfusions for severe anaemia

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18
Q

Macrocytosis tests

A

Blood film shows hypersegmented neutrophils, target cells if liver disease
Red cell folate and serum B12
Bone marrow biopsy shows either (megaloblastic/ normoblastic (e.g. liver/ hypothyroid)/ abnormal erythropoiesis/ inc erythropoiesis (haemolysis))

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19
Q

Causes of folate deficiency

A

Poor diet (alcoholics, elderly, poverty)
Increased demand e.g. malignancy, pregnancy
Malabsorption
Drugs (phenytoin, valproate, methotrexate, trimethoprim)

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20
Q

Folate deficiency treatment

A

Assess underlying cause
Folic acid 5mg/day PO for 4 mths, always with B12 unless pt known to have normal B12
400mcg/day prophylactically in pregnancy until at least 12 wks

21
Q

B12 deficiency causes

A

Dietary (vegans)
Malabsorption due to lack of IF (pernicious anaemia) or terminal ileum damage
Congenital metabolic errors

22
Q

B12 deficiency presentation

A

Pallor and mild jaundice from haemolysis shows lemon tinge + anaemia signs
Peripheral neuropathy
Subacute combined degeneration of spinal cord (extensor plantars, absent knee jerk + absent ankle jerk triad); pain and temp intact

23
Q

What is pernicious anaemia

A

Autoimmune atrophic gastritis so lack of IF secretion by gastric parietal cells

24
Q

Pernicious anaemia tests

A

Tests for macrocytic anaemia and B12 deficiency

Parietal cell Abs and sometimes IF Abs may be found

25
Q

B12 deficient anaemia treatment

A

Hydroxocobalamin (B12) 1mg IM every other day for 2wks
If pernicious 1mg IM every 3mths for life after that
If dietary intake oral B12 50-150mcg daily between meals
Watch for hypokalaemia and iron deficiency due to new RBCs

26
Q

Identifying type of haemolytic anaemia

A

Increased RBC breakdown (normocytic with inc bilirubin, urinary urobilinogen, serum LDH)
Increased RBC production (reticulocytes so inc MCV + polychromosia)
Extravascular (splenomegaly) or intra (more Hb in plasma/bound to albumin; Hb or haemosiderin in urine)

27
Q

Acquired causes of haemolytic anaemia

A

Direct Coombs +ve: drug induced, autoimmune (AIHA), paroxysmal cold Hburia seen in viruses, acute transfusion reaction
Direct Coombs -ve: hepatitis, post vaccination

Microangiopathic: mechanical damage to RBCs due to TTP, eclampsia, heart valves

Infection: all can exacerbate but malaria causes

Paroxysmal nocturnal Hburia: stem cell disorder with haemolysis, marrow failure + thrombophilia

28
Q

Hereditary causes of haemolytic anaemia

A 
Enzyme defects: G6PD deficiency (avoid precipitants and transfuse if severe) and pyruvate kinase deficiency
Membrane defects (Coombs -ve, all need folate): sphero/ ellipto/ ovalo/ stomatocytosis
Hbopathy: Sickle-cell, thalassaemia
29
Q

Sickle-cell pathogenesis

A

HbS polymerises when deoxygenated, RBC deforms to sickle and haemolyse/block small vessels

30
Q

Sickle-cell investigations

A

Hb 60-90g/L, inc reticulocytes and bilirubin
Blood film shows sickle + target cells
Sickle solubility test +ve but no distinction between HbSS and HbAS, Hb electrophoresis can do this

31
Q

Sickle-cell presentations: Vaso-occlusive (microvascular) crisis

A

Pain/ cold/ dehydration/ infection/ hypoxia causes very painful, CNS infarct 10% of children, marrow affected

32
Q

Sickle-cell complications

A

Splenic infarct before 2yrs increases susceptibility to infections
Poor growth

Chronic renal failure
Retinal disease
Lung damage (hypoxia -> fibrosis -> pulmonary hypertension)

Iron overload
Gallstones

33
Q

Sickle cell chronic management

A

Hydroxycarbamide 20mg/kg/d increases fetal Hb production if frequent crises
Bone marrow transplant can be curative

Infection prophylaxis, especially with febrile children
Prenatal testing and parental education prevents deaths

34
Q

Sickle cell crisis management

A

Analgesia early e.g. IV opiates

Septic screen and Abs if temp >38/ chest signs, watch for acute chest syndrome from fat embolus/ infection

Rehydrate with fluids, keep warm and O2 if needed

Measure PCV, reticulocytes, liver + spleen size bidaily
Crossmatch blood, check FBCs + reticulocytes
Blood transfusion if Hb/reticulocytes fall sharply

Exchange transfusion in those rapidly deteriorating

35
Q

Thalassaemia types

A

Minor/trait - carrier which may have mild microcytic anaemia
Intermedia - moderate anaemia due to mild homozygous mutations or trait with anther Hbopathy, no transfusions needed
Major - Serious abnormalities in both beta-globin chains

36
Q

beta-thalassaemia major features

A

Severe anaemia + failure to thrive from 1st year
RBCs made outside marrow causes skull bossing and skull XR shows hair on end sign
Hepatosplenomegaly from haemolysis
Blood film shows hypochromic, microcytic; target cells + nucleated RBCs

37
Q

beta-thalassaemia major treatment

A

Life-long blood transfusions
Iron overload causes endo issues, control with deferiprone PO + desferroxamine SC 2 per wk; ascorbic acid can help inc urinary Fe excretion
Folate supplements + healthy lifestyle
Splenectomy >5yrs old if hypersplenism persists
Endo complication treatment
Marrow transplant can offer chance of cure

38
Q

Alpha thalassaemia

A

4 alpha genes deleted then death in utero (Bart’s hydrops)
HbH disease if 3 deleted: moderate anaemia + haemolysis with beta-4 tetramers in blood film
2 genes deleted is asymptomatic carrier with dec MCV
1 gene deleted is normal clinical state

39
Q

G6PD features

A 
Heinz bodies, bite cells, blister cells on blood film
Neonatal jaundice history
Intravascular haemolysis
Fava beans + henna can trigger
African-Mediterranean descent
40
Q

G6PD induced haemolysis causes

A

Sulph- antibiotics
Ciprofloxacin
Primaquine anti-malarial

Henna
Fava beans

41
Q

What is hereditary spherocytosis

A

Most common hereditary haemolytic anaemia in Northern European descent
Sphere shaped RBCs shorter life-span as removed by spleen

42
Q

Hereditary spherocytosis presentation

A 
Jaundice
Splenomegaly
Gallstones
Erythema infectiosum if with Parvovirus B19 and aplastic crisis
Family Hx
43
Q

Hereditary spherocytosis treatment

A

Folate replacement

Splenectomy

44
Q

Hereditary spherocytosis diagnosis

A 
Family Hx
Normocytic anaemia
Gallstones
Raised MCHC is diagnostic
EMA binding test if diagnosis ambiguous
45
Q

Aplastic anaemia causes

A

Drugs (phenytoin, chloramphenicol, sulphonamides, gold)
Benzene
Parvovirus, hepatitis
Radiation

46
Q

Sickle-cell presentations: Aplastic crisis

A

Parvovirus B19 suddenly reduces bone marrow production

Self-limiting <2wks usually but may need transfusion (reduced reticulocytes)

47
Q

Sickle-cell presentations: Sequestration crisis

A

(inc reticulocytes) Mainly children, pooling of blood in spleen ± liver -> organomegaly, severe anaemia, shock (urgent transfusion needed)

48
Q

Sickle-cell presentations: Acute sickle chest

A

SOB
Chest pain
Reduced pO2
Pulmonary infiltrates on CXR

Haem (10 decks)

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