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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
B12 deficient anaemia treatment
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
Identifying type of haemolytic anaemia
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
Acquired causes of haemolytic anaemia
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
Hereditary causes of haemolytic anaemia
``` 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
Sickle-cell pathogenesis
HbS polymerises when deoxygenated, RBC deforms to sickle and haemolyse/block small vessels
30
Sickle-cell investigations
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
Sickle-cell presentations: Vaso-occlusive (microvascular) crisis
Pain/ cold/ dehydration/ infection/ hypoxia causes very painful, CNS infarct 10% of children, marrow affected
32
Sickle-cell complications
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
Sickle cell chronic management
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
Sickle cell crisis management
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
Thalassaemia types
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
beta-thalassaemia major features
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
beta-thalassaemia major treatment
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
Alpha thalassaemia
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
G6PD features
``` Heinz bodies, bite cells, blister cells on blood film Neonatal jaundice history Intravascular haemolysis Fava beans + henna can trigger African-Mediterranean descent ```
40
G6PD induced haemolysis causes
Sulph- antibiotics Ciprofloxacin Primaquine anti-malarial Henna Fava beans
41
What is hereditary spherocytosis
Most common hereditary haemolytic anaemia in Northern European descent Sphere shaped RBCs shorter life-span as removed by spleen
42
Hereditary spherocytosis presentation
``` Jaundice Splenomegaly Gallstones Erythema infectiosum if with Parvovirus B19 and aplastic crisis Family Hx ```
43
Hereditary spherocytosis treatment
Folate replacement | Splenectomy
44
Hereditary spherocytosis diagnosis
``` Family Hx Normocytic anaemia Gallstones Raised MCHC is diagnostic EMA binding test if diagnosis ambiguous ```
45
Aplastic anaemia causes
Drugs (phenytoin, chloramphenicol, sulphonamides, gold) Benzene Parvovirus, hepatitis Radiation
46
Sickle-cell presentations: Aplastic crisis
Parvovirus B19 suddenly reduces bone marrow production | Self-limiting <2wks usually but may need transfusion (reduced reticulocytes)
47
Sickle-cell presentations: Sequestration crisis
(inc reticulocytes) Mainly children, pooling of blood in spleen ± liver -> organomegaly, severe anaemia, shock (urgent transfusion needed)
48
Sickle-cell presentations: Acute sickle chest
SOB Chest pain Reduced pO2 Pulmonary infiltrates on CXR

Haem (10 decks)

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