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P2 HAEM > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Define anaemia

A

Decrease of Hb in the blood below the reference level for the age and sex of the individual

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2
Q

What is the lifespan for a RBC?

A

120 days

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3
Q

Where are RBCs produced?

A

Bone marrow

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4
Q

What hormone stimulates growth of RBCs?

A

EPO (erythropoietin)

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5
Q

Where are RBCs broken down? (3)

A
  • Spleen
  • Liver
  • Bone marrow
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6
Q

What does a LOW reticulocyte count mean?

A

Production issue eg haematinic deficiency

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7
Q

What does a HIGH reticulocyte count mean?

A

Removal is the issue eg bleeding, haemolytic anaemia

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8
Q

Where is iron stored in the body?

A

FERRITIN - serum ferritin can be used to indirectly measure the iron levels in the body

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9
Q

What are the symptoms of anaemia? (4)

A
  • Fatigue
  • Dyspnoea
  • Palpitations
  • Headache
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10
Q

What are the signs of anaemia? (3)

A
  • Pale skin
  • Pale mucous membranes
  • Tachycardia
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11
Q

What are causes of microcytic anaemia? (3)

A
  • Iron deficiency anaemia (common in UK)
  • Thalassaemia
  • Anaemia of chronic disease
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12
Q

What are the causes of normocytic anaemia? (4)

A
  • Acute blood loss
  • Combined haematinic deficiency (B12 & folate deficiencies cancel each other out)
  • Anaemia of chronic disease
  • Sickle cell anaemia
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13
Q

What are the causes of macrocytic anaemia? (7)

A
  • B12 deficiency
  • Folate deficiency
  • Alcohol excess
  • Liver disease
  • Hypothyroidism
  • Drug therapy
  • Apoplastic bone marrow failure
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14
Q

What is megaloblastic macrocytic anaemia? Give 2 examples

A

Abnormal DNA synthesis, causing larger cells.

  • B12 deficiency
  • Folate deficiency
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15
Q

What is nonmegaloblastic macrocytic anaemia?

A

Increase in membrane lipids, with unimpaired DNA synthesis

  • Alcohol excess
  • Hypothyroidism
  • Drug therapy
  • Liver disease
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16
Q

Where is iron absorbed?

A

Duodenum

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17
Q

What are the causes of iron deficiency anaemia? (3)

A

Loss: menorrhagia, GI bleed, hookworm

Increased demand: during growth & pregnancy

Malabsorption: poor diet/ intake, coeliac disease

18
Q

What are the investigations for iron deficiency anaemia? (3)

A

FBC = RBCs are MICROCYTIC & HYPOCHROMIC
Low reticulocyte count
Low serum iron/ ferritin

19
Q

What is the treatment for iron deficiency anaemia?

A

Oral iron eg ferrous sulphate/ IV iron

20
Q

What are the side effects of iron supplements? (4)

A

Nausea
GI discomfort
Diarrhoea/ constipation
Black stools

21
Q

What are the clinical presentations of iron deficiency anaemia? (4)

A
  • Koilonychia (spoon shaped nails)
  • Atrophic Glossitis (smooth, inflamed tongue)
  • Angular stomatitis (inflammation of corners of mouth)
  • Brittle hair and nails
22
Q

Where in the body is folate absorbed?

A

In duodenum/ proximal jejunum

23
Q

In what foods can folate be found in? (4)

A

Green veg eg spinach, broccoli
Nuts
Yeast
LIver

24
Q

Which drug can cause folate deficiency anaemia and therefore would need to be prescribed folic acid alongside?

A

Methotrexate for RA (anti-folate drug)

25
Q

What are the investigations for folate deficiency anaemia? (2)

A

Blood film = macrocytic anaemia

Erythrocyte folate level - indicates reduced body stores

26
Q

What is the treatment for folate deficiency anaemia? (2)

A

Treat underlying cause
Folic acid supplements w B12
Pregnancy: folate from 0-12wks

27
Q

Where is B12 absorbed in the body?

A

Terminal ileum

28
Q

What is needed for B12 absorption?

A

Bound to intrinsic factor (IF) - produced by the parietal cells of the stomach

29
Q

What is pernicious anaemia (B12 deficiency)?

A

Macrocytic anaemia caused by a lack of intrinsic factor due to autoimmune attack of gastric parietal cells

30
Q

What are the causes of B12 deficiency anaemia? (5)

A
  • Atrophic gastritis (autoimmune)
  • Gastrectomy (leading to malabsorption)
  • Crohn’s
  • Coeliac
31
Q

How would you distinguish between B12 & folate deficiency anaemia?

A

B12 deficiency - neurological features are present (symmetrical paresthesia in fingers/ toes, early loss of vibration sense & proprioception)

No neuropathy in folate deficiency anaemia

32
Q

What are the investigations for B12 deficiency anaemia? (3)

A

Blood film:

  • Macrocytic RBCs
  • Polysegmented neutrophil polymorphs (6+ lobes in nucleus)

Autoantibody screen

  • Parietal cell antibodies
  • IF antibodies
33
Q

What is the treatment for B12 deficiency anaemia?

A

Vitamin B12 (hydroxocobalam) tablets/ injections [not folic acid]

34
Q

What is haemolytic anaemia?

A

Premature breakdown of RBCs before their normal lifespan of 120 days

35
Q

What are the symptoms of haemolytic anaemia? (3)

A

Dark urine
Yellow skin, sclera
Abdominal pain from gallstones (from excess bilirubin)

36
Q

What are the signs of haemolytic anaemia? (4)

A

Jaundice
Hepatosplenomegaly
Leg ulcers (due to poor blood flow)
Signs of underlying disease (eg SLE)

37
Q

What are the investigations for haemolytic anaemia? (3)

A

FBC: reduced Hb
High reticulocyte count
Blood film: presence of SCHISTOCYTES

38
Q

What are the treatments for haemolytic anaemia? (3)

A

Folate & iron supplementation
Immunosuppressives
Splenectomy

39
Q

What are the causes of bone marrow failure? (4)

A

Congenital
Acquired (aplastic anaemia)
Cytotoxic drugs/ radiation
Infections

40
Q

What are the clinical presentations of bone marrow failure? (3)

A

Recurrent infections
Easy bruising
Easy bleeding (from gums, nose)

41
Q

How would you investigate bone marrow failure? (3)

A

FBC: pancytopenia (low in all blood cells)
Low reticulocyte count
Bone marrow biopsy: hepatocellular marrow w increased fat spaces

42
Q

How would you treat bone marrow failure? (4)

A

Remove causative agent
Blood/ platelet transfusion
Bone marrow transplant
Immunosuppressive therapy

P2 HAEM (7 decks)

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