Anaemia Flashcards
What are the symptoms of anaemia?
- Tired all the time
- Short of breath
- Muscle pain on exertion
- Dizzy
- Angina
What are the clinical signs of anaemia?
- Palor in skin and conjunctiva
- Tachycardia
- Rapid breathing
- Peripheral oedema if severe
- Signs relating to the cause of anaemia
What are 4 ways of classifying anaemia?
- Under-production or increased loss of RBC
- Congenital or acquired
- Acute or chronic
- Mean cell volume (microcytic, normocytic and macrocytic)
Describe how you can classify anaemia by MCV (Mean Cell Volume)
Microcytic - (60-80fl) caused by Iron def and thalassaemia
Normocytic - (80-100fl) - blood loss, anaemia of chronic disease and renal impairment.
Macrocytic -(100-120) Megaloblastic anaemia caused by B12/folate deficiency, myelodysplasia
Hypochromic - Cells with low colour (iron def and thalassaemia)
Describe some of the features of Iron Deficiency Anaemia
- Most common cause of anaemia
- Typically reduction in MCV, low Hb, Low ferritin and low transferrin saturation with iron
What is Iron Deficiency anaemia caused by?
Poor intake, Blood loss (menstral, GI), Malabsorption (Coeliac disease), Increased need (growth or pregnancy)
What are some clinical features of Iron Deficiency
Pale, Tachycardia, Koilonychia (nails looked spooned), hair loss, Pica (Kids eating metal/soil), Glossitis (inflammation of tounge)/ Angular Stomatitis (red patches at the edge of mouth) and features relating to the cause
What are some of the investigations of iron deficiency?
- Taking a history
- Confirm iron def by low ferritin and typical FBC
- Screen for coeliac disease
- Upper and lower endoscopy for all except pre-menopausal women.
- Consider other imaging
Describe how you can treat iron deficiency orally.
- Replacement with sufficient iron for long enough period (ferrous sulphate)
- The side effects are naursea, abdo pain, constipation.
- Typically need 3 more months of iron after correction
- Treat the cause
What are some of the parental treatments of iron deficiency
Intramuscular injection - No longer used as it was painful and stained the skin
- Intravenous - Ferric Carboxymaltose over 15-30mins or Iron dextran over 4-6 hours. All IV can cause flu like symptoms
Describe some of the features of a B12 Deficiency
It is typically a macrocytic anaemia. Can cause peripheral neuropathy. Can result from pregnancy, oral contraception, pernicious anaemia (autoimmune) or strict vegan diets or terminal ileal disease.
What are the treatments for B12 Deficiency
Hydrooxocobalamin or Cyanocobalamin
Describe some of the features of Folate deficiency
- Limited stores so deficiency can occur in weeks
- Can occur because of poor intake, increased used for example in pregnancy or because of malabsorbtion drugs
- Replacement with oral folic acid (5mg per day)
Describe how you can treat anaemia from blood loss
- Blood transfusion to replace loss
Describe some of the features anaemia of chronic disease
- It is typically normoctic anaemia associated with chronic inflammatory
- They have plentiful iron stores but poor transfer to RBC due to hepcidin and cytokines
- History of chronic disease, inflammatory markers increase,
- Will respond to treatment of underlying disease
Describe some features of anaemia renal failure
- This is mainly due to a lack of erthythopoietin
- Contribution from blood loss at dialysis and inflammatory disease
- Response well to erythropoietin
Describe some of the features of anaemia due to haemolysis
- It is increased RBC destruction
- Can be acute or chronic, congenital or acquired.
- It gives issues with RBC membranes, RBC enzymes and globin chains in Hb
What are the two types of anaemia haemolysis
Congenital Spherocytosis - Causes spherical cells
Auto-immune haemolysis - Auto immune bodies against RBC surface antigens
What are some of the causes of haemolysis?
Prosthetic heart valve, disseminated intravascular coagulation, RBC enzyme deficiency
Describe how anaemia is caused by abnormal haemoglobin
Haemoglobinopathy (sickle cell disease where glutamic acid to valine)
- shortened RBC survival and reduced production.
- treated by hydroxycarbamide to increase Hbf production
Describe some of the features of thalassaemia
- Inbalance of globin chain production
- Progressive anaemia treated with supportive care or transfusion
- Progressive iron overload
How does anaemia arise from marrow infiltration
Myeloma - B cell maligancy of mature plasma cells. It presents as chance finding, anaemia, renal failing, hypercalacaemia, bone pain or fracture. Treatment is supportive care, chemotherapy or radiotherapy.
Haematological malignancy - diagnosed by marrow sampling and treated by chemotherapy/immunotherapy.
Describe how anaemia arises from marrow failure
Myelodysplatic disorders - Cancers in which immature blood cells do not mature
Aplastic anaemia - Bone marrow doesn’t produce enough blood cells
What does MCV, MCH and MCHC mean?
MCV - Mean Cell Volume
MCH - mean corpuscular hemoglobin (average amount of hemoglobin found in the red blood cells in the body)
MCHC - mean corpuscular hemoglobin concentration (measure of the average concentration of haemoglobin inside a single red blood cell
