Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y1S2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

what is the typical Hb count for a male and female

A
  • male 135-175

- female 120-155 g/ (previously g/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the symptoms of anaemia

A

Symptoms relating to reduced O2 delivery

  • short of breath
  • muscle pain on exertion
  • dizzy
  • angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

clinical signs of anaemia

A
  • Palor in skin and conjunctiva
  • Tachycardia
  • Rapid breathing
  • Peripheral oedema if severe anaemia
  • Signs relating to cause of anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

adaption to anaemia results in

A
  • Mild anaemia likely to cause no symptoms unless extreme exertion
  • Cardiac output increases- rate and stroke volume
  • Changes in distribution of blood flow
  • Change in O2 dissociation curve2,3 DPG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the classifications of anaemia

A
  • Under-production or increased loss of RBC
  • Congenital or acquired
  • Acute or chronic
  • By mean cell volume (MCV) – microcytic/normocytic/macrocytic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification by MCV (MCH and MCHC)

A

• MCV –mean cell volume
Haematocrit (Hct) (%) X10 / RBC count (number as 1012/l)

  • MCH- mean cell Hb - Hb / RBC
  • MCHC- mean cell Hb concentration- Hb / Hct
  • RDW red cell distribution width is a measure of spread of RBC size eg retics/transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

classification by MCV

A
  • Microcytic - MCV 60-80fl - iron def, thalassaemia
  • Normocytic - MCV 80-100fl - blood loss, anaemia of chronic disease, renal impairment
  • Macrocytic – MCV 100-120fl - megaloblastic anaemia- B12/folate deficiency, myelodysplasia
  • (Hypochromic- MCHpg 22-26 iron def, thalassaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Iron deficiency anaemia

A

-Typically reduction in MCV (microcytic) to 65-80
- then in Hb, low ferritin, low transferrin saturation with iron.
Rest of blood count normal- ?
raised platelets if bleeding.
- Poor intake
- Blood loss
- menstrual
- GI tract ?haematemesis or melaena eg peptic ulcer/cancer/angiodysplasia/hookworm
- Malabsorption
- coeliac disease
- Increased need eg growth spurt/pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Iron def- clinical features

A
  • Pale
  • Tachycardia
  • Koilonychia
  • Hair loss
  • Pica
  • Glossitis/angular stomatitis
  • Features relating to the cause eg wt loss/abdo pain/bowel change/heavy periods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Iron def- investigation

A

• Be guided by history
- recent and past and clinical findings
• Confirm iron def by low ferritin and typical FBC
• Screen for coeliac disease (IgA tissue transglutaminase or tGA)
• Upper and lower endoscopy for all except pre-menopausal women
• Consider other imaging/capsule endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Iron def- treatment- oral

A
  • Oral- replacement with sufficient iron for long enough period eg ferrous sulfate 200mg 2 or 3 per day- 65mg elemental iron per dose
  • Side effects- nausea/abdo pain/constipation- dose related- may improve if changed to ferrous gluconate or fumarate
  • Typically patients need 3 months of iron AFTER correction of anaemia to build up iron stores
  • Treat the underlying cause
  • Rise in Hb generally 10g/l per week if not bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Iron def treatment- parenteral

A

• Intramuscular- not used now- painful, multiple doses, stains skin
• Intravenous Ferric carboxymaltose- ferinject- over 15-30mins.
Often needs 2 doses Iron dextran- cosmofer- over 4-6 hours after a test dose.
All IV iron preparations can cause ‘flu like symptoms and a small risk of hypersensitivity reaction or anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

B12 deficiency

A

• Typically a macrocytic anaemia- MCV 100-120 and later a pancytopenia.
Often bilirubin and LDH raised
• Can also cause peripheral neuropathy- demyelination and posterior column damage
• B12 result can be falsely low in pregnancy/oral contraceptive/on metformin
• Pernicious anaemia- gastric atrophy and auto antibodies to parietal cells and intrinsic factor preventing absorption
• Strict vegan or terminal ileal disease also possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

B12 deficiency - treatment

A
  • Hydroxocobalamin 1mg IM alternate days for 5 doses then 3 monthly if confirmed ongoing need eg pernicnious anaemia
  • Cyanocobalamin available orally but not available on prescription
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Folate deficiency

A
  • Blood count and film appearance same as B12 def.
  • Limited stores of folate so deficiency can develop in weeks
  • Poor intake, increased use eg pregnancy/haemolysis, malabsorption, drugs eg anti-epileptics or trimethoprim
  • Replacement with oral folic acid 5mg per day
  • Pre-conception folic acid reduces neural tube defects. Likely plan to add folic acid to flour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anaemia- blood loss

A
  • Hb immediately after blood loss will be normal
  • Drop after fluid replacement
  • Each 500ml loss gives approx drop of Hb by 10-15 g/l
  • Retic response within hours/days
  • May need blood transfusion to replace loss eg trauma/GI bleed/around delivery
17
Q

Anaemia of chronic disease

A
  • Typically a normocytic anaemia associated with chronic inflammatory disease
  • Plentiful iron stores but poor transfer to RBC due to hepcidin and cytokines
  • History of chronic disease, inflammatory markers increased eg CRP/ESR/plasma viscosity, exclusion of other causes
  • Will respond to treatment of underlying disease
18
Q

Anaemia of renal failure

A
  • Drop in Hb once creatinine clearance drops below 20-30 ml/min chronically
  • Mainly due to lack of erythropoietin
  • Contribution from blood loss at dialysis, inflammatory disease
  • Responds well to erythropoietin eg weekly or alternate weeks s/c
19
Q

Anaemia- haemolysis

A

• Increased RBC destruction, marrow can increase production 5-10 fold
• Can be acute or chronic, congenital or acquired
• Issues to do with
- RBC membrane
- RBC enzymes
- Globin chains in Hb

20
Q

Haemolysis- RBC membrane

A

• Congenital spherocytosisautosomal dominant defect in spectrin causing spherical cells – less able to deform so shortened survival
• Auto-immune haemolysis
- auto antibodies against RBC surface antigens
- Fc portion recognised by macrophages in spleen. Treated with steroids/splenectomy/rituximab

21
Q

Haemolysis- RBC membrane and enzymes

A

Prosthetic heart valve- mechanical Disseminated intravascular coagulation (DIC)- eg in sepsis, prostate cancer causing RBC fragmentation by fibrin
RBC enzyme def eg G6PD or pyruvate kinase can cause shortened RBC survival

22
Q

Anaemia- abnormal haemoglobin

A
  • Haemoglobinopathy eg Sickle cell diseasesingle point mutation causing Hb polymerisation in hypoxic cells in homozygotes
  • Shortened RBC survival, reduced production
  • Chronic anaemia and bone/liver/lung/brain “crisis” ie acute infarction
  • Treated by supportive care, hydroxycarbamide to increase HbF production, ??stem cell transplant
23
Q

Anaemia- thalassaemia

A
  • Inbalance of globin chain production • Beta thalassaemia- as Hb F (2 alpha, 2 gamma chains) declines after birth- progressive anaemia. Supportive care, transfusion, ?stem cell transplant
  • Progressive iron overload
  • Antenatal screen for Hb-opathy and thalassaemia
24
Q

Anaemia- marrow infiltration

A

• MyelomaB cell malignancy of mature plasma cells
- produce monoclonal immunoglobulin or light chains Presents as chance finding, anaemia, renal failure, hypercalcaemia, bone pain or fracture Treatment
- supportive care, chemotherapy, radiotherapy
• Haematological malignancy eg lymphoma, acute leukaemia
• Diagnosed by sampling marrow- pelvis or sternum
• Treated by chemotherapy/immunotherapy
• Other “solid” tumours can spread to marrow eg prostate, breast, small cell lung

25
Q

Anaemia- marrow failure

A
  • Myelodysplastic disorders- progressive decline in Hb, neutrophils, platelets, macrocytosis. Tendency to progress to acute leukaemia. Treated by supportive care, chemotherapy or stem cell transplant in some.
  • Aplastic anaemia- pancytopenia. Expected result post chemotherapy but can be drug induced eg NSAIDs, chloramphenicol or idiopathic. Treated by supportive care, anti- thymocyte globulin, stem cell transplant

Y1S2 (73 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions