Anaemia Flashcards
In microcytic anaemias, which conditions affect the haem ring and the global chains? What is the resultant change in cell division?
Haem ring: Iron deficiency, ACD
Globin: Thalassaemia
Cell division increases
Give 3 blood film signs of iron deficiency anaemia.
Give a finger nail sign of IDA.
Give a mouth sign of IDA
- Aniso-poikilocytosis
- Pencil cells
- Hypochromic & microcytic RBC
- Koilonychia
- Angular cheilitis
What protein increases in Anaemia of chronic disease?
How do IDA and ACD differ in levels of Ferritin and Total Iron Binding Capacity?
What type of anaemia is ACD often.
Hepcidin
IDA: low ferritin, high TIBC
ACD: Normal/ high ferritin, low TIBC
Ferritin is acute phase protein, rises during infections.
ACD often normocytic
What is the inheritance pattern of Thalassaemia?
What are the 4 types of alpha Thalassaemia?
What are the 3 types of beta Thalassaemia.
Autosomal recessive. Alpha is Chr 16, Beta is Chr 11.
- Alpha +, Alpha°, Hb H, Hb Barts- first two are mild anaemias, H is significant, Barts is death in utero.
- Beta Minor- resistance to Falciparum Malaria, Beta intermedia, Beta major
Give 2 blood investigation findings for thalassaemia.
When does it typically present?
- Microcytic anaemia
- Normal iron studies.
- Typically presents 3-6 months after birth.
Give 4 factors that pre-dispose to sickling in sickle cell disease.
- Hypoxia
- Dehydration
- Acidosis
- Infection
Give a sign of sickle cell anaemia on blood film other than sickled cells.
Give 5 clinical signs of sickle cell anaemia.
What skull and facial change can be seen?
Howell-Jolly Bodies.
DAPHA
- Dactylitis
- Acute Chest syndrome
- Priapism
- Haemolytic anaemia
- Aplastic crisis
Chipmunk facies/ skull abnormalities due to extra medullary haematopoeisis.
Give 5 steps in management of Sickle Acute Painful Crisis
SAPC:
- Saturate: supportive oxygen
- Antibiotics (if needed).
- Pain relief
- Cannula- IV fluids.
- Exchange blood transfusion.
Give 2 diagnostic investigations for sickle cell anaemia.
Give 3 medical managements of sickle cell.
What is the curative treatment?
- Hb electrophoresis + blood film
- Vaccinations, Hydroxyurea (increases HbF), Prophylactic Abx.
- Bone marrow transplant is curative.
Give a cause of megaloblastic anaemia.
- Give 2 blood film findings.
- Folate/ B12 defiiciency
- Hypersegmented neutrophils, macrocytic cells.
Give 2 common causes of Vit B12/ Folate deficiency.
- Give 3 other causes of B12 deficiency
- Give 2 other causes of Folate deficiency.
- Alcohol and IBD/ Coeliac.
B12: Bariatric surgery, pernicious anaemia, diet
Folate: Anti-folate drugs, pregnancy
What are the autoimmune targets in pernicious anaemia?
- Anti-parietal cells- produce intrinsic factor.
- Anti-intrinsic factor- forms GIT resistant complex with B12
Give 4 diagnostic features of pernicious anaemia.
- Macrocytosis
- Megaloblastic film
- Neuro signs
- Low B12- reserves last 3-4 years
Give 3 diagnostic features of folate deficiency
- Macrocytosis
- Megaloblastic film
- low folate- reserves last 6 months
Give 4 blood findings in haemolytic anaemia.
Give 3 examination findings in haemolytic anaemia.
- Low Hb
- Low Haptoglobin
- High unconjugated bilirubin
- High LDH.
- Scleral icterus
- Conjunctival pallor
- Pallor.
What is a DAT/ Coombs test?
Direct Antiglobulin Test
- Detects presence of antibody bound to red cell surface.
- Indicates autoimmune haemolytic anaemia.
Negative in Microangiopathic Haemolytic anaemias- DIC, HUS, TTP.
What does Glucose-6-Phosphate deficiency make cells vulnerable to?
What is the inheritance?
What foods can’t be eaten?
What is seen on blood film in active haemolysis?
What is seen on blood film in previous haemolysis?
- Vulnerable to oxidative stress
- X-linked recessive
- Broad beans.
- Heinz bodies in active haemolysis
- Bite cells in previous haemolysis.
what is the inheritance pattern of hereditary spherocytosis.
- Give two protein deficiencies found in HS.
Give 2 tests for HS.
Give a cause of aplastic crisis for patients with HS.
Autosomal dominant
- Beta spectrin or Ankyrin.
- Osmotic fragility test and Coombs negative.
- Parvovirus B19
What is microangiopathic haemolytic anaemia?
Microthrombi formation causes cross-linked platelets- destroy RBCs, produce schistocytes.
How does E. Coli cause haemolytic uraemic syndrome?
- Young child, E. Coli produces Shiga-like toxin.
- Toxin binds to endothelial cells in kidney and damages them.
- Causes platelet plug formation leading to microthrombi.
- Microthrombi shear red blood cells causing acutely dysfunctional kidney alongside haemolytic anaemia.
Give 2 GI, Renal and Haemolytic features of HUS.
What demographic is affected?
- GI: Abdominal pain, bloody diarrhoea.
- Renal features: Oliguria, creatinine
- Haemolytic: Jaundice, conjunctival pallor.
- Disease of early childhood.
Give 3 bleeding features of DIC
Give 2 clotting features of DIC
Give 2 haemolytic features of DIC
Describe Platelet, Fibrinogen, FDP and D-Dimer levels in DIC
Bleeding: Petechiae, Ecchymoses, Haematuria
Clotting: Prolonged PT and APTT
Haemolytic: Jaundice, conjunctival pallor.
Low platelet, low Fibrinogen, high FDPs, high D-Dimer.
Which defunct enzymes causes Thrombotic Thrombocytopaenic Purpura?
- Give 6 signs of TTP
Defunct ADAMTS-13 enzyme- breaks down von Willebrand Factor. ADAMTS: - Antiglobulin negative - Decreased platelets - AKI - MAHA - Temperature - Swinging CNS signs.
Give 3 autoimmune causes of Acquired Haemolytic Anaemia. What antibody type is causative?
Give drug cause of AHA.
Give infection cause of AHA.
Warm >37C. IgG. Idiopathic, SLE, CLL.
Cold <37C. IgM. Idiopathic, Mycoplasma, Mononucleosis.
- Dapsone (anti-leprosy ABx)
- Plasmodium Falciparum malaria.
