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Yr 3 MedEd > Anaemia > Flashcards

Anaemia Flashcards

1
Q

In microcytic anaemias, which conditions affect the haem ring and the global chains? What is the resultant change in cell division?

A

Haem ring: Iron deficiency, ACD
Globin: Thalassaemia

Cell division increases

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2
Q

Give 3 blood film signs of iron deficiency anaemia.
Give a finger nail sign of IDA.
Give a mouth sign of IDA

A
  • Aniso-poikilocytosis
  • Pencil cells
  • Hypochromic & microcytic RBC
  • Koilonychia
  • Angular cheilitis
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3
Q

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.

A

Hepcidin

IDA: low ferritin, high TIBC
ACD: Normal/ high ferritin, low TIBC
Ferritin is acute phase protein, rises during infections.

ACD often normocytic

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4
Q

What is the inheritance pattern of Thalassaemia?
What are the 4 types of alpha Thalassaemia?
What are the 3 types of beta Thalassaemia.

A

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
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5
Q

Give 2 blood investigation findings for thalassaemia.

When does it typically present?

A
  • Microcytic anaemia
  • Normal iron studies.
  • Typically presents 3-6 months after birth.
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6
Q

Give 4 factors that pre-dispose to sickling in sickle cell disease.

A
  • Hypoxia
  • Dehydration
  • Acidosis
  • Infection
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7
Q

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?

A

Howell-Jolly Bodies.

DAPHA

  • Dactylitis
  • Acute Chest syndrome
  • Priapism
  • Haemolytic anaemia
  • Aplastic crisis

Chipmunk facies/ skull abnormalities due to extra medullary haematopoeisis.

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8
Q

Give 5 steps in management of Sickle Acute Painful Crisis

A

SAPC:

  • Saturate: supportive oxygen
  • Antibiotics (if needed).
  • Pain relief
  • Cannula- IV fluids.
  • Exchange blood transfusion.
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9
Q

Give 2 diagnostic investigations for sickle cell anaemia.
Give 3 medical managements of sickle cell.
What is the curative treatment?

A
  • Hb electrophoresis + blood film
  • Vaccinations, Hydroxyurea (increases HbF), Prophylactic Abx.
  • Bone marrow transplant is curative.
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10
Q

Give a cause of megaloblastic anaemia.

- Give 2 blood film findings.

A
  • Folate/ B12 defiiciency

- Hypersegmented neutrophils, macrocytic cells.

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11
Q

Give 2 common causes of Vit B12/ Folate deficiency.

  • Give 3 other causes of B12 deficiency
  • Give 2 other causes of Folate deficiency.
A
  • Alcohol and IBD/ Coeliac.
    B12: Bariatric surgery, pernicious anaemia, diet
    Folate: Anti-folate drugs, pregnancy
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12
Q

What are the autoimmune targets in pernicious anaemia?

A
  • Anti-parietal cells- produce intrinsic factor.

- Anti-intrinsic factor- forms GIT resistant complex with B12

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13
Q

Give 4 diagnostic features of pernicious anaemia.

A
  • Macrocytosis
  • Megaloblastic film
  • Neuro signs
  • Low B12- reserves last 3-4 years
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14
Q

Give 3 diagnostic features of folate deficiency

A
  • Macrocytosis
  • Megaloblastic film
  • low folate- reserves last 6 months
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15
Q

Give 4 blood findings in haemolytic anaemia.

Give 3 examination findings in haemolytic anaemia.

A
  • Low Hb
  • Low Haptoglobin
  • High unconjugated bilirubin
  • High LDH.
  • Scleral icterus
  • Conjunctival pallor
  • Pallor.
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16
Q

What is a DAT/ Coombs test?

A

Direct Antiglobulin Test
- Detects presence of antibody bound to red cell surface.
- Indicates autoimmune haemolytic anaemia.
Negative in Microangiopathic Haemolytic anaemias- DIC, HUS, TTP.

17
Q

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?

A
  • Vulnerable to oxidative stress
  • X-linked recessive
  • Broad beans.
  • Heinz bodies in active haemolysis
  • Bite cells in previous haemolysis.
18
Q

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.

A

Autosomal dominant
- Beta spectrin or Ankyrin.

  • Osmotic fragility test and Coombs negative.
  • Parvovirus B19
19
Q

What is microangiopathic haemolytic anaemia?

A

Microthrombi formation causes cross-linked platelets- destroy RBCs, produce schistocytes.

20
Q

How does E. Coli cause haemolytic uraemic syndrome?

A
  • 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.
21
Q

Give 2 GI, Renal and Haemolytic features of HUS.

What demographic is affected?

A
  • GI: Abdominal pain, bloody diarrhoea.
  • Renal features: Oliguria, creatinine
  • Haemolytic: Jaundice, conjunctival pallor.
  • Disease of early childhood.
22
Q

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

A

Bleeding: Petechiae, Ecchymoses, Haematuria
Clotting: Prolonged PT and APTT
Haemolytic: Jaundice, conjunctival pallor.
Low platelet, low Fibrinogen, high FDPs, high D-Dimer.

23
Q

Which defunct enzymes causes Thrombotic Thrombocytopaenic Purpura?
- Give 6 signs of TTP

A 
Defunct ADAMTS-13 enzyme- breaks down von Willebrand Factor.
ADAMTS:
- Antiglobulin negative
- Decreased platelets
- AKI
- MAHA
- Temperature
- Swinging CNS signs.
24
Q

Give 3 autoimmune causes of Acquired Haemolytic Anaemia. What antibody type is causative?

Give drug cause of AHA.
Give infection cause of AHA.

A

Warm >37C. IgG. Idiopathic, SLE, CLL.
Cold <37C. IgM. Idiopathic, Mycoplasma, Mononucleosis.

  • Dapsone (anti-leprosy ABx)
  • Plasmodium Falciparum malaria.
25
Q

What is Anti-Phospholipid syndrome?

Give 4 clinical features of anti-phospholipid syndrome.

A
  • Autoimmune thrombosis- often manifesting during pregnancy.
  • Recurrent miscarriages. (3+)
  • VTE
  • Stroke/ MIs, HTN- arterial problems
  • Livedo reticularis
26
Q

Give 2 blood tests for anti-Phospholipid Syndrome.

A
  • Anti-cardiolipin +ve

- Lupus anti-coagulant test +ve.

27
Q

What is polycythaemia rubra vera.
Give 4 clinical features of PRV.
What are Hb and haematocrit level changes?
What genetic mutation is found.

A
  • Philadelphia chromosome negative myeloproliferative disorder.
  • Older
  • Asymptomatic
  • Aquagenic pruritus
  • Hyperviscosity syndrome.
  • Elevated Hb and haematocrit. +/- thrombocytosis.
  • JAK2 V617F mutation +ve in almost all PCV: increases haematopoiesis.
28
Q 
What is myelofibrosis?
What mutation is associated?
Give two risk factors.
What is seen in BM aspirate?
What is seen in blood film?
A 
Fibrosis in response to a BM malignancy.
JAK2 mutation.
- Old age, radiation.
- Dry tap aspirate 
- Tear drop cells on blood film.
29
Q 
What is aplastic anaemia?
What is the aetiology? What is the most common congenital cause of aplastic anaemia?
What anaemia feature is seen
Give 4 other features.
What is seen in BM aspirate?
A
  • Bone marrow failure causing pancytopenia.
  • Auto-immune reaction to BM stem cells. Caused by radiation/ infection. Most common congenital: Fanconi’s anaemia.
  • Raised EPO.
  • Bleeding, petechiae, sepsis, recurrent infections.
  • Hypocellular aspirate.

Yr 3 MedEd (31 decks)

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