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Heamotology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is Anaemia?

A

A low level of haemoglobin in the blood (an = without, emia = blood)

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2
Q

What is an essential component in creation of the haemoglobin molecule?

A

Iron

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3
Q

What is the diagnostic criteria for anaemia?

A

FBC - look for low levels of haemoglobin
Women = <120g/l
Men = <130-180g/l

MCV = 80-100Fl

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4
Q

What type of anaemia would you have if you had a MCV of less than 80?

A

Microcytic

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5
Q

What type of anaemia would someone have if they had a MCV of 80-100?

A

Normocytic

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6
Q

What type of anaemia would someone have if they had a MCV of over 100?

A

Macrocytic anaemia

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7
Q

What are the causes of microcytic anaemia?

A
  • Thalassaemia
  • Iron dificiency
  • Chronic disease
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8
Q

What is the most common cause of microcytic anaemia?

A

Iron deficiency

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9
Q

What are the causes of normocytic anaemia?

A 
A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism
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10
Q

What are the two categories of macrocytic anaemia?

A

Megaloblastic or normoblastic.

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11
Q

What can cause megaloblastic anaemia?

A

B12 or folate deficiency

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12
Q

What are the causes of normoblastic microcytic anaemia?

A

Alcohol excess or reticulocytosis or hypothyroidism or liver disease

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13
Q

What are some non-specific symptoms of anaemia?

A
  • Tiredness
  • SOB
  • Headaches
  • Dizziness
  • Palpitations
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14
Q

What are some anaemia symptoms that are specific to iron deficiency anaemia?

A
  • Pica
  • Hair loss
  • Coilinica (spooning of the nails)
  • Brittle hair and nails
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15
Q

What are some generic symptoms of anaemia?

A
  • Pale skin (Pallor)
  • Conjunctiva pallor
  • Tachycardia
  • Raise RR
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16
Q

What is a symptom specific to haemolytic anaemia?

A
  • Jaundice
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17
Q

What investigations would you do in someone you suspect to have anaemia?

A
  • Hb
  • MCV
  • B12 and folate level
  • Ferritin level
  • Blood film to look for abnormal inclusions in the blood
18
Q

What are the situations in which iron stores in the body can be used up causing the patient to become iron deficient and therefore struggle to create haemoglobin?

A
  • Insufficient dietary iron
  • Slow bleeding resulting in iron loss
  • Increased demand of iron e.g in pregnancy
  • Inadequate iron absorption in the GI tract
19
Q

Where is iron absorbed?

A

In the duodenum and the jejunum

20
Q

How does the stomach acid play a part in iron absorption?

A

It changes iron into its soluble form (ferrous Fe2+)

21
Q

How can proton pump inhibitors lead to iron deficiency?

A

They lower the stomach acid so iron isn’t converted into soluble ferrous and therefore not absorbed

22
Q

What can cause inadequate iron absorption in the GI tract?

A

Inflammation of the duodenum or jejunum i.e in coeliac disease of IBD

23
Q

What is the most common cause of iron deficiency anaemia?

A

Blood loss e.g from a heavy menstrual period or from a GI source like a gastrointestinal cancer

24
Q

What is the most common cause of iron deficiency in children?

A

Increased demand due to growing

25
Q

What is the most common source of blood loss in non menstruating women and in men?

A

Gastrointestinal bleeding e.g through a cancer

26
Q

What is total iron binding capacity?

A

Basically means the total space on the transferrin molecules for the iron to bind. So total iron binding capacity is directly related to the amount of transferrin in the body

27
Q

What is the form that iron takes when it is store in cells?

A

Ferritin

28
Q

Why is serum iron on its own not a useful measure?

A

Because the serum iron fluctuates throughout the day. For example, it is higher in the morning and after eating a meal containing foods high in iron

29
Q

What happens to the total binding capacity and transferrin levels in iron deficiency?

A

They increase.

30
Q

What is the normal serum ferritin?

A

40-100

31
Q

What is the normal total binding capacity?

A

45-80

32
Q

How do you manage iron deficient anaemia?

A

Treating the underlying cause

  • Blood transfusions (this will immiedetly correct the anaemia but not the iron deficiency so it will come back)
  • Iron infusion
  • Oral iron e.g ferrous sulphate 200mg 3 x a day
33
Q

What are the side effects of oral iron?

A

Constipation and black stools

34
Q

What is pernicious anaemia?

A

A cause of B12 deficiency anaemia

35
Q

What is pernicious anaemia?

A

A cause of B12 deficiency anaemia.

An autoimmune disease where antibodies are formed against the parietal cells in the duodenum causing decrease intrinsic factor and therefore insufficient B12 absorption.

36
Q

What is the management of pernicious anaemia?

A

Dietary insufficiency can be corrected using oral supplements but in pernicious anaemia oral replacement is inadequate because the problem is absorption. They can be treated with 1mg of intramuscular hydroxycobalamin 3 times weekly for 2 weeks, then every 3 months.

37
Q

What is haemolytic anaemia?

A

Where there is destruction of RBC’s (haemolysis) which leads to a low Hb count which is called anaemia.

38
Q

What are the 5 inherited haemolytic anaemias?

A
  1. Hereditary Spherocytosis
  2. Hereditary Elliptocytosis
  3. Thalassaemia
  4. Sickle Cell Anaemia
  5. G6PD Deficiency
39
Q

What are examples of acquired haemolytic anaemias?

A
  1. Autoimmune haemolytic anaemia
  2. Alloimmune haemolytic anaemia (transfusions reactions and haemolytic disease of newborn)
  3. Paroxysmal nocturnal haemoglobinuria
  4. Microangiopathic haemolytic anaemia
  5. Prosthetic valve related haemolysis
40
Q

What is the presentation of haemolytic anaemia?

A
  • Anaemia - due to the reduction in circulating red blood cells
  • Splenomegaly - as the spleen becomes filled with destroyed red blood cells
  • Jaundice - as bilirubin is released during the destruction of red blood cells
41
Q

What investigations would you do if haemolytic anaemia is suspected?

A
  • Full blood count shows a normocytic anaemia
  • Blood film shows schistocytes (fragments of red blood cells)
  • Direct Coombs test is positive in autoimmune haemolytic anaemia
42
Q

What is Hereditary Spherocytosis?

A

It is an autosomal dominant condition. It causes sphere shaped red blood cells that are fragile and easily break down when passing through the spleen.

Heamotology (7 decks)

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