Anaemia Flashcards
Anaemia sx
Skin + mucosal pallor
Pale conjuctivae
Fatigue
Increased RR + HR if severe
Causes of microcytic anaemia
Haem ring dysfunction: Iron deficiency Anaemia of chronic disease Globin chain dysfunction: Thalassaemia Sickle cell
Causes of iron deficiency
Reduced uptake
- malnutrition, coeliac, IBD, achlorhydria
Increased loss
- GI malignancy, peptic ulcer, IBD, menstruation
Increased requirement
- pregnancy, breastfeeding
ID blood film
Aniso-poikilocytosis
Pencil cells
Hypochromic
Compare blood results due to ID and ACD microcytic anaemia
ID - low ferritin, high TIBC ACD - high/normal ferritin, low TIBC - high hepcidin due to increased cytokine activity
How is thalassaemia diagnosed?
Bloods show normal iron studies w/ microcytic anaemia
Hb electrophoresis to see problem
- alpha, factor 8 [chr16]
- beta, factor 9 [chr11]
What are sickle cell pts pre-disposed to?
Hypoxia, dehydration, acidosis, infection due to chr 11 mutation in beta-globin gene, resulting in the formation of HbS
Sickled RBCs are prone to clumping together into large polymers
Sickle cell blood film
Howell-Jolly bodies
Sickled cells
Microcytic anaemia findings
What may a sickle cell crises result in and how is it managed?
Acute painful crisis = saturate (O2), Abx (if needed), pain relief, cannula (IV fluids) Stroke = exchange blood transfusion Sequestrian crisis = splenectomy Chronic cholecystitis = cholecystectomy
How is sickle cell anaemia managed?
Conservative
- avoid triggers
Medical
- vaccines
- hydroxyurea; increase HbF production
- prophylactic Abx; if no spleen, reduced immune function
Surgical
- bone marrow transplant; curative
Megaloblastic anaemia blood film
Hypersegmented neutrophils
Macrocytic cells
Causes of megaloblastic anaemia
Folate deficiency
- alcohol, IBD, coeliac, anti-folate drugs (methotrexate, anti-convulsants like phenytoin), pregnancy
B12 deficiency
- alcohol, IBD, coeliac, bariatric surgery, malnutrition, pernicious anaemia
What is pernicious anaemia?
Rare AI mediated B12 deficiency
- anti-parietal cells => produces IF
- anti-intrinsic factor => forms GIT resistant complex with B12
Which deficiency causes what neuro sx?
B12 deficiency causes:
- glove and stocking parasthesia
- hyporeflexia
- Romberg’s +ve
- subacute combined degeneration of cord
=> lateral corticospinal tract lesion; myopathy
=> dorsal column tract lesion; pressure, vibration and touch sense diminished
Causes of non-megaloblastic anaemia
Low Hb, large MCV: = Alcoholics: alcohol = May: myelodysplasia = Have: hypothyroidism = Liver failure: liver disease
Haemolytic anaemia presentation
Normocytic anaemia
Haptoglobin, unconjugated bilirubin
Increased LDH
Scleral icterus, pallor, pale conjuctivae
Causes of hereditary haemolytic anaemias
Membrane
= hereditary spherocytosis
Enzymes
= G-6-PD deficiency
Haemoglobin
= sickle cell
= thalassaemia
Hereditary spherocytosis summary card
AD condition, spherocytes on blood film
- defect in protein on wall so no cytoskeleton (beta spectrin/ankyrin deficiency)
- leads to aplastic crisis when infected with parovirus B19
- osmotic fragility test (hypotonic solution leads to lysis of RBCs) + -ve Coomb’s test is diagnostic
What is the Coomb’s test?
aka DAT
= direct Coombs test detects antibodies that are stuck to the surface of the red blood cells
= +ve means you have antibodies that attack your RBCs therefore autoimmune haemolytic anaemia
G-6-PD deficiency summary card
X-linked recessive disorder
- oxidative stressors trigger this, i.e. naphthalane moth ball, antimalarials (quinine), flava beans
- blood film shows heinz bodies (active haemolysis) or bite cells (previous haemolysis)
Causes of acquired haemolytic anaemias
Haemolytic uraemic syndrome
= E. Coli shigella toxin in < 5yo
Disseminated intravascular coagulaton
= sepsis, trauma, pancreatitis, cancers, obstetric complications, ABO reactions
Thrombotic purpura
= defective ADAMTS-13 enzyme needed to degrade large vWF multimers
HUS features
H aemolysis = jaundice, conjuctive pallor U rinary problems = oliguria, increased creatinine S hits = abdo pain, bloody diarrhoea
DIC features
Bleeding = haematuria, ecchymoses, petechia, increased D-dimer + fibrin degradation products, reduced plts + fibrinogen Clotting = prolonged APTT and PT Haemolytic = jaudince, conjuctive pallor
TP features
(rarely complete pentad) A ntiglobulin -ve D ecreased plts A KI M AHA T emperature S winging CNS signs
Possible ddx of +ve Coombs test
If +ve in warm (>37degrees)
= IgG antibodies
= idiopathic, SLE, CLL
If +ve in cold (<37degrees)
= IgM antibodies
= idiopathic, mycoplasma, mononucleosis
Anti-phospholipid syndrome summary card
AI-mediated thrombosis, manifesting during pregnancy
= recurrent miscarriages (3+), VTE, strokes/MI, HTN, liverdo reticularis (mottled, purplish disclouration)
= +ve anti-cardolipin, +ve lupus anti-coagulant test
Types of polycythaemia
Primary
= rubra vera due to philadelphia chromosome -ve myeloproliferative disorder
Secondary
= appropriate; hypoxic response
= inappropriate; EPO-secreting tumour
Clinical features of primary polycythaemia
Older (>60yo)
Asymptomatic
Aquagenic pruritus
Hyperviscosity syndrome
Mutation that results in rubra vera
JAK2 V617F +ve (almost all)
= results in excess haematopoiesis
= receptor stays ‘open’ when should ‘close’ when there is no longer any EPO-release from kidneys
Myelofibrosis presentation
Fibrosis in response to BM malignancy, JAK2 mutation association
= >65 yo, exposure to radiation
= BM aspirate shows ‘dry tap’ fibrosis
= Blood film shows tear drop cells
Aplastic anaemia summary card
Bone marrow failure causing pancytopaenia
=> Fanconi’c anaemia (AI), infections, radiation
=> BM aspirate shows HYPOcellular
- anaemia; increased EPO
- thrombocytopaenia; bleeding, petechiae
- leucopaenia; sepsis, recurrent infections
Krusty is a 54 year old Clown and fast food franchise owner. He reports 6 kg of weight loss over the last 3 months alongside ‘stomach issues’. On examination, he has angular cheilitis, koilonychia and appears pale.
A blood film shows hypochromic red blood cells with evident anisopoikilocytosis and multiple pencil cells.
What is the diagnosis? A Anaemia of Chronic Disease B Thalassaemia Major C Iron Deficiency Anaemia D Chronic Lymphocytic Leukaemia E Hyperthyroidism
C Iron Deficiency Anaemia
Abe Simpson is 83 year old man with enlarged lymph nodes. He has lost 5kg in the last 2 months. He reports episodes of fevers and night sweats. On examination he has hepatosplenomegaly. After follow up from an urgent two week referral, he is diagnosed with Non-Hodgkin’s Lymphoma. Blood testing also identifies an anaemia related to his condition.
Which is increased in Anaemia of Chronic Disease?
A Intrinsic factor B Hepcidin C TIBC D Transferrin E Ferroportin
B Hepcidin
Kent Brokodopolis is a news reporter from Greek Cyprus. His son is 6 months old and has stunted growth. On examination the boy is small, docile with pale conjunctivae. He has hepatosplenomegaly and skull abnormalities with ‘chipmunk’ facies.
Which investigation will confirm the likely diagnosis?
A HLA typing B Haemoglobin Electrophoresis C Peripheral Blood Smear D Full Blood Count E Plain Skull X-ray
B Haemoglobin Electrophoresis
Carl Carlson is a 36 year old male with Sickle Cell Anaemia. He is admitted to Hospital while undergoing an acute painful crisis.
How should Carl be managed?
A Fluids, Oxygen and Analgesia B Exchange Blood transfusion C Emergency Splenectomy D Urgent Cholecystectomy E Allogeneic stem cell transplant
A Fluids, Oxygen and Analgesia
Marge is a 38 year old female who presented with a painless goitre, which she reports covering up for a number of years with her pearl necklace. She was recently diagnosed with Hashimoto’s thyroiditis. Her recent blood results also demonstrated some haematological abnormalities.
Which of the following patterns is most likely to be shown?
A Low Hb, Low MCV, High RDW
B Low Hb, High MCV, megaloblastic on film
C Low Hb, High MCV, non-megaloblastic on film
D Normal Hb, Normal MCV, Normal Haematocrit
E High Hb, Low MCV, High Haematocrit
C Low Hb, High MCV, non-megaloblastic on film
Lisa is a 12 year old girl presenting to her GP with tiredness and tingling sensations in her hands. Lisa has recently modified her diet, taking part in Veganuary this year and is following this through currently. Her mother has been diagnosed with Hashimoto’s.
On examination she appears pale. The corners of
her lips are notably sore.
Which is the most likely cause of her symptoms?
A Dietary induced B12 deficiency B Pernicious Anaemia C Coeliac Disease D Folate Deficiency E Iron Deficiency
B Pernicious Anaemia
Which of these must be avoided in individuals with known
G-6-PD deficiency?
A Gluten products B Cow’s Milk protein C Broad beans D ACE inhibitors E Smoking
C Broad beans
Maggie is a 14 month old infant. She has a recent 5 day history of abdominal pain which her parents believe is related to food she ate at their recent trip to the state fair. The paediatric registrar on call believes she has now developed an AKI. Her blood tests reveal a normal PT, normocytic anaemia with leucocytosis and thrombocytopaenia. A section of her blood film shows schistocytes
What is the most likely cause?
A ALL B DIC C HUS D Pyelonephritis E Sepsis
C HUS
Which of these statements is incorrect about Antiphospholipid
syndrome?
A APS is screened for after 3 miscarriages
B Patients have an increased risk of thrombosis
C Lupus Pernio is a clinical sign
D Diagnosis includes screening for the Lupus anticoagulant
E Diagnosis includes screening for anti-cardiolipin antibodies
C Lupus Pernio is a clinical sign
it’s livedo reticularis actually
Which of the following mutations is classically associated with Polycythaemia Rubra Vera?
A EHEC O157N7 B BCR ABL1 C TP53(17q-) D PML-RARa E JAK2 V617F
E JAK2 V617F
Montgomery Burns is an 89 year old owner of a nuclear powerplant. He is hypertensive and managed with Amlodipine. He is referred to his doctor after his dentist notices he appears cachectic and his dentures no longer fit. On examination, Mr Burns has massive splenomegaly. A blood test and subsequent bone marrow biopsy are carried out: RBC – Low Hb – Low WCC – Low Plts – High Film: poikilocytosis Biopsy: ‘dry tap’
Which is the most likely cause of his symptoms?
A Multiple Myeloma B Acute Myeloid Leukaemia C Essential Thrombocytosis D Myelofibrosis E Myelodysplasia
D Myelofibrosis
A 60 year old man presents with lethargy to the GP. A full blood count and
smear is requested. The following is found:
Hb: 10 g/dl (135-180)
Platelets: 310 (150-400)
WBC: 14 (4-11)
Film: Leucoerythroblastic picture with tear-drop poikilocytes seen
What is the most likely diagnosis:
- Iron deficiency anaemia
- Myelofibrosis
- Chronic myeloid leukaemia
- Haemolytic anaemia
- Myelodysplasia
- Myelofibrosis
A 55 year old lady presents to the GP with long standing pain in her
hands. On examination there are gross deformities of her fingers and
joint swelling.
A FBC reveals
Hb: 7.3 (11.5-186.0)
MCV: 94 (82-100)
WCC: 7 (4-11)
What is the most likely cause of the blood results?
- Thalassaemia
- Iron deficiency anaemia
- Vitamin B12 deficiency
- Anaemia of chronic disease
- Sideroblastic anaemia
- Anaemia of chronic disease
A 21 year old female presents with chronic fatigue and tiredness. On
further questioning she reveals a longstanding history of heavy
periods. On examination you notice pale conjunctivae.
What is the most likely cause of her symptoms:
- Alcohol excess
- Iron deficiency anaemia
- Folate deficiency
- Thalassaemia
- Vitamin B12 deficiency
- Iron deficiency anaemia
A 35 year old man presents to his GP with worsening fatigue over the past
few months. He mentions that his stools have been darkening recently
and he’s been having recurrent pins and needles in his hands. He has
a history of Crohn’s disease which is managed with azathioprine but
has had several flares this year which required hospital admission. A
full blood count shows the following:
Hb: 10 (13.5-18.0)
MCV: 124 (84-100)
Platelet: 240 (150-400)
What is the most likely diagnosis:
- Vitamin B12 deficiency
- Anaemia of chronic disease
- Alcohol excess
- Iron deficiency anaemia
- Haemolytic anaemia
- Vitamin B12 deficiency
A 7 year old male with known sickle cell disease present to A+E with mild
pain in his back for the last 2 days. He has already tried paracetamol
and ibuprofen. On examination he has a blood pressure of 94/62
mmHg, heart rate of 110 bpm, respiratory rate of 30/min and a
temperature of 38.4 degrees. There is no obvious source of infection.
What is the most appropriate next step?
- Prescribe oramorph and review tomorrow
- Prescribe daily codeine and ask GP to review in a week
- Chest x-ray and dipstick urine (give antibiotics if +ve)
- Admit urgently
- Full blood count and review tomorrow
- Admit urgently
?sepsis = temperature = low BP = tachycardic = tachypnea
A 22 year old female presents with lethargy. The following blood results are obtained: Hb: 10.6 (11.5-16) Platelets: 300 (150-400) WCC: 5.5 (4-11) MCV: 65 (84-100) HbA2: 4.5% (<3%)
What is the most likely diagnosis?
- Beta-thalassaemia major
- Sickle cell anaemia
- Hereditary spherocytosis
- Beta-thalassaemia trait
- Iron deficiency anaemia
- Beta-thalassaemia trait
