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Y3 MedEd > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Main signs of anaemia (5)

A

Skin and mucosal pallor
Pale conjunctiva
Fatigue
RR and HR increased

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2
Q

4 causes of microcytic anaemia

A

Sickle cell
Anaemia of chronic disease (but can be normocytic often too)
Thalassaemias
IDA

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3
Q

What does anisopoikilocytosis mean

A

Anisocytosis - unequal size

PoiKILOcytosis - unequal shape

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4
Q

What disease are pencil cells seen in

A

IDA

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5
Q

What is seen on the blood film of IDA (5)

A 
Anisocytosis
Poikilocytosis
Pencil cells
Hypochromic
Microcytic cells
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6
Q

Three main ways you can get IDA

A

Reduced uptake
Increased loss
Increased requirement

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7
Q

What can cause reduced uptake IDA (4)

A

Malnutrition
Coeliac
IBD
Achlorhydria

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8
Q

What can cause increased loss IDA (4)

A

GI Malignancy
Peptic ulcer
IBD
Menstruation

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9
Q

What can cause increased requirement IDA (2)

A

Pregnancy

Breastfeeding

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10
Q

What is the triad for colon cancer

A

Unexplained IDA
PR bleeding
Weight loss

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11
Q

Which is increased in Anaemia of Chronic Disease?

Intrinsic factor
Hepcidin
TIBC
Transferrin 
Ferroportin
A

Hepcidin

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12
Q

Changes to level of ferritin and TIBC in IDA?

A

Ferritin - down

TIBC - up

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13
Q

Changes to level of ferritin and TIBC in ACD?

A

Ferritin - up

TIBC - down

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14
Q

What causes anaemia of chronic disease

A

Increased hepcidin which reduces iron uptake, storage and release

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15
Q

Why does ferritin increase in ACD

A

It is an acute phase protein and so increases in infections

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16
Q

The chipmunk facies/skull abnormalities seen in thalassaemia are due to what

A

Extramedullary haematopoiesis

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17
Q

What are the 7 different types of thalassaemia

A 
Alpha defect:
Alpha+ 
Alpha°
Hb H
Hb Barts

Beta defect:
Beta minor
Beta intermedia
Beta major

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18
Q

Which type of thalassaemia is rarer - alpha or beta

A

Alpha

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19
Q

Which chromosome is affected to cause alpha thalassaemia

A

Chr 16

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20
Q

Which chromosome is affected to cause beta thalassaemia

A

11

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21
Q

Which thalassaemia does a defect in chromosome 16 cause

A

Alpha

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22
Q

Which thalassaemia does a defect in chromosome 11 cause

A

Beta

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23
Q

Describe the alpha thalassaemias and their severities

A

Alpha+ and Alpha° cause very mild anaemias (where you lack 1 or 2 alpha genes)

Hb H causes a significant anaemia (where you lack 3 alpha genes)

Hb Barts causes death in utero (no alpha genes)

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24
Q

Describe the beta thalassaemias and their severities

A

Beta minor often presents with a mild anaemia but a disproportionately low MCV
Beta intermedia is a variant condition – be aware it exists nothing more
Beta major – severe anaemia presenting in the first few months of life

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25
Q

Ix for thalassaemias

A

Microcytic anaemia

Normal Iron studies

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26
Q

When does alpha thalassaemia present

A

From birth

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27
Q

When does beta thalassaemia present

A

From early infancy

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28
Q

What is seen on the blood film of a sickle cell patient (2)

A

Howell-Jolly bodies

Sickled cells

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29
Q

Mx of an acute painful sickle cell crisis (4)

A

Saturate (supportive Oxygen)
Antibiotics (if needed)
Pain relief
Cannula (IV fluids)

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30
Q

Mx of a stroke with sickle cell disease

A

Exchange Blood Transfusion

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31
Q

Mx of a sequestration crisis with sickle cell disease

A

Splenectomy

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32
Q

Mx of a chronic cholecystitis with sickle cell disease

A

Cholecystectomy

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33
Q

How to diagnose SCA (2)

A

Hb electrophoresis + Blood film

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34
Q

Medical Mx of SCA

A

Vaccinations
Hydroxyurea
Prophylactic ABx

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35
Q

How does hydroxyurea work in SCA

A

Hydroxyurea increases production of HbF (which does not contain the defective beta globin S chain) which inadvertently reduces the total level of sickle-able cells.

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36
Q

Surgical Mx of SCA

A

Bone Marrow Transplant (curative)

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37
Q

What causes megaloblastic anaemia

A

Folate or B12 deficiency

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38
Q

What is seen in the blood film of megaloblastic anaemia

A

Hypersegmented neutrophils and macrocytic cells

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39
Q

Causes of vitamin B12 related megaloblastic anaemia (5)

A 
Alcohol
IBD/Coeliac
Bariatric surgery
Malnutrition
Pernicious anaemia
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40
Q

Causes of folate related megaloblastic anaemia (5)

A

Alcohol
IBD/coeliac
Anti-folate drugs
Pregnancy

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41
Q

S/s of B12 deficiency (4)

A

Glove & stocking parasthesiae
Hyporeflexia
Romberg’s +ve
Subacute combined degeneration of the cord

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42
Q

Does B12 deficiency cause hypo or hyperreflexia

A

Hyporeflexia

43
Q

In the subacute combined degeneration of the cord what does lateral corticospinal tract lesion result in:

A

Myopathy

44
Q

In the subacute combined degeneration of the cord what does dorsal column tract lesion result in:

A

pressure, vibration and touch sense diminished

45
Q

How long do your B12 reserves last for

A

3-4 years

46
Q

Average onset of pernicious anaemia?

A

60 years old

47
Q

RF for pernicious anaemia

A

AI PMHx

48
Q

Which auto-antibodies are involved in pernicious anaemia (2)

A

Anti-Parietal cells

Anti-Intrinsic factor

49
Q

Diagnostic criteria of pernicious anaemia (4)

A

Macrocytosis
Megaloblastic film
Neuro signs as seen in B12 deficiency anaemia
Low B12

50
Q

Diagnostic criteria of folate deficiency (3)

A

Macrocytosis
Megaloblastic film
Low Folate

51
Q

How long do our folate reserves last for

A

Around 6 months

52
Q

Non-megaloblastic causes of macrocytic anaemia

A

Alcoholics May Have Liver Failure

Alcohol
Myelodysplasia
Hypothyroidism
Liver disease

53
Q

Features of haemolytic anaemia (3)

A

Scleral icterus
Pallor
Pale conjuctiva

54
Q

Bloods tests for haemolytic anaemia (4)

A

Hb low
Haptoglobin low
Unconjugated bilirubin raised
LDH raised

55
Q

What are hereditary haemolytic anaemias and what are they a defect in (4)

A

Membrane - hereditary spherocytosis

Enzymes - G6PD deficiency

Haemoglobin - SC and thalassaemia

56
Q

What is the direct anti globulin test also known as

A

Coombs test

57
Q

What is the Coombs test also known as

A

Direct antiglobulin test

58
Q

What does the Coombs test test for

A

Presence of antibody on the red cell surface - e.g. in AI haemolytic anaemia

59
Q

What should be avoided if you have G6PD deficiency and why (2)

A

Beans and antimalarials - quinines due to oxidative stress

60
Q

What is seen on blood film in G6PD deficiency anaemia (2)

A

Heinz bodies and Bite cells

61
Q

What is the inheritance pattern of G6PD deficiency

A

X linked recessive

62
Q

What is the inheritance pattern hereditary spherocytosis

A

Autosomal dominant

63
Q

Diagnostic criteria for hereditary spherocytosis

A

Osmotic fragility test and Coombs’ test negative

64
Q

Complications of hereditary spherocytosis

A

Aplastic crisis

65
Q

What can trigger aplastic crisis in hereditary spherocytosis

A

Parvovirus B19

66
Q

What is the ‘triad’ seen in HUS

A

Haemolysis
Urinary problems
Shits

67
Q

What are the GI features of HUS (2)

A

Abdominal Pain

Bloody Diarrhoea

68
Q

What population gets HUS

A

Early childhood - usually through infection of EHEC O157 that produces Shiga-like toxin

69
Q

What are the renal features of HUS (2)

A

Oliguria

Creatinine

70
Q

What are the haemolytic features of HUS (2)

A

Jaundice

Conjunctival pallor

71
Q

How does AKI manifest in HUS

A

a child is infected with E. coli and develops the classical bloody diarrhoea associated with that. It produces a Shiga-like toxin (like shigella’s toxin) which is capable of binding to endothelial cells within the kidney. It enters these cells and damages them. This damaged endothelium attracts widespread platelet plug formation. This leads to microthrombi which shear red blood cells. The end result is an acutely dysfunctional kidney – AKI – alongside a haemolytic anaemia.

72
Q

How does HUS cause uraemia

A

The endothelial damage to make a dysfunctional kidney reduces kidney function which means compounds such as urea are not excreted leading to uraemia

73
Q

Causes of DIC (6)

A 
Pancreatitis
Sepsis
Obstetric complications
Cancers
Trauma
ABO reaction
74
Q

Blood results of DIC (4)

A

Platelets↓
Fibrinogen ↓
FDPs ↑
D-dimer ↑

75
Q

Clotting features of DIC (2)

A

Prolonged APTT

Prolonged PT

76
Q

What is the pathology behind TTP

A

Defunct ADAMTS-13 enzyme

77
Q

What is the 6 things in TTP

A

ADAMTS

Antiglobulin (Coombs) negative
Decreased platelets
AKI
MAHA
Temperature
Swinging CNS signs
78
Q

Neurological manifestations of TTP? (6)

A

Neurologic manifestations include alteration in mental status, seizures, hemiplegia, paresthesias, visual disturbance, and aphasia

79
Q

What happens in TTP

A

Defunct ADAMTS-13 enzyme fails to break down clots forming through vWF leading to blood clots forming in smaller vessels

80
Q

Which drug can cause haemolytic anaemia

A

Dapsone

Anti-leprosy ABx

81
Q

Which infection can cause haemolytic anaemia

A

Plasmodium falciparum

82
Q

What cause of anaemia would result in a positive Coombs test

A

AI

83
Q

What are the 2 types of a positive Coombs test and what do they indicate

A

Warm - above 37
IgG antibodies

Cold - below 37
IgM antibodies

84
Q

What causes +ve warm Coombs’ test (3) and what antibody

A

IgG antibodies Idiopathic
SLE
CLL

85
Q

What causes +ve cold Coombs’ test (3) and what antibody

A

IgM Antibodies
Idiopathic
Mycoplasma
Mononucleosis

86
Q

Which thrombosis often manifests during pregnancy

A

Anti-phospholipid syndrome

87
Q

Clinical features of APL syndrome (5)

A

Recurrent miscarriages (3+)
VTE
Stroke/MIs, HTN (arterial problems)
Livedo reticularis (mottled)

88
Q

Ix for APL syndrome (2)

A

Anti-cardolipin +ve

Lupus anti-coagulant test +ve

89
Q

Clinical features of PRV (4)

A

Older (~60)
Asymptomatic
Aquagenic pruritis
Hyperviscosity syndrome

90
Q

Ix for PRV (4)

A

Elevated Hb & haematocrit

+/- Thrombocytosis

91
Q

What is PRV and what happens in it

A

A Philadelphia chromosome negative myeloproliferative disorder which involves JAK2 leading to RBC proliferation independent of EPO

92
Q

Which gene is affected in PRV

A

JAK2 V617F +ve

93
Q

What happens in myelofibrosis

A

Fibrosis in response to a BM malignancy

94
Q

What is associated with myelofibrosis

A

Moderate JAK2 mutation association

95
Q

Age of myelofibrosis

A

Over 65

96
Q

RF for myelofibrosis

A

Radiation

97
Q

Ix for myelofibrosis

A

BM aspirate showing dry tap fibrosis

Blood film shows tear drop cells

98
Q

What do tear drop cells on a blood film suggest

A

Myelofibrosis

99
Q

What does aplastic crisis occur in

A

SCA and hereditary spherocytosis

100
Q

What happens in aplastic anaemia

A

Aplastic anaemia typically arises from an autoimmune reaction to the haematopoietic stem cells of the BM. This leads to complete BM failure as all cell lines are affected

101
Q

RFs of aplastic anaemia

A

Radiation and some infections (including EBV, HIV

102
Q

Ix for aplastic anaemia (3)

A

FBC showing pancytopenia
EPO raised
BM aspirate hypocellular

103
Q

Features of aplastic anaemia

A

Anaemia features:
+ EPO raised

Thrombocytopaenia:
Bleeding
Petechiae

Leucopoenia:
Sepsis
Recurrent infections

Y3 MedEd (34 decks)

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