Anaemia Flashcards
What are the most common signs of Anaemia?
Skin & Mucosal Pallor
Conjunctival Pallor
Fatigue
Tachypnoea
Tachycardia
How does Iron Deficiency Anaemia look on Blood Film?
Poikilocytosis (Unequal shape)
Pencil Cells
Hypochromic and Microcytic
What causes Iron Deficiency Anaemia?
Reduced Uptake - Malnutrition, Coeliac, IBD, Achlorhydria
Increased Loss - GI Cancer, Peptic Ulcer, IBD, Menstruation
Increased Requirement - Pregnancy, Breastfeeding
What is the triad of presenting symptoms associated with Colon Cancer?
Weight Loss
PR Bleeding
Unexplained IDA
How do you differentiate between IDA and ACD on blood tests?
IDA - Low Ferritin, High TIBC
ACD - High Ferritin, Low TIBC
What is Thalassaemia?
Globin Chain mutations, causing quantitative defects in the Alpha or Beta chains of Haemoglobin
What are the key features of Thalassaemia?
‘Greek Cyprus Origin’
Severity of Anaemia depends on the Thalassaemia
, Beta Major and HbH most severe.
Microcytic
What is Sickle Cell?
Autosomal Recessive disorder causing the formation of HbS, whcih has a weaker membrane when deoxygenated and is prone to intravascular haemolysis.
What may you see on the blood film of someone with Sickle Cell Disease?
Howell-Joly Bodies
Sickled Cells
How can Sickle-Cell Crises present?
Acute Painful Crisis
Stroke
Sequestration Crisis
Chronic Cholecystitis
What are the key presenting features of Sickle Cell?
Dactilytis
Actue Chest Syndrome
Haemolytic Anaemia
Aplastic Crisis
Priapism
How is Sickle Cell diagnosed?
Hb Electrophoresis
Blood Film
How do you manage a patient with Sickle Cell?
Trigger Avoidance
Vaccinations, Hydroxyurea, Prophylactic Antibiotics
Bone Marrow Transplant
Fluids, Analgesia, Oxygen (In a crisis)
What can cause a Microcytic Anaemia?
Iron-Deficiency
Chronic Disease
Thalassaemia
Sickle Cell
What might you see on the Blood Film of a patient with Folate or B12 deficiency?
Hypersegmented Neutrophils
Macrocytic Cells
What can cause a Vitamin B12 Deficiency?
Alcohol
IBD/Coeliac
Bariatric Surgery
Malnutrition
Pernicious Anaemia
What can cause a Folate Deficiency?
Alcohol
IBD/Coeliac
Anti-Folate Drugs
Pregnancy
What are the main symptoms of B12 Deficiency?
Megaloblastic Anaemia
+ Neuro Signs
Glove + Stocking paraesthesia
Hyporeflexia
Romberg’s +ve
Subacute combined degeneration of the cord
What is Pernicious Anaemia?
Autoimmune mediated B12 Deficiency.
Anti-Parietal Cells
Anti-Intrinsic Factor
How does Folate Deficiency present?
Classic Megaloblastic Anaemia
What are the non-megaloblastic causes of a Macrocytic Anaemia?
Alcoholics May Have Liver Failure
Alcohol
Myelodysplasia
Hypothyroidism
Liver Disease
How does Haemolytic Anaemia present?
Scleral Icterus
Pallor
Conjunctival Pallor
‘Anaemia & Jaundice’
What are the main types of Hereditary Haemolytic Anaemia?
Hereditary Spherocytosis
G-6-PD Deficiency
Sickle Cell
Thalassaemia
What is the DAT/Coombs Test?
Direct Antiglobulin Test
Detects the presence of antibodies bound to RBCs (basically determines whether it’s autoimmune or not)
What should be avoided in G6PD Deficiency?
Oxidative stressors, such as antimalarials, broad beans and ‘napthalene moth ball’.
What might you see on the blood film of someone with G6PD Deficiency?
Heinz Bodies
Bite Cells
What is Hereditary Spherocytosis?
Autosomal Dominant condition leading to the formation of spherocytes due to the defective attachment of the cytoskeleton to membrane proteins.
How do you investigate a suspected case of Hereditary Spherocytosis?
Osmotic Fragility Test leads to cell lysis
Coombs test Negative
What are the complications of Hereditary Spherocytosis?
Aplastic Crisis, often caused by Parvovirus B19 infection
What is Microangiopathic Haemolytic Anaemia?
Microthrombi formation due to platelet cross-linking leads to the shearing of RBCs and the formation of schistocytes.
How does Haemolytic Uraemic Syndrome typically present?
Young Children
GI (E.Coli)- Abdominal Pain, Blood Diarrhoea
Renal - Oliguria, Creatinine rise
Haemolysis - Jaundice
What is Disseminated Itravascular Coagulation?
Severe concurrent Clotting and Bleeding.
Too much clotting = thrombocytopaenia = severe bleeding
What can cause Disseminated Intravascular Coagulation?
Pancreatitis
Sepsis
Obstetric Complications
Cancers
Trauma
ABO Reaction
How does DIC present?
Bleeding - eg. Petechiae, Haematuria, Ecchymoses
Clotting - eg. PT/APTT prolongation
Haemolysis - eg. Jaundice
What is Thrombotic Thromocytopenic Prupura?
Condition caused by a defunct ADAMTS-13 Enzyme
Causes: Thrombocytopaenia, AKI, MAHA, Fever, Swinging CNS Signs
What is Anti-Phospholipid Syndrome?
Autoimmune mediated thombosis that commonly manifests during pregnancy, sadly causing miscarriage
What are the main clinical features of Anti-Phospholipid Syndrome?
Recurrent Miscarriages
VTE
Stroke/MIs
HTN
‘Livedo reticularis’
How would you investigate suspected Anti-Phospholipid Syndrome?
Anti-Cardolipin + Lupus Anti-Coagulant test
both +ve
What is Polycythaemia Rubra Vera?
Myeloproliferative disorder characterised by the increased production of RBCs by bone marrow.
How does Polycythaemia Rubra Vera typically present?
Older
Asymptomatic usually
Itchiness after a hot bath
Hyperviscosity Syndrome - eg. retinopathy, headache
How would you investigate suspected Polycythaemia Rubra Vera?
Polycythaemia, Raised haematrocrit
+/- Thrombocytosis
JAK2 V617F +ve
What is Myelofibrosis?
BM Fibrosis in response to bone marrow malignancy.
Moderate association with JAK2 mutation
What would you see when investigating a case of Myelofibrosis?
‘Dry Tap’ on BM Aspiration
‘Tear Drop Cells’ on Blood Film
What is Aplastic Anaemia?
Bone Marrow Failure causing Pancytopenia.
Autoimune mediated
How does Aplastic Anaemia present?
Hypocellular BM Aspirate
Anaemia + Raised EPO
Blleding, Petechiae
Sepsis, Recurrent Infections
