Anaemia Flashcards by Elliot Colman

What are the most common signs of Anaemia?

Skin & Mucosal Pallor

Conjunctival Pallor

Fatigue

Tachypnoea

Tachycardia

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How does Iron Deficiency Anaemia look on Blood Film?

Poikilocytosis (Unequal shape)

Pencil Cells

Hypochromic and Microcytic

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What causes Iron Deficiency Anaemia?

Reduced Uptake - Malnutrition, Coeliac, IBD, Achlorhydria

Increased Loss - GI Cancer, Peptic Ulcer, IBD, Menstruation

Increased Requirement - Pregnancy, Breastfeeding

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What is the triad of presenting symptoms associated with Colon Cancer?

Weight Loss

PR Bleeding

Unexplained IDA

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How do you differentiate between IDA and ACD on blood tests?

IDA - Low Ferritin, High TIBC

ACD - High Ferritin, Low TIBC

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What is Thalassaemia?

Globin Chain mutations, causing quantitative defects in the Alpha or Beta chains of Haemoglobin

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What are the key features of Thalassaemia?

‘Greek Cyprus Origin’

Severity of Anaemia depends on the Thalassaemia

, Beta Major and HbH most severe.

Microcytic

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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.

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What may you see on the blood film of someone with Sickle Cell Disease?

Howell-Joly Bodies

Sickled Cells

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How can Sickle-Cell Crises present?

Acute Painful Crisis

Stroke

Sequestration Crisis

Chronic Cholecystitis

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What are the key presenting features of Sickle Cell?

Dactilytis

Actue Chest Syndrome

Haemolytic Anaemia

Aplastic Crisis

Priapism

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How is Sickle Cell diagnosed?

Hb Electrophoresis

Blood Film

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How do you manage a patient with Sickle Cell?

Trigger Avoidance

Vaccinations, Hydroxyurea, Prophylactic Antibiotics

Bone Marrow Transplant

Fluids, Analgesia, Oxygen (In a crisis)

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What can cause a Microcytic Anaemia?

Iron-Deficiency

Chronic Disease

Thalassaemia

Sickle Cell

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What might you see on the Blood Film of a patient with Folate or B12 deficiency?

Hypersegmented Neutrophils

Macrocytic Cells

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What can cause a Vitamin B12 Deficiency?

Alcohol

IBD/Coeliac

Bariatric Surgery

Malnutrition

Pernicious Anaemia

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What can cause a Folate Deficiency?

Alcohol

IBD/Coeliac

Anti-Folate Drugs

Pregnancy

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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

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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