Anaemia Flashcards

1
Q

What is anaemia?

A

Describes Hb below normal for age and sex

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2
Q

What are the general symptoms of anaemia?

A

Pallor

Dyspnoea

Fatigue

Palpitations

Dizziness

Headaches

Ankle swelling

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3
Q

What are the 3 morphological types of anaemia?

A

Hipochromic Microcytic

Normochromic Normocytic

Macrocytic

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4
Q

What are the causes of hypochromic microcytic anaemia?

A

Iron deficiency anaemia

Congenital sideroblastic anaemia

Thalassaemia

Lead poisoning

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5
Q

What test is used to distinguish the cause of hypochromic microcytic anaemia?

A

Ferritin

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6
Q

What is the most common type of anaemia worldwide?

A

Iron deficiency anaemia

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7
Q

What are the causes of iron deficiency anaemia?

A

Decreased intake

  • Vegetarians
  • Infants as breast milk is low in iron

Decreased absorption

  • Coeliac
  • IBD
  • Gastrectomy due to reduced gastric acid

Increased demand

  • Adolescence as rapidly growing
  • Pregnancy as increased iron requirement for fetal development

Increased loss

  • GI blood loss (Gastritis, Gastric ulcer)
  • Menorrhagia
  • Colon cancer, in elderly assume until proven otherwise
  • Hookworms in developing countries
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8
Q

How does iron deficiency anaemia present?

A

General anaemia signs

Koilonychia

Hair loss

Atrophic glossitis

Angular stomatitis

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9
Q

What investigations are used in iron deficiency anaemia diagnosis?

A

FBC

  • Decreased Hb/MCH
  • Decreased MCV

Blood smear

  • Microcytic hypochromic

Decreased Ferritin

Decreased serum iron

Increased total Iron Binding Capacity (TIBC), describes the amount of unbound transferrin in the blood

Increased transferrin, as no iron bound to it

Screen for coeliac with Anti-TTG

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10
Q

What blood film sign is seen in iron deficiency anaemia?

A

Target cells

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11
Q

How is iron deficiency anaemia managed?

A

Correct the deficiency

  • Oral ferrous sulphate for 3 months
  • IV iron if intolerant of oral
  • Blood transfusion

Correct the Cause

  • Diet
  • Ulcer therapy
  • Surgery
  • Gynae interventions
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12
Q

What are side effects of oral iron supplements?

A

Nausea

Diarrhoea

Constipation

Abdominal pain

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13
Q

What is absorbed iron bound to?

A

Mucosal ferritin

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14
Q

What transports absorbed iron?

A

Ferroportin

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15
Q

What binds to transported iron?

A

Transferrin

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16
Q

What reduces iron absorption?

A

Hepcidin by blocking ferroportin

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17
Q

What is sideroblastic anaemia?

A

Condition in which red ells fail to completely form haem, leading to build up of iron, resulting in immature and dysfunctional RBCs

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18
Q

What are the causes of sideroblastic anaemia?

A

Congenital

Aquired

  • Myelodysplasia
  • Alcohol
  • Lead
  • Anti-TB medications
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19
Q

How is sideroblastic anaemia managed?

A

Supportive

Treat any underlying cause

Pyridoxine may help

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20
Q

What are the Thalassaemias?

A

Group of congenital anaemias characterised by reduced production rate of alpha or beta chains, and therefore abnormal form or inadequate level of haemoglobin

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21
Q

What is B-Thalassaemia?

A

Autosomal recessive anaemia characterised by reduced B-globin production of haemoglobin, causing a mild hypochromic, microcytic anaemia

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22
Q

In what age group does B Thalassaemia occur?

A

Present at 3-6 months of age

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23
Q

What ethnicitys is B Thalassaemia more common?

A

Mediterranean

Middle East

Asia

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24
Q

What mode of inheritence is B Thalassaemia?

A

Autosomal recessive

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25
How does B Thalassaemia present?
Severe anaemia Expansion of ineffective bone marrow Bony deformities/hypertrophy Splenomegaly Growth retardation
26
How is B Thalassaemia managed?
Chronic transfusion support 4-6 weekly Iron Chelation Therapy Bone Marrow Transplantation
27
Give complications of B Thalassaemia
Secondary hemosiderosis from repeated blood transfusions
28
What blood film sign is seen in thalassaemia?
Target cells
29
What are the causes of normochromic normocytic anaemia?
Haemolytic anaemia Acute blood loss Chronic kidney disease Aplastic anaemia Secondary anaemia/anaemia of chronic disease * Infection * Inflammation * Malignancy
30
What test is used to distinguish the cause of normochromic normocytic anaemia?
Reticulocyte count
31
What are the features of aplastic anaemia?
Normochromic, normocytic anaemia Leukopenia, with lymphocytes relatively spared **Thrombocytopenia** May be the presenting feature acute lymphoblastic or myeloid leukaemia Minority of patients later develop paroxysmal nocturnal haemoglobinuria or myelodysplasia
32
What are the causes of aplastic anaemia?
Idiopathic Congenital * Fanconi anaemia, dyskeratosis congenita Drugs * Cytotoxics * Chloramphenicol * Sulphonamides * **Phenytoin** * Gold * benzene Infections * Parvovirus * Hepatitis Radiation
33
What is haemolytic anaemia?
Anaemia characterised by abnormal premature destruction of RBCs
34
What are the congenital causes of haemolytic anaemia?
Hereditary Spherocytosis G6PD Deficiency Sickle Cell Disease
35
What are the acquired causes of haemolytic anaemia?
Autoimmune haemolytic anaemia (associated with **mycoplasma pneumoniae**) Infection Transfusion reaction Lymphoma Drugs DIC Artificial valves
36
What investigations are used in haemolytic anaemia diagnosis?
**High unconjugated and total bilirubin** * Produced in red cell breakdown Increased Reticulocyte * Trying to make more RBC to compensate for loss Raised LDH Blood film Haptoglobin * Decreased in autoimmune Coomb's test * Detects antibody or complement on red cell membrane to determine whether haemolytic anaemia is immune
37
What is warm autoimmune haemolytic anaemia?
Autoimmune haemolytic anaemia in which the antibody (usually IgG) causes haemolysis best at body temperature and occurs in extravascular sites such as the spleen
38
What are the causes of warm autoimmune haemolytic anaemia?
Autoimmune disease * SLE Neoplasia * Lymphoma * CLL Drugs * Methyldopa
39
What is cold autoimmue haemolytic anaemia?
Haemolytic anaemia in which the antibody, usually IgM, causes haemolysis best at 4 deg C and occurs mainly intravascularly. Often features symptoms of Raynaud's and acrocynaosis
40
What causes cold haemolytic anaemia?
Neoplasia * Lymphoma Infections * Mycoplasma * EBV
41
How is autoimmue haemolytic anaemia managed?
Steroids Immunosuppression Splenectomy
42
What is sickle cell disease?
Autodomal recessive anaemia characterised by haemoglobin chain mutation/HbS, resulting in sickle and rigid red blood cells
43
What mode of inheritence is sickle cell disease?
Autosomal recessive
44
What group is sickle cell disease more common in?
People of African descent as the heterozygous condition offers some protection against malaria
45
What crises can occur in sickle cell disease?
Thrombotic/painful/vaso-oclusive crisis * Clinical diagnosis * Precipitated by infection, dehydration, deoxygenation, cold Sequestration crisis * Sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia * High reticulocyte count Acute chest syndrome * Dyspnoea, chest pain, cough, hypoxia and new **pulmonary infiltrates** Aplastic * Sudden fall in haemoglobin and decreased reticulocytes * Caused by parovirus infection Haemolytic * Fall in haemoglobin due an increased rate of haemolysis * High reticulocyte count
46
What investigation diagnoses sickle cell disease?
Haemoglobin electrophoresis
47
What blood film sign is seen in sickle cell disease?
Target cells
48
What is the acute management of sickle cell crisis?
Morphine sulphate IV fluids Oxygen Consider antibiotics/ceftriaxone Blood transfusion Red cell exchange transfusion if stroke, acute chest syndrome, multi-organ failure or rapid drop in haemoglobin
49
What is the longterm management of sickle cell disease?
Hydroxyurea, prophylactic management of sickle cell crises Pneumococcal polysaccharide vaccine every 5 years
50
Give complications of sickle cell disease?
Gallstones Leg ulcers Avascular necrosis of femoral head Chronic renal disease
51
What is G6PD deficiency?
X linked recessive anaemia characterised by enzyme deficiency that leaves red cells vulnerable to oxidative damage
52
What is the role of G6PD?
Produces NADPH which is vital for maintaining a healthy Hb, allowing it to withstand the stresses caused by drugs and sepsis Deficiency means Hb breaks down under stress, resulting in haemolytic anaemia
53
What is the mode of inheritence of G6PD deficiency?
X linked recessive
54
How does G6PD deficiency present?
Neonatal Jaundice Vomiting and diarrhoea Intravascular haemolysis Splenomegaly Pigment gallstones
55
What can trigger G6PD deficiency haemolysis?
Drugs * Antimalarials * Ciprofloxacin * Sulphasalazine * Sulfonylurea Infection Broad/fava beans
56
What investigations are used in G6PD deficiency diagnosis?
Blood film * Heinz bodies * Bite and blister cells * Schistocytes and spherocytes G6PD enzyme assay * Levels should be checked at time of presentation and around 3 months after an acute episode of hemolysis to avoid false negatives
57
How is G6PD deficiency managed?
Avoidance of drugs known to precipitate haemolysis Folic acid in acute episode Consideration for splenectomy
58
What is Hereditary Spherocytosis?
Autosomal dominant anaemia characterised by mutations in membrane proteins/defect of cell cytoskeleton, causing spherical fragile red cells
59
What is the mode of inheritence of hereditary spherocytosis?
Autosomal dominant
60
How does hereditary spherocytosis present?
Neonatal jaundice Splenomegaly Pigment gallstones Failure to thrive Aplastic crisis precipitated by parvovirus infection
61
What investigations are used in hereditary spherocytosis diagnosis?
EMA binding test Blood film * **ONLY spherocytes present**
62
How is hereditary spherocytosis managed?
Acute haemolytic crisis * Treatment is generally supportive * Transfusion if necessary Longer term treatment * Folate replacement * Splenectomy
63
What are the causes of macrocytic anaemia?
F: Folate deficiency A: Alcohol, liver disease T: Hypothyroidism R: Reticulocytosis B: B12 deficiency, baby/pregnancy C: Cytotoxic drugs: Methotrexate
64
What test is used to distinguish the cause of macrocytic anaemia?
B12/folate assay * **Megaloblastic is B12/folate deficiency, normoblastic is anything else** **​**Blood film * Hypersegmented neutrophils
65
What is pernicious anaemia?
Autoimmune disease resulting in malabsorption of dietary B12 due to lack of intrinsic factor
66
How does pernicious anaemia present?
Typical anaemia features Neurological and neuropsychiatric features Lemon tinge Glossitis
67
What can cause B12 deficiency?
Pernicious anaemia, associated with hypothyroidism and DM1 Post gastrectomy Vegan/poor diet Disorders or surgery of terminal ileum, as this is site of absorption * Chrons Rarely, metformin
68
What investigations are used in pernicious anaemia diagnosis?
Antibodies against * Intrinsic factor * gastric parietal cells (less specific) FBC * Pancytopenia Blood film * Cabot rings
69
How does B12 deficiency/pernicious anaemia present?
Macrocytic anaemia Sore tongue and mouth Neurological symptoms * Dorsal column is usually affected first (joint position and vibration) Neuropsychiatric symptoms/mood disturbances
70
Why do symptoms of B12 deficiency take 3 years to occur?
B12 stores up to 3 years
71
How is B12 deficiency/pernicious anaemia managed?
If no neurological involvement, 1 mg of IM hydroxocobalamin/B12 3 times each week for 2 weeks as loading dose, then once every 3 months for maintenance If a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
72
What causes folate deficiency?
Dietary * Lack of green vegetables Increased requirements * Haemolysis GI Pathology * Coeliac
73
What blood film sign is seen in folate deficiency anaemia?
Hyper-segmented neutrophil polymorphs
74
How is folate deficiency managed?
Oral replacement Ensure B12 is normal if neuropathic symptoms
75
Give causes of polycythaemia
Relative * Dehydration * Stress Primary * Polycythaemia vera Secondary * COPD * Altitude * Obstructive sleep apnoea * Uterine fibroids, hepatoma and cerebellar haemangioma all cause excessive erythropoietin