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Haematology > Anaemia > Flashcards

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
Q

How does B Thalassaemia present?

A

Severe anaemia

Expansion of ineffective bone marrow

Bony deformities/hypertrophy

Splenomegaly

Growth retardation

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26
Q

How is B Thalassaemia managed?

A

Chronic transfusion support 4-6 weekly

Iron Chelation Therapy

Bone Marrow Transplantation

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27
Q

Give complications of B Thalassaemia

A

Secondary hemosiderosis from repeated blood transfusions

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28
Q

What blood film sign is seen in thalassaemia?

A

Target cells

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29
Q

What are the causes of normochromic normocytic anaemia?

A

Haemolytic anaemia

Acute blood loss

Chronic kidney disease

Aplastic anaemia

Secondary anaemia/anaemia of chronic disease

  • Infection
  • Inflammation
  • Malignancy
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30
Q

What test is used to distinguish the cause of normochromic normocytic anaemia?

A

Reticulocyte count

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31
Q

What are the features of aplastic anaemia?

A

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
Q

What are the causes of aplastic anaemia?

A

Idiopathic

Congenital

  • Fanconi anaemia, dyskeratosis congenita

Drugs

  • Cytotoxics
  • Chloramphenicol
  • Sulphonamides
  • Phenytoin
  • Gold
  • benzene

Infections

  • Parvovirus
  • Hepatitis

Radiation

33
Q

What is haemolytic anaemia?

A

Anaemia characterised by abnormal premature destruction of RBCs

34
Q

What are the congenital causes of haemolytic anaemia?

A

Hereditary Spherocytosis

G6PD Deficiency

Sickle Cell Disease

35
Q

What are the acquired causes of haemolytic anaemia?

A

Autoimmune haemolytic anaemia (associated with mycoplasma pneumoniae)

Infection

Transfusion reaction

Lymphoma

Drugs

DIC

Artificial valves

36
Q

What investigations are used in haemolytic anaemia diagnosis?

A

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
Q

What is warm autoimmune haemolytic anaemia?

A

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
Q

What are the causes of warm autoimmune haemolytic anaemia?

A

Autoimmune disease

  • SLE

Neoplasia

  • Lymphoma
  • CLL

Drugs

  • Methyldopa
39
Q

What is cold autoimmue haemolytic anaemia?

A

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
Q

What causes cold haemolytic anaemia?

A

Neoplasia

  • Lymphoma

Infections

  • Mycoplasma
  • EBV
41
Q

How is autoimmue haemolytic anaemia managed?

A

Steroids

Immunosuppression

Splenectomy

42
Q

What is sickle cell disease?

A

Autodomal recessive anaemia characterised by haemoglobin chain mutation/HbS, resulting in sickle and rigid red blood cells

43
Q

What mode of inheritence is sickle cell disease?

A

Autosomal recessive

44
Q

What group is sickle cell disease more common in?

A

People of African descent as the heterozygous condition offers some protection against malaria

45
Q

What crises can occur in sickle cell disease?

A

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
Q

What investigation diagnoses sickle cell disease?

A

Haemoglobin electrophoresis

47
Q

What blood film sign is seen in sickle cell disease?

A

Target cells

48
Q

What is the acute management of sickle cell crisis?

A

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
Q

What is the longterm management of sickle cell disease?

A

Hydroxyurea, prophylactic management of sickle cell crises

Pneumococcal polysaccharide vaccine every 5 years

50
Q

Give complications of sickle cell disease?

A

Gallstones

Leg ulcers

Avascular necrosis of femoral head

Chronic renal disease

51
Q

What is G6PD deficiency?

A

X linked recessive anaemia characterised by enzyme deficiency that leaves red cells vulnerable to oxidative damage

52
Q

What is the role of G6PD?

A

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
Q

What is the mode of inheritence of G6PD deficiency?

A

X linked recessive

54
Q

How does G6PD deficiency present?

A

Neonatal Jaundice

Vomiting and diarrhoea

Intravascular haemolysis

Splenomegaly

Pigment gallstones

55
Q

What can trigger G6PD deficiency haemolysis?

A

Drugs

  • Antimalarials
  • Ciprofloxacin
  • Sulphasalazine
  • Sulfonylurea

Infection

Broad/fava beans

56
Q

What investigations are used in G6PD deficiency diagnosis?

A

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
Q

How is G6PD deficiency managed?

A

Avoidance of drugs known to precipitate haemolysis

Folic acid in acute episode

Consideration for splenectomy

58
Q

What is Hereditary Spherocytosis?

A

Autosomal dominant anaemia characterised by mutations in membrane proteins/defect of cell cytoskeleton, causing spherical fragile red cells

59
Q

What is the mode of inheritence of hereditary spherocytosis?

A

Autosomal dominant

60
Q

How does hereditary spherocytosis present?

A

Neonatal jaundice

Splenomegaly

Pigment gallstones

Failure to thrive

Aplastic crisis precipitated by parvovirus infection

61
Q

What investigations are used in hereditary spherocytosis diagnosis?

A

EMA binding test

Blood film

  • ONLY spherocytes present
62
Q

How is hereditary spherocytosis managed?

A

Acute haemolytic crisis

  • Treatment is generally supportive
  • Transfusion if necessary

Longer term treatment

  • Folate replacement
  • Splenectomy
63
Q

What are the causes of macrocytic anaemia?

A

F: Folate deficiency

A: Alcohol, liver disease

T: Hypothyroidism

R: Reticulocytosis

B: B12 deficiency, baby/pregnancy

C: Cytotoxic drugs: Methotrexate

64
Q

What test is used to distinguish the cause of macrocytic anaemia?

A

B12/folate assay

  • Megaloblastic is B12/folate deficiency, normoblastic is anything else

​Blood film

  • Hypersegmented neutrophils
65
Q

What is pernicious anaemia?

A

Autoimmune disease resulting in malabsorption of dietary B12 due to lack of intrinsic factor

66
Q

How does pernicious anaemia present?

A

Typical anaemia features

Neurological and neuropsychiatric features

Lemon tinge

Glossitis

67
Q

What can cause B12 deficiency?

A

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
Q

What investigations are used in pernicious anaemia diagnosis?

A

Antibodies against

  • Intrinsic factor
  • gastric parietal cells (less specific)

FBC

  • Pancytopenia

Blood film

  • Cabot rings
69
Q

How does B12 deficiency/pernicious anaemia present?

A

Macrocytic anaemia

Sore tongue and mouth

Neurological symptoms

  • Dorsal column is usually affected first (joint position and vibration)

Neuropsychiatric symptoms/mood disturbances

70
Q

Why do symptoms of B12 deficiency take 3 years to occur?

A

B12 stores up to 3 years

71
Q

How is B12 deficiency/pernicious anaemia managed?

A

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
Q

What causes folate deficiency?

A

Dietary

  • Lack of green vegetables

Increased requirements

  • Haemolysis

GI Pathology

  • Coeliac
73
Q

What blood film sign is seen in folate deficiency anaemia?

A

Hyper-segmented neutrophil polymorphs

74
Q

How is folate deficiency managed?

A

Oral replacement

Ensure B12 is normal if neuropathic symptoms

75
Q

Give causes of polycythaemia

A

Relative

  • Dehydration
  • Stress

Primary

  • Polycythaemia vera

Secondary

  • COPD
  • Altitude
  • Obstructive sleep apnoea
  • Uterine fibroids, hepatoma and cerebellar haemangioma all cause excessive erythropoietin

Haematology (7 decks)

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