Anaemia Flashcards
What are some of the main symptoms of anaemia?
Fatigue Restless legs Dysponea Pallor Hair loss Dizziness Headaches Tinnitus
What are some of the main signs of anaemia?
Glossitis (tongue inflammation) Angular stomatitis Conjunctival pallor Koiknychia Jaundice
What are the main investigations to do for anaemia?
Blood films FBC Ferritin levels RTC Vit. B12 & folate levels DAGT (Coombs test)
What does MCV stand for and what does it tell you?
Mean corpuscular volume
Tells you the volume of the RBCs, so you can find out if it’s micro, normo or macrocytic
What does MCH stand for and what does it show you?
Mean corpuscular hemoglobin
Shows the Hb content of the RBCs
If a blood film comes back that shows microcytic but normoblastic anemia, what should you check that the patient has taken?
Alcohol
What is the function of Glucose-6 Phosphate Dehydrogenase (G6PD)?
Prevents oxidative damage when RBCs are metabolised
What is the function of folate?
Increases the production of RBCs
What is the function of the protein Ankyrin?
Maintains RBC’s membrane
What does Iron do in relation to Hb?
Allows oxygen to bind to it
How many chains does Hb have?
4
2x alpha chains and 2x beta chains
What chromosome number produces the 2 alpha chains of Hb?
16
What chromosome number produces the 2 beta chains of Hb?
11
Why a intrinsic factor important in amemias?
As you need it to absorb vit. B12
What protein transports iron from the duodenum (oral iron obvs) to the blood?
Ferroprotein
What chemical transports iron from the blood to the liver, after ferroprotein transports it from the duodenum into the blood?
Transferrin
Which chemical stores iron in the liver?
Ferritin
What happens to Fe levels due to hepicidin?
Decreases
What chemicals are responsible for:
A. Transporting iron from duodenum to blood
B. Transporting iron from blood to liver
C. Stores iron in the liver
A. Ferroprotein
B. Transferrin
C. Ferritin
Give 2 bacterial infections that cause of anaemia?
TB
Brucella
Give 2 examples of viral infections that cause anaemia
EBV
CMV
Give 3 examples of parasitic infections that cause anaemia.
Malaria
Schistomiasis
Leishmaniasis
Give examples of the following infections that can cause anaemia:
A. Bacterial
B. Viral
C. Parasitic
A. TB and Brucella
B. EBV and CMV
C. Malaria, schistosomiasis and leishmaniasis
Give an example of a connective tissue disease that can cause anaemia
SLE
What is the name of a storage pool disorder than can cause anaemia?
Gaucher’s disease
What are the 2 man broad types of anaemia?
Acquired and congenital
What common stationary utensil are microcytic RBCs suppose to look similar to?
Pencils
What is the main test to do for an acquired anaemia?
Blood film
If tests to you do for the following blood film results:
A. Microcytic and hypochromic
B. Normocytic and normochromic
C. Macrocytic and macrochronic
A. Ferritin levels
B. Reticulocyte count
C. Vit. B12 and folate levels
What are potential causes of anaemia if the ferritin levels of a microcytic and hypochromic anaemia are:
A. Increased or normal
B. Decreased
A. Secondary anaemia or thalassemia
B. Fe deficiency anaemia
What are potential causes of anaemia if the reticulocyte count (RTC) of a normocytic and normochromic anaemia are:
A. Increased
B. Decreased/normal
A. Haemolysis or acute blood loss
B. Secondary anaemia
What are potential causes of a macrocytic and hyperchromic anaemia that show RBCs that are:
A. Megaloblastic
B. Non-megaloblastic
A. Vit. B12 or folate deficiency
B. Myelodysplasia or methotrexate use
Apart from showing non-megalobastic, macrocytic and hyperchromic cell’s on a blood film, what are some other signs of myleodysplasia on a blood film?
RBCs aniscytosis (unequal sizes)
Hypogranular neutrophils
What is the most common cause of anaemia?
Fe deficiency
How is Fe deficiency treated?
Oral or IV iron
Dietary changes
Treating the cause
If a female is having anaemia but is still having periods, should you refer to GI to check for a peptic ulcer?
Nah mate
What are some of the causes of Fe deficiency anaemia?
Peptic ulcer Gastritis Menorrhagia Malabsorption Pregnancy Poor dietary Fe intake (vegan baby)
What are the 2 different types of MCV for secondary anaemia and what is the most common?
Microcytic
Normocytic (most common)
How would you treat Vit. B12 deficiency anaemia?
Vit. B12 or folate supplements
If you’ve just diagnosed that the anaemia is due to a Vit. B12 or folate deficiency, do you give them both Vit. B12 and folate supplements?
Yes, as you’ve got no idea what the diagnosis is yet bruv
If an anaemic patient complains of pins and needles and feels like they are walking on cotton wool, what is the likely cause of their anaemia?
Vit. B12 or folate deficiency
What are some causes of Vit. B12 deficiency?
Pernicious anaemia
GI disease
What are some causes of folate deficiency anemia?
Dietary issues
Hemolysis
Pernicious anaemia is the most common cause of Vit. B12 deficiency. How long does it take to develop?
Around 1-2 years
Gradual development
What causes pernicious anaemia?
Antibodies against intrinsic factor and parietal cells
How is pernicious anaemia treated?
IM Vit. B12 injections
What are the 2 types of pernicious anaemia?
Type 1- B12 can’t bind to intrinsic factor
Type 2- B12 can’t be absorbed at the distal ileum
For type 2 pernicious anaemia, where in the GI tract can B12 no longer be absorbed?
Distal ileum
What is the main cause of haemolytic anaemia?
Autoimmune haemolytic anaemia
Apart from autoimmune haemolytic anaemia, what are some of the other causes of haemolytic anaemia?
ABO mismatch
Sickle cell
G6PD deficiency
Infections
What type of congenital anaemia is haemolytic anaemia associated with?
Hereditary spherocytosis
What respiratory disease is haemolytic anaemia associated with?
Pneumonia
What is the main test to do for haemolytic anaemia?
Direct Anti-Globulin Test (DAGT)
What is the old fashioned name for DAGT?
Coombs test
What are the two types of haemolytic anaemia?
Non-immune and intravascular
Immune and extravascular
Is intravascular and extravascular haemolytic anaemia immune or non-immune?
Intra= Non-immune
Extra= Immune
What is the function of a DAGT?
Differentiates between immune and non-immune haemolytic anaemia
If a DAGT is positive, is the haemolytic anaemia immune or non-immune?
Immune
If a DAGT is negative, is the haemolytic anaemia immune or non-immune?
Non-immune
What do you check for after you diagnose immune, extravascular haemolytic anaemia?
Warm antibodies
Cold antibodies
Alloantibodies
For a case of haemolytic anaemia that’s DAGT +ve, if warm antibodies are present, what are the potential causes?
Autoimmune disease
CLL
Drugs
For a case of haemolytic anaemia that’s DAGT +ve, if cold antibodies are present, what are the potential causes?
Cold Haem-agglition Disease (CHAD)
For a case of haemolytic anaemia that’s DAGT +ve, if alloantibodies are present, what are the potential causes?
Transfusion reaction
What are some of the causes of nonimmune, intravascular haemolytic anaemia?
Haemolytic uremic syndrome (HUS)
On a blood film, what do the RBCs look like for non-immune haemolytic anaemia?
Fragments
Congenital anaemia are due to 3 different types of defects. What are the 3?
Defects in:
RBCs membrane
RBCs metabolism
Haemoglobin
What type of congenital anaemia occurs due to a defect in the RBC’s membrane?
Hereditary spherocytosis
What type of inheritance is hereditary spherocytosis?
Autosomal dominant
What type of congenital anaemia is due to a defect in RBC metabolism?
G6PD deficiency
What mode of inheritance is G6PD deficiency?
X-linked recessive
What 2 types of congenital anaemia is due to a defect in haemoglobin?
Sickle cell disease (SCD)
Thalassaemia
What mode of inheritance are both sickle cell and thalassaemia?
Autosomal recessive
What are some of the classic clinical features (other than anaemia symptoms) of congenital anaemias?
Jaundice
Splenomegaly
Pigmented gallstones
What sorta gallstones commonly occur along with congenital anaemias?
Pigmented gallstones
Can G6PD deficiency occur in girls?
Nah only boys cause it’s X-linked recessive, so since boys only have one X chromosome they’re buggered
Bros before hoes
What shape are the RBCs in hereditary spherocytosis?
Spheres (who would’ve ducking thought)
What does G6PD stand for?
Glucose 6 Phosphate Dehydrogenase
Why does a deficiency in G6PD cause anaemia?
As G6PD protects RBCs from oxidative damage
What parasitic infection are suffers of G6PD protected from?
Malaria
On a blood film (morphological features) of G6PD deficiency?
Bite cells (Suarez)
Blister cells (DofE)
What are the 2 main triggers of G6PD deficiency?
DKA
Fava beans
What sorta beans can trigger G6PD deficiency?
Fava
For Vit. B12 deficiency, how long would you give the IM Vit. B12 injections?
Every 3 months
Give examples of the GI causes that result in microcytic anaemia.
Oesophageal varices
Peptic-ulcers
Haemorrhoids
IBD
Give examples of the non-GI causes that result in microcytic anaemia.
Menorrhagia (main)
Dysfunctional uterine bleeding
Epitstaxis
Renal carcinoma
What is the commonest cause of Fe deficiency in woman?
Menorrhagia
Malabsorption can cause Fe deficinency anaemia, what can cause this?
Coeliacs
What must you always consider when Fe deficiency anaemia is likely?
Thalassemia
although the ferritin level will be sound ehhhh
When would you suspect thalassemia?
Microcytic & hypochromic anaemia
Normal ferritin levels
African
Alcohol excess causes what type of anaemia?
Macrocytic
What drug is given to treat Fe deficieincy anaemia to boost Fe levels?
Ferrous sulphate
How may hereditary spherocytosis, or any congenital anaemia for that matter, first present?
Neonatal jaundice
