Anaemia Flashcards
What is anaemia?
- Reduction in HAEMOGLOBIN in the blood - not necessarily RED CELLS
What are 3 causes of anaemia in relation to haemoglobin?
- Reduced PRODUCTION
- Increased LOSSES
- Increased DEMAND
How long should RBC’s last?
- 120 days
Once cause of anaemia is when there is a reduction of the normal red cells in the blood. What is the most common reason for this?
- Bone marrow failure
What is aplastic anaemia?
- A rare and serious blood disorder caused by the bone marrow not functioning properly. In people with aplastic anaemia, the bone marrow fails to produce enough of all three types of blood cells - red, white and platelets
- The word aplastic means the body’s inability to create new cells, so that the tissue cannot grow or regenerate
Once cause of anaemia is when there are normal red cells in the blood but not enough Hb in them. What are the most common reasons for this? (3 points)
- Deficiency states
- Abnormal globin chains
- Chronic inflammatory disease
What are the 3 deficiency states that cause reduced Hb production anaemia?
- Iron (Fe) deficiency
- Folate
- Vit B12
What are the 2 types of anaemia caused by reduces production of Hb due to abnormal globin chains being produced?
- Thalassaemia
- Sickle cell
What is thalassaemia?
- Any group of hereditary haemolytic diseases cause by faulty haemoglobin synthesis
What chronic inflammatory diseases can cause anaemia? (8 points)
- Rheumatoid arthritis
- HIV/AIDS/TB
- Inflammatory bowel disease (Crohn’s and ulcerative colitis)
- Diabetes and heart failure
What is pernicious anaemia?
- Caused by a lack of Vit B12
What is haemolytic anaemia?
- A condition in which RBC’s are destroyed earlier than normal
What are haematinics?
- A general term for those substances including metallic ions (iron), Vit B12 and folic acid and proteins which are required for normal erythropoiesis
What are 3 examples of haematinics?
- Iron
- Vitamin B12
- Folic acid (folate)
What are 3 different sources of iron?
- Meat
- Green leafy veg
- Iron tablets
What is Achlorhydria?
- Lack of stomach acid
Why does achlorhydria cause anaemia?
- As due to lack of stomach acid there is no conversion of non-haem iron
- This is important as it makes it difficult to change non-haem iron from 3+ to 2+ which is the one that can be absorbed
What may cause achlorhydria?
- May be drug induced (proton pump inhibitors)
Which disease can cause iron deficiency anaemia?
- Coeliacs disease
- Loose villae from surface of endothelial cells
- Get a flattening of intestinal lining which gives much reduced surface area for absorption
What are common causes of iron loss in the body? (4 points)
- Gastric erosion and ulcers
- IBD (Crohn’s, Ulcerative colitis)
- Bowel cancer (colonic or rectal)
- Haemorrhoids
What are haemorrhoids?
A swollen vein or group of veins in the anus. Also called piles
What are examples of vitamin B12 sources? (2 points)
- Animal products
- Meat and diary
What are 3 things that can cause a vitamin B12 deficiency?
- Lack of intake (in diet)
- Lack of intrinsic factor
= Autoimmune stomach disease (pernicious anaemia)
= Gastric disease
- Disease of the terminal ilium
= Crohn’s disease
What are examples of sources of folic acid?
- Green, leafy veg
What does folic acid do in relation to nerves?
- It is important in nerve maturation
Why is a folic acid deficiency in pregnancy bad?
- Can lead to neural tube defects in foetus
- It can give a predisposition to spina bifida
How can folic acid deficiencies be caused? (2 points)
- Lack of intake (through diet)
- Absorption failure
= Jejunal disease - Coeliac disease
= Usually seen co-deficient with iron
What is folic acid usually seen co-deficient with?
- Iron
What should you check for in blood tests if you think a patient has a haematinic deficiency? (3 points)
- Ferritin (iron)
- Vitamin B12
- Folate
What is thalassemia?
- An inherited blood disorder characterised by the formation of abnormal form of haemoglobin
- Normal haem is produces but the globin chain you make to wrap around the haem is deficient
What are the 2 types of thalassaemia and which races are these common to?
- Alpha Chains (alpha thalassaemia)
= Asians
- Beta chains (beta thalassemia)
= Mediterranean’s
What are the clinical effects of thalassaemia? (5 points)
- Chronic anaemia
- Marrow hyperplasia (skeletal deformities)
- Splenomegaly
- Cirrhosis
- Gallstones
What is chronic anaemia?
Anaemia that lasts longer thean 2 to 6 months
What is marrow hyperplasia?
- Enlargement of the bone marrow
- Marrow hyperplasia as the bone marrow has to make more globin
- This makes the marrow a slightly different shape
What is splenomegaly?
- A condition where the size of the spleen is increased
- Because spleen will remove blood cells at a larger rate as there are more that are deformed
What is Cirrhosis?
- A degenerative disease of the liver resulting in scarring and liver failure
- Due to iron storage problems
What are gallstones?
- A small hard crystalline mass formed abnormally in the gall bladder or bile ducts from bile pigment, cholesterol and calcium salts. Can cause severe pain and blockage of the bile ducts
How can you manage thalassaemia? (2 points)
- Blood transfusions
- Prevent iron overload
What is sickle cell anaemia?
- A severe hereditary form of anaemia in which a mutated form of Hb distorts the RBC’s into a crescent shape at low oxygen levels
- Abnormal globin chains
What conditions are required for RBC’s to change shape in people with sickle cell anaemia and what is the problem of this?
- Low oxygen conditions
- Prevents RBC’s from passing through the capillaries
- This causes tissue ischaemia - pain and necrosis
What is tissue ischaemia?
The condition in which living tissue doesn’t get oxygen and nutrients, usually due to an obstruction of the blood flow to that tissue
What is heterozygous sickle cell anaemia?
- Sickle cells trait
What is homozygous sickle cell anaemia?
- Sickle cell disease
What is the shape of normal RBC’s?
- Bi-concave disks
What is the haematocrit count?
- The ratio of the volume of RBC’s to the total volume of blood
If a person has anaemia but their RBC’s are normal, what is the cause of the anaemia?
- Bleeding
- Usually GI bleeding - chronic loss
If a person has anaemia and their RBC’s are abnormal, what is usually the cause of this?
- Autoimmune disease
- Hereditary - SICKLE, G6PD, spherocytosis
In anaemia caused by hereditary conditions the RBC’s have a reduces lifespan. What are the cells removed from the blood by?
- The spleen
What tests can be used to identify anaemia due to RBC losses?
- RCC
- HCT
What is Spherocytosis?
- The production of abnormal RBC’s that are in the shape of a sphere instead of the concave disk shape of normal RBC’s, resulting in fragile and abnormal RBC’s
What 2 conditions cause an increased demand on blood volume required in the body, which can lead to anaemia?
- Pregnancy
- Malignant disease
What is microcytic anaemia?
- Small RBC’s
- Smaller than they should be - shrunk too far as don’t have enough stuff inside it
What is microcytic anaemia usually caused by?
- Iron (Fe) deficiency
- Thalassaemia
What is macrocytic anaemia?
- Large RBC’s
- RBC’s start big as they mature they get smaller - if macrocytic means they have not shrunk enough
What causes macrocytic anaemia? (3 points)
- Vit B12/Folate deficiency
- Retics
What is a reticulocyte?
An immature RBC without a nucleus
What is normocytic anaemia?
- Where RBC’s are a normal size
What 3 things can cause normocytic anaemia?
- Bleed
- Renal disease as erythrocytes are made in the kidney’s
- Chronic disease
What is hypochromic anaemia (microcytic)?
- Anaemia where RBC’s are abnormally small and paler in colour than normal
Are reticulocytes mature or immature RBC’s?
- Immature, but almost mature RBC’s
When are reticulocytes released into the blood stream?
- Released early into the circulation to replace losses
- If suddenly lost a lot of blood - body realises this and wants to replace the blood quickly - can replace the fluid quickly but takes cells that are just about ready and puts them into the circulation
When reticulocytes are released into the blood stream what do they raise?
- Will raise MCV (average cell size)
What is MCV?
- Mean corpuscular volume (also known as mean cell volume) is a value that describes the average size of RBC’s in a blood sample
For an anaemia diagnosis what do you need to know? (4 points)
- What are the Hb levels? (degree of anaemia - is it normal or not normal)
- What are the RCC and HCT? (shows if it is a cell deficiency or Hb formation deficiency)
- What is the MCV? (is there a deficiency and what is the likely deficiency)
What may a person with anaemias mucosa look like? (only applies to some people - poor guide to anaemia diagnosis)
- Pale mucosa
In relation to the tongue, what may be a sign of a person with iron deficiency anaemia? (not a good guide to if someone has anaemia as people who don’t have anaemia may have this as well)
- Smooth tongue
In relation to the tongue, what may be a sign of a person with Vitamin B12 deficiency anaemia? (not a good guide to if someone has anaemia as people who don’t have anaemia may have this as well)
- ‘Beefy’ tongue
What are common signs that someone may have anaemia? (2 points)
- Pale (may or may not be)
- Tachycardia (fast heart rate as pumping cells around the body quicker due to a reduced number)
What are common symptoms that a person may be anaemic? (4 points)
- Tired and weak
- Dizzy
- SOB (shortness of breath)
- Palpitations
What are rare symptoms that a person may have if they are anaemic? (2 points)
- Enlarged liver
- Enlarged spleen
What are investigations you may do if you suspect a person has anaemia? (6 points)
- History
- FBC (ferritin/ RC Folate/Vit B12)
- FOB (faecal occult blood)
- Endoscopy/colonoscopy
- Renal function
- Bone marrow examination
What do you wan to treat when someone has anaemia?
- Want to treat the cause of the anaemia
How do we treat anaemia? (3 points)
Replace haematinics:
- FeSO4 200mg tablets for 3 months
- 1mg IM vit B12 x 6 then 1mg/2 months
- 5mg Folic acid daily
- Transfusion - if these is a production failure
- Erythroprotein - if these is a production failure e.g. if the patient has renal disease
Why should you be wary when giving an LA to a patient with anaemia?
- O2 capacity - in an anaemic patient there is a risk of hypoxia and damage to the tissues during the operation
What should you look for orally in a patient who has anaemia caused by deficiency states? (4 points)
- Mucosal atrophy
- Candidiasis
- ROU (recurrent oral ulceration)
- Dysaesthesia (altered sensory modalities - pins and needles)
What should you check all Sickle cell diseased patients for before giving them a GA?
- NEGROID background
- SICKLEDEX test even if they don’t have anaemia
What is a common cause of blood loss in the elderly?
- Bowel cancer
What are common causes of blood loss in younger people?
- Menstrual cycle
- Drinking (liver problems)
What does the SICKLEDEX test indicate?
The presence or absence of the abnormal haemoglobin that causes sickle cell anaemia
