Anaemia Flashcards
What is the definition of anaemia?
A reduced total red cell mass
What will happen to the reticulocyte count in anaemias caused by a decreased production of red blood cells?
Low reticulocyte count
What will happen to the reticulocyte count in anaemias caused by an increased loss or destruction of red blood cells?
High reticulocyte count
What are the two main examples of anaemia caused by increased loss or destruction of red blood cells?
Bleeding and haemolysis
A blood film which is ‘polychromatic’ suggests the presence of what cells?
Reticulocytes
What products of red blood cell breakdown may be present in excess in patients with haemolytic anaemia?
Serum unconjugated bilirubin and urinary urobilinogen
What type of murmur may be heard in patients with anaemia?
Ejection systolic murmur loudest over the apex
What cause of a microcytic, hypochromic anaemia is caused by a deficiency of globin chains, rather than a deficiency of haem?
Thalassaemia
What type of anaemia (i.e. micro, normo or macrocytic) is sideroblastic anaemia?
Microcytic anaemia
What is the most common cause of microcytic anaemia?
Iron deficiency
What happens to the ferritin level in microcytic anaemia caused by iron deficiency?
Low ferritin
What happens to the ferritin level in microcytic anaemia not caused by iron deficiency?
High/normal ferritin
What happens to the total iron binding capacity in microcytic anaemia caused by iron deficiency?
High total iron binding capacity
What happens to the total iron binding capacity in microcytic anaemia not caused by iron deficiency?
Low total iron binding capacity
What happens to the % saturation of transferrin in iron deficiency anaemia?
Low % saturation of transferrin
What happens to the % saturation of transferrin in anaemia of chronic disease?
Low % saturation of transferrin
A blood film showing anisopoikilocytosis, target cells and pencil pokilocytes is suggestive of what diagnosis?
Iron deficiency anaemia
What are the three main reasons for being iron deficient, leading to anaemia?
Blood loss, insufficient nutritional intake, reduced absorption
What diagnosis should always be considered in men or post-menopausal women with iron deficiency anaemia?
GI blood loss
What condition is most likely to cause a deficiency of iron absorbed, leading to anaemia?
Coeliac disease
What is the treatment for iron deficiency anaemia?
Oral ferrous sulphate
How long should ferrous sulphate be taken for when treating iron deficiency anaemia?
For 3 months after the deficiency has been corrected
What are some common side effects of taking oral ferrous sulphate?
Nausea, abdominal pain, altered bowel habit
What are the main causes of megaloblastic macrocytic anaemia?
B12 and/or folate deficiency
What are the main causes of non-megaloblastic macrocytic anaemia?
Alcohol, liver disease, hypothyroidism, pregnancy
What are the main causes of spurious (false) macrocytosis?
Reticulocytosis and cold agglutinins
Vitamin B12 travels down the gut bound to what?
Intrinsic factor
Where is vitamin B12 absorbed?
Terminal ileum
What lifestyle choice can lead to an inadequate intake of of vitamin B12?
Vegan diet
What is the most common cause of vitamin B12 deficiency?
Pernicious anaemia
Which disease of the bowel is most likely to cause a deficiency of vitamin B12?
Crohn’s disease
What is the pathophysiology behind pernicious anaemia?
An autoimmune destruction of gastric parietal cells resulting in a deficiency of intrinsic factor
What lifestyle choice can lead to an inadequate intake of folate?
Alcoholism
What drugs are recognised as a cause of folate deficiency?
Anti-convulsants, particularly phenytoin
How long do stores of vitamin B12 last for in the body?
2-4 years
How long do stores of folate last for in the body?
4 months
What is the daily requirement of vitamin B12?
1.5mcg
What is the daily requirement of folate?
200mcg
Where is folate absorbed?
Duodenum and jejunum
A sore tongue can be a feature of which type of anaemia?
Megaloblastic macrocytic anaemia
What neurological problem can vitamin B12 deficiency lead to eventually?
Subacute combined degeneration of the cord
What cause of anaemia is most likely to cause neurological and neuropsychiatric features?
Vitamin B12 deficiency
Are the neurological consequences which occur as a result of vitamin B12 deficiency reversible?
No
A blood film showing macrovalocytes and hypersegmented neutrophils is suggestive of which type of anaemia?
Megaloblastic macrocytic anaemia
What antibodies can be tested for if pernicious anaemia is suspected as a diagnosis?
Anti-GPC and anti-IF
How is pernicious anaemia treated?
Vitamin B12 injections for life
Why should you never give folic acid tablets before treating B12 deficiency, unless the B12 level is known to be normal?
This can precipitate subacute combined degeneration of the cord
What type of anaemia (i.e. micro, normo, macrocytic) does aplastic anaemia cause?
Normocytic
What is the most common cause of a normocytic anaemia?
Anaemia of chronic disease
What happens to the serum iron in anaemia of chronic disease?
Low serum iron
What happens to the ferritin level in anaemia of chronic disease?
Normal or increased serum ferritin
What is the congenital cause of aplastic anaemia?
Fanconi’s anaemia
How is Fanconi’s anaemia inherited?
Autosomal recessive
Which spinal cord tract is affected first by vitamin B12 deficiency?
Dorsal columns
If there is no neurological involvement, how is vitamin B12 deficiency treated?
1mg IM injection of vitamin B12 3 times weekly for 2 weeks, then once every 3 months
