Anaemia Flashcards
What are 5 causes of normocytic anaemia?
- Anaemia of chronic disease
- Chronic kidney disease
- Aplastic anaemia
- Haemolytic anaemia
- Acute blood loss
What are 5 causes of microcytic anaemia?
- Iron-deficiency anaemia
- Thalassaemia
- Congenital sideroblastic anaemia
- Anaemia of chronic disease (more commonly normocytic, normochromic)
- Lead poisoning
What should you be worried about if you see normoal haemoglobin level with microcytosis?
if not at risk of thalassaemia, should raise possibility of polycythaemia rubra vera
What should you investigate for in new onset microcytic anaemia in elderly patients?
urgently investigate to exclude underlying malignancy
What are 2 groups that macrocytic anaemia can be grouped into?
megaloblastic bone marrow, and normoblastic bone marrow
What are 2 megaloblastic causes of macrocytic anaemia?
- Vitamin B12 deficiency
- Folate deficiency
What are 7 normoblastic causes of macrocytic anaemia?
- Alcohol
- Liver disease
- Hypothyroidism
- Pregnancy
- Reticulocytosis
- Myelodysplasia
- Drugs: cytotoxics
What is the most common cause of anaemia worldwide?
iron deficiency anaemia
How does iron deficiency cause anaemia?
iron is needed to make haemoglobin in red blood cells, therefore a deficiency of iron leads to a reduction in red blood cells/ hb i.e. anaemia
What are the 4 main causes of iron deficiency anaemia?
- Excessive blood loss
- Inadequate dietary intake
- Poor intestinal absorption
- Increased iron requirements
Which age group has the highest prevalence of iron deficiency anaemia?
preschool age children
What is the commonest cause of excessive blood loss leading to IDA in women?
blood loss due to menorrhagia
What is the commonest cause of excessive blood loss leading to IDA in men and post-menopausal women?
gastrointestinal bleeding - always suspect colon cancer
What are 2 sources of iron in the diet?
- meat
- dark green leafy vegetables
What are 2 states of increased iron requirements which can lead to IDA?
- Children - during periods of rapid growth
- Pregnancy
What are 2 reasons why IDA is common in pregnancy?
- Increased demand as baby will receive iron supply from mother
- Increase in plasma volume causes dilution
What are 9 features of IDA?
- Fatigue
- Shortness of breath on exertion
- Palpitations
- Pallor
- Nail changes: koilonychia
- Hair loss
- Atrophic glossitis
- Post-cricoid webs (see picture)
- Angular stomatitis
What are 6 investigations in suspected iron deficiency anaemia?
- Taking history - diet, medication, menstrual, weight loss, bowel habit
- FBC
- Serum ferritin
- Total iron-binding capacity (TIBC)/ transferrin
- Blood film
- Endoscopy to rule out malignancy in males and post-menopausal females
What are 5 things to ask about in the history if anaemia is suspected?
- Changes in diet
- Medication history
- Menstrual history
- Weight loss
- Change in bowel habit
What will FBC show in IDA?
hypochromic microcytic anaemia
What is serum ferritin likely to show in IDA?
likely to be low as serum ferritin correlates with iron stores;
however, important to recognise that ferritin can be raised during states of inflammation so if raised doesn’t rule it out i.e. in co-existent inflammatory disease
What is the total iron binding capacity likely to show in IDA?
will be high - high TIBC reflects low iron stores
What will transferrin saturation be in IDA?
low
What are 3 things that will be seen on a blood film in IDA?
- Anisopoikilocytosis (red blood cells of different sizes and shapes)
- Target cells
- ‘Pencil’ poikilocytes
When is it important to perform endoscopy in iron deficiency anaemia?
males and post-menopausal females who present with unexplained iron-deficiency anaemia
When should iron deficiency anaemia trigger a 2 week wait referral to gastroenterology?
- Post-menopausal women: Hb <100
- Post-menopausal men: Hb <110
What are 3 aspects of the management of iron-deficiency anaemia?
- Underlying cause identified and managed (exclude malignancy)
- Oral ferrous sulfate
- Iron-rich diet: dark green leafy vegetables, meat, iron-fortified bread
For how long should oral ferrous sulfate be continued to manage IDA?
continue to take for 3 months after the IDA has been corrected in order to replenish iron stores
What are 4 common side effects of oral ferrous sulfate?
- nausea
- abdominal pain
- constipation
- diarrhoea
How do the blood test results compare for IDA vs anaemia of chronic disease? 4 points
- Serum iron: IDA <8, AOCD <15
- TIBC: IDA high, AOCD low
- Transferrin saturation: low for both
- Ferritin: low for IDA, high for AOCD
What are 4 situations when NICE suggests you UST refer urgently (within 2 weeks) to colorectal services for investigation?
- patients ≥40 years with unexplained weight loss AND abdominal pain
- patients ≥50 years with unexplained rectal bleeding
- patients ≥60 years with iron deficiency anaemia OR change in bowel habit
- tests show occult blood in their faeces (see below)
What are 7 situations when a 2 week wait referral to colorectal services for investigation should be considered according to NICE?
- there is a rectal or abdominal mass
- there is an unexplained anal mass or anal ulceration
- patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
- → abdominal pain
- → change in bowel habit
- → weight loss
- → iron deficiency anaemia
In addition to screening, when else is faecal occult blood testing (now faecal immunochemical test screening) offered?
- patients 50years or older with unexplaiend abdominal pain or weight loss
- patients <60 years with changes in their bowel habit or iron deficiency anaemia
- patients 60years or older who have anaemia even in the absence of iron deficiency
If oral iron supplements do not resolve the situation what is the next line treatment?
IV iron e.g. Ferrinject
What are 5 reasons why a patient may fail to respond to oral iron?
- Malabsorption
- Poor compliance
- Ongoing iron loss
- Concomitant anaemia of chronic disease
- Erroneous diagnosis
What are 5 things which can guide the decision to resort to blood transfusion for anaemia?
- Anaemic heart failure
- Hb <5g/dL with symptoms
- Hb <4g/dL in any situation
- Acute blood loss - shock or signs of heart failure despite IV fluids
- Need for emergency major surgery with pre-operative Hb<7g/dL
What are 3 ypes of transfusion reactions?
- Severe transfusion reaction: ABO incompatibility or bacterial contamination of the unit
- Simple febrile and allergic reactions: temp rise by 1 degree, rash/itching
- Delayed transfusion reaction: 5-10 days later, sensitisation to RBCs following previous transfusions/pregnancy
