Anaemia Flashcards
Hb in males
140 + per litre (or 14 decilitres)
Hb in females
120 + per litre
Normal range for ferritin
10-120
How do you work out what type of anaemia it is?
Look at the mean cell volume (not down a microscope)
Causes of microcytic anaemia
IDA
ACD/Chronic inflammatory problems
Thalassaemia
What do you do to work out which of these three is the cause of microcytic anaemia?
Iron studies
CRP ESR
Electrophoresis
IDA
Serum iron low Transferrin high Trans saturation Soluble transferrin receptor Ferritin
ACD
Low serum iron
low transferrin
normal/high ferritin
How do you classify normocytic anaemia?
Look at reticulocyte count
Causes of normocytic anaemia
Haemorrhage (loss) Acute haemolysis (breakdown)
Aplastic anaemia
How many litres of blood do we have in our body?
5L
How much blood do you give when you donate blood?
Half a litre
10% of blood volume
What is aplastic anaemia
(bone marrow failure e.g. due to B19 parvovirus)
What does the reticulocyte count tell you?
If high:
it’s due to blood loss, break down
OR
low: aplastic anaemia (production problem)
What are the signs of haemorrhage?
Tachycardia Hypotension Breathless Reduced GCS Cold peripheries
SHOCK
Commonest causes of shock in a post op patient
Haemorrhage
Sepsis (note even though we associate fever with infections, in sepsis they are really cold).
How do you deal with a patient with SHOCK?
FLUIDS
Are there any active bleeding sites? If so, apply pressure
Two wide bore cannulae
Verbal prescription for 15L oxygen through non rebreathe
500ml bolus of 0.9ml saline solution
then ABCDE approach
What fluid would you give?
Hartman’s solution or/Saline solution 0.9%
What is the cause of death in haemmorhage?
Myocardial infarction - due to hypoperfusion
Why don’t you warm up the patient in shock?
Vasodilation in peripheries would cause a further drop in BP
What is A? What do you do?
If they are conscious and talking to you, it’s fine
But if they’re unconscious, shake them to see if they respond
If not, their muscles could relax and their tongue could flop into their airway, so you need to keep their airway open.
Also, put out a:
Peri arrest call
Call an anaesthetist
If you’re worried about the airway and you’re worried about the c-spine, what do you do?
Jaw thrust
Can put in guedel
If you’re not worried about the c-spine, what do you do?
Head tilt
Chin lift
Breathing - what do you check for?
Do ABG (raised lactate would suggest sepsis)
Check for haemothorax
Portable chest x ray
Listen to lungs
What would you tell the anaesthetist to get them to come?
This patient is non-responsive and tolerating a guedel
What type of bloods do you need to order? what does this depend on?
Female, reproductive age: 2 units of o neg
OR
Male patient or post reproductive patient:
2 units of O positive
AND
4units of their blood type
What else do you have to check after an ABC approach?
Check glucose
Check active sites of bleeding
Rash (septiciemia)
Pulsatile masses
What are the classifications of macrocytic anaemia?
Megaloblastic
Non-megaloblastic
Megaloblastic causes
Folate/B12 deficiency
Methotrexate
Non-megaloblastic causes
Alcohol
Hypothyroidism
Pregnancy
Blood film
What are the mechanisms of anaemia?
Reduction in production of RBC
Blood loss
Breakdown
What are the mechanisms of anaemia?
Reduction in production of RBC
Blood loss
Breakdown (intravascular or extravascular)
What are the causes of extravascular
Hyposplenism
autoimmune haemolytic anaemia
Bartenelosis (bartenela infection)
Malaria
Intravascular causes
HUS
DIC
TTP
What would you see in the blood tests if you have haemolysis?
LDH increased (as it’s stored inside RBC)
high bilirubin
high reticulocytes
Reduction in haptoglobin
What does haptoglobin do?
(binds to free haemoglobin which is about to be destroyed)
Causes of reduction in production
BM failure Kidney disease (CKD) Hypothyroidism B12/iron deficiency Chronic inflammatory problems Anaemia of chronic disease
What is the breakdown product of
Haem splits into bilirubin and iron
Haptoglobin takes the haemoglobin before it’s even broken down, and takes it to the spleen
