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P year haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

what is anaemia?

A

Low haemoglobin which is:
Men <13.5g/dl
Women <11.5g/dl

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2
Q

what are symptoms of anaemia?

A 
fatigue
dyspnoea
faint
palpitations
headache
tinnitus

Normally symptoms are due to cause more than anaemia

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3
Q

what is the diagnostic approach to anaemia?

A

FBC to confirm anaemia

MCV to categorise anaemia

Microcytic: iron panel

normocytic: reticulocyte count to assess bone marrow

Macrocytic:
Peripheral blood smear to decide if it’s megaloblastic or non-megaloblastic.

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4
Q

What are the classifications of anaemia based on MCV?

A

MCV <80fL: microcytic
MCV 80-100fL: normocytic
MCV >96: macrocytic

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5
Q

what are causes of microcytic anaemia?

A 
IRON LAST
Iron deficiency
Lead poisoning
Anaemia of chronic disease
Sideroblastic anaemia
Thalassaemia
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6
Q

what is the most common cause of microcytic anaemia?

A

iron deficiency

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7
Q

what are the investigation results seen in iron deficient anaemia?

A 
Low serum iron
Low ferritin
High transferrin
High TIBC
Low TIBC SATURATION
Blood films can show poikilocytosis, target and pencil cells
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8
Q

what are clinical features of iron deficient anaemia?

A 
fatigue
SOB
Palpitations
pallor
hair loss
atrophic glossitis
angular stomatis
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9
Q

what tests might you consider doing in someone with iron deficient anaemia?

A

occult blood tests, haemoglobin electrophoresis, anti-TTG
endoscopy/colonoscopy

Men of any age with a Hb under 110g/L should be referred under 2WW

Patients >60 should be referred for colonoscopy

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10
Q

what is the management for iron deficient anaemia?

A

Ferrous sulfate oral TDG 200mg.

reticulocyte count will improve in 7 days and treatment should carry on for 5-6 months

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11
Q

what is sideroblastic anaemia?

A

Iron granules form a ring around the nucleus in developing erythroblasts due to a defect in haem synthesis.

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12
Q

what type of anaemia does sideroblastic anaemia cause?

A

Hypochromic microcytic picture

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13
Q

what are investigation findings in sideroblastic anaemia?

A

low TIBC
Raised serum iron
hypochromic RBC’s
ringed sideroblasts

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14
Q

what is the management of sideroblastic anaemia?

A

regular transfusions and iron chelation

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15
Q

what is the effect of haemolysis on reticulocyte count?

A

Increased as more RBC’s are produced by the bone marrow to try and compensate

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16
Q

what are causes of normocytic anaemia?

A 
Anaemia of chronic disease
CKD/RA
Pregnancy (due to increased plasma volume)
acute blood loss
Aplastic anaemia
Haemolytic anaemias
17
Q

what is aplastic anaemia?

A

Bone marrow failure causes a normocytic anaemia, leukopenia and thrombocytopenia

18
Q

what are causes of aplastic anaemia?

A

phenytoin, sulphonamides, chloramphenicol, ALL, AML, parvovirus, hepatitis

Congenital is X linked recessive

19
Q

what are investigation findings in aplastic anaemia?

A

low reticulocyte count (as bone marrow can’t produce new RBC’s)
neutropenia

20
Q

what is diagnostic Ix for aplastic anaemia?

A

Bone marrow biopsy

21
Q

what are type of haemolytic anaemia?

A

Intrinsic defects:

  • Haemoglobinopathies (sickle cell, HbC)
  • enzyme deficiencies (pyruvate kinase deficiency, G6PD deficiency)
  • Membrane defects (Paroxysmal nocturnal haemoglobinuria, hereditary spherocytosis)

Extrinsic defects: autoimmune haemolytic anaemia, microangiopathic haemolytic anaemia, infections or mechanical destruction

22
Q

what are the two categories of macrocytic anaemia?

A

megaloblastic vs non megaloblastic

Megaloblastic: Have large and immature nuclei due to delayed nuclear maturation with defective DNA synthesis

Non-megaloblastic:
Normal DNA synthesis and no hypersegmented neutrophils

23
Q

what are causes of megaloblastic macrocytic anaemia?

A

Vitamin B12 deficiency
Folate deficiency
Myelodysplasia

24
Q

what is the neurological consequence of vitamin B12 deficiency?

A

Subacute combined degeneration of the spinal cord

  • affects the pyramidal and dorsal columns
  • symmetrical polyneuropathy
25
Q

what are causes of vitamin B12 deficiency?

A

Inadequate intake: poor diet, vit B12 comes from animal sources mainly milk, eggs etc
Malapsorption: Perncious anaemia, gastrectomy, congenital intrinsic factor deficiency

intestinal causes:
bacterial colonisation, ileal resection, crohns disease

26
Q

what is pernicious anaemia?

A

autoimmune gastritis and reduced secretion of intrinsic factor and acid.
Often have antibodies to intrinsic factor and parietal cells

27
Q

what investigations can you consider for someone with b12 deficiency?

A

intrinsic factor antibody
parietal cell antibodies
serum gastrin levels
upper GI endoscopy

28
Q

what is the management of vit b12 deficiency?

A

1mg IM hydroxocobalamin

*if folate and b12 deficient treat the B12 first to prevent neuropathy

29
Q

what is the most common cause of Vit B12 deficiency?

A

Pernicious anaemia.

30
Q

how much folate acid does the body store?

A

4 months worth

31
Q

why does pernicious anaemia lead to vit B12 defiency?

A

You have intrinsic factor antibodies which bind to intrinsic factor preventing vitamin B12 binding

You have gastric parietal cell antibodies which mean reduced acid production and atrophic gastritis. This leads to less intrinsic factor being produced and therefore less VitB12 absorption.

32
Q

what is vitamin B12 important for?

A

Production of blood cells

Myelination of nerves

33
Q

what antibody test is most specific for pernicious anaemia?

A

Anti intrinsic factor antibodies is highly specific

Anti gastric parietal cell antibodies are sensitive but have low specificity.

34
Q

what are causes of folate deficiency?

A

Nutritional: old age, poverty and famine

Malabsorption: Gluten induced enteropathy, dermatitis herpetiformis

Increased use: pregnancy, lactation, haemolytic anaemia, carcinoma, lymphoma, myeloma, corhns, RA, malaria.

excess urinary loss: congestive heart failure and chronic dialysis

drugs: anticonvulsants and sulfasalazine
mixed: liver disease and alcoholism

35
Q

what are causes of non megaloblastic macrocytic anaemia?

A 
Pregnancy
alcohol excess
liver isease
hypothyroid
myeloma 
myeloma
reticulocytosis
36
Q

what are the associations of plummer vinson syndrome?

A

Iron deficient anaemia
Dysphagia (post cricoid)
Oesophageal webs

  • increased risk of glossitis and oesophageal SCC.
37
Q

what is one of the biggest causes of macroytosis?

A 
Alcohol 
aplastic anaemia
cytotoxic drugs
myeloma
liver disease
myxoedema
pregnancy
newborn

P year haematology (12 decks)

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