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103-theme 2 > anaemia > Flashcards

anaemia Flashcards

1
Q

what is the definition of anaemia?

A
  • haemoglobin concentration falls below defined level (outside the normal range)
  • g/L
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2
Q

what is the clinical consequence of anaemia?

A

-insufficient O2 delivery

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3
Q

what are the clinical causes of anaemia? 3

A
  • decreased Hb content
  • decreased red blood cells
  • altered Hb does not carry sufficient O2
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4
Q

what are the normal ranges of Hb?

  • children
  • women
  • pregnant woman
  • men
A
  • 110-160
  • 115-165
  • 110-160
  • 130-180
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5
Q

why is men’s normal haemoglobin count higher than women’s?

A

testosterone is a contributing factor

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6
Q

what is haematocrit?

A

% of red blood cells after centrifugation

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7
Q

what is the number of red blood cells per litre of blood?

A

4 x 10^12/L

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8
Q

what does MCV, MCH and MCHC stand for?

A
  • mean cell volume
  • mean cell Hb
  • mean cell Hb concentration
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9
Q

what are the symptoms of anaemia? 5

A
  • lethargy/fatigue
  • shortness of breath
  • palpitations
  • headache
  • worse symptoms is acute onset e.g. for a bleed
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10
Q

what are the signs of anaemia? 5

A
  • skin pallor
  • pale conjunctiva
  • tachypnoea
  • tachycardia
  • spoon shaped nails
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11
Q

what are the main causes of anaemia? 2

A
  • problems of inadequate synthesis

- problems of blood loss or consumption

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12
Q

explain the how we can have inadequate synthesis of blood? 2

A
  • deficiency of necessary components (iron, B12, folic acid)
    -bone marrow dysfunction/infiltration
    (myelodysplasia)
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13
Q

explain how we can have problems with blood loss of consumption? 2

A
  • bleeding

- haemolytic (increased red cell destruction, shortened RBC lifespan)

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14
Q

how do we classify anaemia? 3

A
  • size of red blood cell
  • acute or chronic
  • underlying aetiology
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15
Q

what is the most common type of anaemia?

A

iron deficiency (is not a diagnosis in itself and should prompt other investigations to establish the underlying cause)

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16
Q

how can iron deficiency be caused? 3

A
  • bleeding
  • nutritional deficiency
  • increased requirements
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17
Q

how do we confirm an iron deficiency? 4

A
  • with iron studies
  • ferritin (measure of iron stores)
  • serum Fe
  • transferrin
  • transferrin saturation
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18
Q

name 4 diagnostic tests for iron?

A
  • serum ferritin
  • serum iron
  • serum transferrin
  • % transferrin saturation
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19
Q

what does serum ferritin test show? 2

A

-storage form of iron

low=iron deficient

20
Q

what does serum iron test show?

A

-labile in blood so reflects the recent intake of iron

21
Q

what does the serum transferrin test show? 3

A
  • carrier molecule for iron from gut to stores
  • homeostatically goes up if iron is deficient
  • reflects total iron binding capacity (TIBC) of the blood
22
Q

what does the % transferrin saturation test show? 3

A
  • sensitive measure of iron status
  • reflects proportion of transferrin with iron bound
  • low TF saturation indicates iron deficiency
23
Q

how can bleeding cause iron deficiency? 3

A
  • occult gastrointestinal blood loss (GI malignancy, GI peptic ulceration)
  • menstrual
  • renal tract
24
Q

how can we have an iron deficiency of inadequate intake? 2

A
  • dietary= vegan/vegetarian

- malabsorption= coeliac and crohn’s disease

25
Q

how can we have an iron deficiency of increased requirements?

A

pregnancy

26
Q

what is anaemia of chronic disease caused by?

A

chronic inflammation and is seen in conditions such as connective tissue disease, malignancy and chronic infection such as TB

27
Q

what are the different sizes of red blood cells? 3

A
  • microcytic (small)- caused by an iron deficiency , shows inherited disorders of Hb (beta-thalassaemia)
  • macrocytic (large)- caused by a B12 and folate deficiency (needed for the synthesis of nucleotides), shows myelodysplasia (causes defective erythropoiesis)
  • normocytic (normal)- show anaemia of chronic disease, acute haemorrhage or renal faliure
28
Q

what does a blood film show? 4

A
  • haematinic deficiency (microcytic/ macrocytic)
  • haemoglobinopathy (sickled cells)
  • haemolysis
  • other abnormalities in white cells, platelets leukocytes
29
Q

what is the lifespan of a red blood cell?

A

100-120

30
Q

what does reticulocyte count show? 4

A
  • newly produced red blood cells
  • can be calculated on a blood film
  • indicates the rate of production of RBC by the bone marrow (low if bone marrow is infiltrated or precursor deficiencies)
  • helps monitor response to treatment
31
Q

what is red blood cell production driven by?

A

-erythropoietin from the kidney

32
Q

what would an iron deficient blood film show? 4

A
  • hypochromia
  • microcytosis
  • pencil cells
  • target cells
33
Q

what history would we have to take when anaemia is suspected? 7

A
  • GI symptoms
  • menstrual history
  • bowel history
  • dietary history
  • travel history
  • ethnic origin
  • family history
34
Q

what is megaloblastic anaemia? 2

A
  • caused by the deficiency of vitamin B12 and folate
  • macrocytic red blood cells
  • hypersegmented neutrophils (more than 4 nuclear lobes)
35
Q

what type of anaemia shows B12 deficiency? 8

A
  • pernicious anaemia
  • autoimmune
  • deficiency of intrinsic factor
  • cannot absorb B12 in terminal ileum where IF receptor are located
  • check for autoantibodies
  • treat with B12 injections
  • common in strict vegans (need oral B12)
  • common in coeliac and crohn’s disease
36
Q

how can someone have a folate deficiency? 5

A
  • dietary
  • malabsorption
  • excess utilisation (haemolysis and pregnancy)
  • alcohol
  • drugs
37
Q

what is the most common for of anaemia in hospitalised patients? 1 what causes this?8

A

-anaemia of chronic disease

  • chronic inflammation
  • chronic infection
  • autoimmune conditions
  • cancer
  • renal failure
  • poor utilisation of iron in the body (iron is stuck in the macrophages of the reticuloendothelial system) (there is poor mobilisation of the iron from the stores into the erythroblasts)
  • dysregulation of iron haemostasis (decreased transferrin, increased ferritin, increased hepcidin)
  • impaier proliferation of erythroid progenitors (iron is functionally unavailable)
38
Q

what causes sickle cell anaemia? 5

A
  • point mutation in the beta globin gene causing HbS (sickle Hb)
  • increased turnover of red cells= survival approx 20 days due to haemolysis
  • sickle cell crisis= triggered by low blood oxygen level, vaso-occlusive due sickling in the vessels causing ischaemia leading to pain
  • manage with analgesics, hydration and transfusion
  • red blood cells become sticky and inflexible
39
Q

what causes thalassaemia? 2
clinical features? 3
two types of beta?

A
  • insufficient production of normal Hb- imbalance of alpha and beta chains
  • inherited autosomal recessive- either alpha or beta
  • enlarged spleen, liver, and heart
  • bones may misshapen
  • (beta) look for microcytic cells and hypochromic cells
  • beta-thal major (homo)=disease, requires long-life transfusions)
  • beta-thal minor (hetero)= carrier- clinically healthy
40
Q

what are the 3 types of bone marrow infiltration?

A
  • leukaemia (non-specific symptoms, bone marrow failure)
  • lymphoma (lymphadenopathy, weight loss)
  • myeloma (anaemia, hypercalcaemia, renal failure, bone lesions)
41
Q

how do we obtain an bone marrow sample? 2

A
  • aspirate film for morphology of cells

- trephine biopsy for histological section

42
Q

when do we transfuse during acute anaemia? 4

A
  • acute> chronic
  • be guided by symptoms rather than Hb levels
  • can the patient make blood with haematinic therapy
  • if not then transfuse for symptoms
43
Q

how can you get anaemia from a chronic hemorrhage? 2

A
  • haematemesis (vomiting blood)

- melaena (darkened stools)

44
Q

how do we manage chronic anaemia? 3

A
  • treat the underlying cause: iron supplementation, folic acid and B12
  • erythropoietin weekly sub-cut injections in patients receiving haemodialysis or with kidney failure
  • long term transfusion causes- iron overload (iron deposition in organs) allo-antibodies (to foreign red cells)
45
Q

what is the worldwide impact of childhood anaemia? 5

A
  • increased risk of morbidity in children
  • impaired physical and cognitive development
  • poor pregnancy outcome
  • contributes to 20% of all maternal deaths
  • reduced work productivity in adults

103-theme 2 (9 decks)

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