Anaemia Flashcards by Ben Moore

Basic features of anaemia?

Pale conjunctivae and skin, fatigue and high RR and HR if severe

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IDA on blood film features?

Aniso-poiliocytosis
Pencil Cells
Hypochromic and microcytic

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Causes of IDA?

Reduced uptake: malnutrition, coeliac, IBD

Increased Loss: GI malignancy, peptic ulcer, IBD, menstruation

Increased requirement: pregnancy and breastfeeding

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High plant based foods for iron?

Spinach, broccoli, lentils

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Pathology of ACD?

Chronic disease causes cytokine release so increased Hepcidin to reduce iron to infection normally. Therefore decreased ferroportin and transferrin activity and increased storage in Ferritin

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IDA vs ACD bloods?

Both Iron low
IDA = low ferritin and high TIBC
ACD = High or normal ferritin and decreased TIBC

TIBC = transferrin iron binding capacity

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What is thalassaemia?

Globin chain quantitative defcts. Autosomnal recessive and high in Mediterranean and CYPRUS
Resistant to Malaria

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Thalassaemia types?

Chr 16 = alpha and alpha O is mild anaemia, HbH is significant and needs transfusion.HbBarts is death in utero

Chr 11 = beta major needing transfusions

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Investigations for thalassaemia?

Microcytic anaemia + film
Normal iron studies
Gel electrophoresis

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Haemoglobin types?

HBA1 = 2alpha + 2beta
HBA2 = 2 alpha and 2 delta
HbF = 2 alphga and 2 gamma

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What predisposes sickling in SCD?

hypoxia, dehydration, acidosis and infection

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SCD features?

Point mutation on beta globin gene on CHR 11. autosomnal recessive and resistant to malaria

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SCD on blood films?

Howell-Jolly bodies in RBC and sickled cells (10-20 day lifespan)

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Acute Management of various SCD crises?

Sickle Acute Painful Crises: Saturate (O2), Abx, Pain Relief, Cannula (IV fluids)

Stroke: Exchange blood transfusion

Sequestration = splenectomy

Chronic cholecystitis = cholecystectomy

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SCD presentation and diagnosis?

Dactylitis, acute chest syndrome, haemolytic anaemia, aplastic crisis, priapism

Hb electrophoresis + blood film

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SCD chronic management?

Conservative: avoid triggers, vaccination.

Medical: Vaccinations, hydroxyurea, prophylactic Abx

Surgical: bone marrow transplant

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Features of folate + B12 deficiency Blood film?

Megaloblastic anaemia from hypersegmented neutrophils and macrocytic cells

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Causes of megaloblastic anaemia types?

Vit B12 = alcohol, IBD and coeliac, malnutrition and pernicious anaemia

Folate: alcohol, IBD and coeliac, anti-folate drugs and pregnancy

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B12 Deficiency ?

Megaloblastic + Neuro changes +/- pernicious anaemia (either parietal or IF)

Neuro: glove and stocking parasthesiae, hyporeflexia, Rombergs +ve, Subactue combined degeneration of the spinal cord

Non-megaloblastic macrocytic anaemia causes?

Alcoholics may have liver failure

Alcohol, Myelodysplasia, Hypothyroidism, liver disease

What must be avoided in patients with G6PD deficiency?

Beans e.g. fava or broad

General features of haemolytic anaemia?

Scleral ictus and jaundice, pale conjunctivae and skin.

Blood tests = Hb low, haptoglobin low, unconjucated bilirubin raised and LDH raised

Hereditary haemolytic anaemias?

Membrane = hereditary spherocytosis
Enzymes = G6PD deficiency
Hb = SCD and thalassaemia

Pathology of G6PD?

Vulnerable to oxidative stress as decreased NAPDH so less glutathione.
Beans means HEINZ bodies

G6PD on blood film?

Heinz bodies and Bite cells (previous haemolysis)

Pathology of hereditary spherocytosis?

Beta spectrin or ankyrin deficiency so weak cytoskeleton so no biconcave shape

Investigations and complications of hereditary spherocytosis?

Osmotic fragility test by giving hypotonic saline which causes lysis Coombs test Negative Complication is aplastic crises due to Parvovirus B19

HUS classic grouping?

Child AKI and MAHA features (jaundice, conjunctival pallor, schistocytes), thrombocytopenia GI: abdo pain and bloody diarrhoea Typically E.Coli producing SHiga

Pathology Microangiopathic Haemolytic Anaemia?

Microthrombi causing schistocyte formation Can be due to DIC

Causes of DIC?

Pancreatitis, sepsis, obstetric complication, ABO reaction, trauma and cancers e.g. MM

DIC Features?

Bleeding: petechiae, ecchymoses, haematuria all due to decreased platelets and fibrinogen, increased FDPs and D-dimer Clotting: Prolonged APTT and PT Haemolytic: jaundice and conjunctival pallor + underlying pathology

Thrombotic thrombocytopaenic Purpura (TTP) pathology?

Dysfunctional ADAMTS-13 that cannot cleave VWF

TTP features?

COOMBS NEGATIVE Defunct ADAMTS Antiglobulin negative, Decreased platelets, AKI, MAHA, Temperature and Swinging CNS signs Form Pentad with HUS triangle

MAHA components?

DIC, HUS, TTP

What is the Coombs test?

Direct antiglobulin test (DAT) | Detects presence of Ab attached to RBC surface e.g. autoimmune haemolytic anaemia

What are the other acquired haemolytic anaemias?

Autoimmune: so anti-RBC Abs Drugs e.g. Dapsone (anti-leprosy Abx) Infections e.g. Malaria

Describe agglutination in Coombs?

Warm >37: IgG Abs so idiopathic, SLE or CLL Cold <37: IgM so idiopathic, mycoplasma or mononucleosis

Presentation of MM, AML, Essential thrombocytosis and Myelodysplasia?

MM has increase in WCCs, AML does not have splenomgealy but CML does, ET does not cause splenomegaly and common in 35-55YO, and myelodysplasia does not have elevated platelets or splenomgealy

Myelofibrosis presentation?

In response to BM malignancy Myelofibrosis has characteristic dry tap of bone, in older patients with radiation exposure, low RBC< Hb and WCC with poikilocytosis and high platelets Tear drop cells on blood film

Causes of polycythaemia?

Primary: Rubra Vera Secondary: Appropriate (hypoxic response from altitude, COPD, heart disease) or Inappropriate (EPO-secreting tumour) e.g. lung cancer

Whats the classic mutation for PCV?

JAK2 V617F activates itself instead of needing EPO so high Hb and primary polycythaemia Nearly 100% of PCV

Features of polycythaemia rubra vera

Philadelphia Chr negative myeloproliferative disorder. Older>60, asymptomatic aquagenic pruritis, hyper-viscosity syndrome Elevated Hb and haematocrit +/- thrombocytosis

Symptoms of hyperviscosity?

headaches and ligh headedness, visual disturbances and strokes

What is anti-phospholipid syndrome?

autoimmune mediated thrombosis. Often in pregnancy. CausesL recurrent miscarriages 3+, VTE, Stoke/MIs, HTN, livedo reticularis (mottled) By anti-cardiolipin +ve and lupus anti-coagulant test +ve

What is aplastic anamia?

Bone marrow failure causing pancytopaenia Caused by fanconis (congential, infections e.g. parvovirus and radiation Anaemia features + raised EPO Thrombocytopaenia: bleeding + petechiae Leucopoenia: sepsi + recurrent infections BM aspirate in hypocellular

When do you get aplastic crisis?

In SCD and hereditary spherocytosis - restricted due to RBC