Anaemia Flashcards
what the symptoms of anaemia?
fatigue dyspnoea faintness palpitations headache tinnitus angina
whats are the signs of anaemia?
conjunctival and skin pallor glossitis koilonychia stomatitis tachycardia ES murmur
A microcytic anaemia is when there is low MCV. What causes it?
IDA
thalassaemia
sideroblastic anaemia
chronic disease (some)
TICS
A normocytic anaemia is when there is a normal MCV. What causes it?
Acute blood loss Anaemia of chronic disease Bone marrow failure renal failure hypothyroidism haemolysis
A macrocytic anaemia is when there is a high MCV. What causes it?
B12 or folate deficiency
Alcohol xs
Reticulocytosis
myelodysplastic syndrome
What causes IDA?
GI blood loss (Golden rule IDA in males and postmenopausal women is GI blood loss until proven otherwise)
Menstruation
Malabsorption i.e coeliacs
what investigations are done in IDA and what are their results?
Hb, MCV and MCH
- all are low
Blood film
- microcytic, hypochromic RBCS
- Anisocytosis (RBCs of varying size)
- Poikilocytosis (RBCs of varying shape)
Serum ferritin and serum iron
- both low
Total iron binding capacity
- increased
Coeliac serology
OGD and colonoscopy
what is the treatment of IDA?
Oral iron replacement
- Ferrous sulphate
- Ferrous Gluconate
- Ferrous fumarate
Ascorbic acid
- increases iron absorption
IV iron replacement
- iron dextron
- sodium ferric gluconate complex
what are the side effects of iron replacement?
Nausea, GI upset, diarrhoea/constipation, black stools
what is thalassaemia?
a relative lack of globin genes leading to decreased globin production and subsequent low Hb
how many alpha globin genes are there and where are they located?
4 located on Ch16
how many beta globin genes are there and where are they located?
2 on Ch11
how does missing alpha globin genes manifest?
missing 1 gene - mild microcytosis
missing 2 genes = microcytosis, increased red cell count and sometimes very mild anaemia
missing 3 genes = significant anaemia and bizzare small red cells known as HbH disease as the B-chains join together
Missing 4 = not compatible with life
how is HbH disease managed?
blood transfusions during periods of stress
Hepatosplenomegaly
lef ulcers
jaundice
how does B-thalassaemia major manifest physically and on blood analysis?
skull deformities
hepatosplenomegaly
osteopenia
FBC shows microcytic anaemia and leucocyte and platelet derrangement
blood smear shows microcytic RBCs with irregular teardrop shape
how is B-thalassaemia managed? what are the side effects of this management?
life long blood transfusions
can lead to;
- endorcrine failure
- liver disease
- cardiac toxicity
what are the S&S of sickle cell disease?
Fhx
persistent pain in skeleton, chest and/or abdomen
Dactylitis i.e swollen hands/feet
how is sickle cells disease investigated?
Hb electrophoresis
Blood smear - nucleated RBCs, sickle shaped cells
FBC - anaemia
how is sickle cell disease managed?
hydroxycarbamide
L-glutamine
Abx and immunisation for hyposplenism
Bone marrow transplant
how can sickle cell crisis manifest and how is treated?
Stroke, Acute chest syndrome, dactiliyits, hyposplenism, kidney infarct, priapism
managed with IV opiates, crossmatch, septic screen, IV fluids, keep warm, 02
what are the signs of B12 deficiency and how is treated?
pallor
Glossitis
Cheliosis
Neuropsychriatric i.e irritiability, depression, paraesthesiae
Neurological = peipheral neuropathy, paraesthesiae and absent reflexes
treat with hydroxocobalamin
what lab tests indicates haemolytic anaemia?
Increased RBC breakdown
- anaemia with normal/increased MCV
- increased bilirubin
- increased urinary urobilinogen
- increased serum LDH (released from RBCs)
RBC production
- increased reticulocytes causing increased MCV
what are the signs and symptoms of haemolytic anaemia?
jaundice dark urine hepatosplenomegaly gallstones (increased bilirubin) Anaemia symptoms Leg ulcers (poor bloodflow)
what are the causes of immune mediated/coombs +ve haemolytic anaemia?
Drug induced
Autoimmune haemolytic anaemia
Isoimmune e.g transfusion reaction
what are the causes of Coombs negative haemolytic anaemia?
Autoimmune hepatitis
Hep B and C
what are the causes of microangiopathic haemolytic anaemia?
haemolytic uraemic syndrome
thrombotic thrombocytopenic purpure
DIC
Pre-eclampsia
Outline Warm AIHA
IgG mediated
Casued by CLL, lymphoma, drugs, autoimmune disease
RBCs spherocytic and polychromic
Treat with steroids/immunosupression and/or splenectomy
Outline cold AIHA
IgM mediated
causes a chronic anaemia worsened by cold
may follow infection e.g Mycoplasma or EBV
treatment = keep warm and usually self limiting
