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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Reduced total cell mass

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2
Q

What are the normal Hb values?

A

Male <130g/L

Female <120g/L

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3
Q

How is Hb concentration measured?

A

Burst the red cells and stabilise. Measure the optical density - the more red, the more absorbed, more Hb

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4
Q

Other than Hb what else can be measured to determine red cell count?

A

Haematocrit

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5
Q

When are Hb and Hct not useful?

A

Rapid blood loss

Haemodilution

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6
Q

Define reticulocytosis

A

Normal response to anaemia is to produce more red cells

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7
Q

Describe reticulocytes

A
  • red cells that have just left the bone marrow
  • remnants of RNA, stain purple
  • blood film appears polychromatic
  • up regulation takes a few days
  • marker of bone marrow function
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8
Q

Name the two key causes of anaemia

A
  • decreased production

- increased loss/destruction

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9
Q

What can cause decreased production of red blood cells?

A

Hypoproliferation - reduced erythropoiesis

Maturation abnormality - erythropoiesis present but ineffective

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10
Q

Name the two subtypes of maturation abnormality

A 
Cytoplasmic defect (impaired haemoglobinisation)
Nuclear defect (impaired cell division)
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11
Q

What causes increased loss/destruction of red blood cells?

A

Bleeding/Haemolysis

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12
Q

How can anaemia be described in terms of mean cell volume?

A

Microcytic

Macrocytic

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13
Q

How is haemoglobin synthesised?

A

Iron from blood enters mitochondria
Fe3+ moves out of mitochondria and binds to protophorphyrin to form haem
Haem binds to globin subunits

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14
Q

How does microcytic anaemia arise?

A

Hb is synthesised in the cytoplasm and requires specific building blocks. If one is missing the cells will continue to divide but will lack certain substances - small

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15
Q

What do microcytic anaemia red blood cells look like?

A

Hypochromic due to little Hb

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16
Q

State the causes of microcytic anaemia

A 
Thalassemia - globulin subunits
Anaemia of chronic disease 
Iron deficiency 
Lead poisoning - porphyrin synthesis 
Sideroblastic - porphyrin synthesis
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17
Q

How can you calculate the average Hb content in a solution?

A

Litres/2

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18
Q

What transports iron?

A

Transferrin

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19
Q

What stores iron?

A

Ferritin

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20
Q

What should the saturation of transferrin be?

A

30-40%

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21
Q

What is the best measure of iron?

A

Ferritin

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22
Q

What can cause a rise in ferritin?

A

Inflammatory disease

23
Q

Name the causes of iron deficiency

A

Diet
Loss of iron - blood loss
Malabsorption (coeliac, achlorhydria)

24
Q

Where is iron absorbed?

A

Proximal small bowel (jejunum and duodenum)

25
Q

Define macrocytosis

A

Reduction in red cells that have a larger volume

26
Q

What are the two key types of macrocytic anaemia?

A

Genuine

Spurious

27
Q

Name the two types of genuine macrocytosis

A

Megaloblastic

Non-megaloblastic

28
Q

What is a megaloblastic cell?

A

An abnormally large nucleated red cell precursor with an immature nucleus

29
Q

Describe megaloblastic anaemia

A

Lack of red cells due to defects in DNA synthesis and nuclear maturation in developing precursor cells in the marrow.
Reduced division, more apoptosis

30
Q

Why do megaloblastic cells still increase in size?

A

There is normal cytoplasmic development and Hb accumulation

31
Q

State the causes of megaloblastic anaemia

A

B12 deficiency
Folate deficiency
Drugs
Inherited disorders

32
Q

How is B12 handled by the body?

A

Binds to rapid binder proteins in stomach
Secretion of intrinsic factor
Binds to IF to form a complex and travels to small bowel
Absorbed in ileum and enters blood
Binds to transcobalamin

33
Q

How long will B12 stores last?

A

2-4 years

34
Q

State the causes of B12 deficiency

A

Dietary
Stomach acid/intrinsic factor
Small bowel - bacteria overgrowth, coeliac, resection, IBD
Inherited disorder

35
Q

What is pernicious anaemia?

A

Autoimmune condition with resulting destruction of gastric parietal cells and inability to secrete IF

36
Q

How is pernicious anaemia treated?

A

IM B12 3 monthly

37
Q

Where is folate absorbed in the body?

A

Jejunum

38
Q

How long do folate supplies last?

A

4 months

39
Q

What causes folate deficiency?

A

Diet
Malabsorption
Excess ultilisation - haemolysis, pregnancy, malignancy, drugs, exfoliating dermatitis

40
Q

Name the clinical features of B12/folate deficiency

A

Anaemia, weight loss, diarrhoea, infertility, sore tongue, jaundice, developmental problems

41
Q

What serious symptom can B12 deficiency cause?

A

Neurological - subacute combined degeneration of the cord

42
Q

Name two auto-antibodies that can be measured in suspected pernicious anaemia

A

Anti-gastric parietal cell

Anti- intrinsic factor

43
Q

How is anaemia treated?

A

B12 injection
Folic acid tablets
Red cell transfusion if life threatening

44
Q

State the causes of non-megaloblastic anaemia

A

Alcohol
Liver disease
Hypothyroidism
Marrow failure

45
Q

What is supious macrocytosis?

A

Volume is normal but MCV is measured as high

46
Q

What can cause supious macrocytosis?

A

Reticulocytosis

Cold Agglutinins

47
Q

What is meant by cold agglutinins?

A

Abnormal protein causes clumping of RBC in infections and cancers. Usually extraordinarily high MCV and accurate sample obtained by warming blood

48
Q

Why does jaundice occur in anaemia?

A

Ineffective erythropoiesis due to intramedullary haemolysis - breakdown occurs in the bone marrow and bilirubin is released

49
Q

State the causes of normocytic anaemia

A 
Marrow failure 
Hypometabolic 
Marrow infiltration 
Renal impairment 
Chronic disease
50
Q

How does inflammation lead to anaemia?

A

Activates monocytes and T cells causing release of cytokines

51
Q

What are the effects of cytokine release leading to anaemia?

A

Increase hepcidin
Inhibition of erythropoietin release
Inhibition of erythroid proliferation
Increased red cell destruction

52
Q

When will anaemia of chronic disease be microcytic?

A

If the predominant mechanism is through hepcidin leading to reduced release of iron

53
Q

What is the key difference between iron deficiency anaemia and anaemia of chronic disease?

A

Ferritin will be normal/raised in anaemia of chronic disease

Haematology (18 decks)

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