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AIP: Shortness of breath > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What are 5 causes of normocytic anaemia?

A
  1. Anaemia of chronic disease
  2. Chronic kidney disease
  3. Aplastic anaemia
  4. Haemolytic anaemia
  5. Acute blood loss
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2
Q

What are 5 causes of microcytic anaemia?

A
  1. Iron-deficiency anaemia
  2. Thalassaemia
  3. Congenital sideroblastic anaemia
  4. Anaemia of chronic disease (more commonly normocytic, normochromic)
  5. Lead poisoning
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3
Q

What should you be worried about if you see normoal haemoglobin level with microcytosis?

A

if not at risk of thalassaemia, should raise possibility of polycythaemia rubra vera

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4
Q

What should you investigate for in new onset microcytic anaemia in elderly patients?

A

urgently investigate to exclude underlying malignancy

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5
Q

What are 2 groups that macrocytic anaemia can be grouped into?

A

megaloblastic bone marrow, and normoblastic bone marrow

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6
Q

What are 2 megaloblastic causes of macrocytic anaemia?

A
  1. Vitamin B12 deficiency
  2. Folate deficiency
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7
Q

What are 7 normoblastic causes of macrocytic anaemia?

A
  1. Alcohol
  2. Liver disease
  3. Hypothyroidism
  4. Pregnancy
  5. Reticulocytosis
  6. Myelodysplasia
  7. Drugs: cytotoxics
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8
Q

What is the most common cause of anaemia worldwide?

A

iron deficiency anaemia

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9
Q

How does iron deficiency cause anaemia?

A

iron is needed to make haemoglobin in red blood cells, therefore a deficiency of iron leads to a reduction in red blood cells/ hb i.e. anaemia

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10
Q

What are the 4 main causes of iron deficiency anaemia?

A
  1. Excessive blood loss
  2. Inadequate dietary intake
  3. Poor intestinal absorption
  4. Increased iron requirements
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11
Q

Which age group has the highest prevalence of iron deficiency anaemia?

A

preschool age children

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12
Q

What is the commonest cause of excessive blood loss leading to IDA in women?

A

blood loss due to menorrhagia

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13
Q

What is the commonest cause of excessive blood loss leading to IDA in men and post-menopausal women?

A

gastrointestinal bleeding - always suspect colon cancer

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14
Q

What are 2 sources of iron in the diet?

A
  1. meat
  2. dark green leafy vegetables
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15
Q

What are 2 states of increased iron requirements which can lead to IDA?

A
  1. Children - during periods of rapid growth
  2. Pregnancy
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16
Q

What are 2 reasons why IDA is common in pregnancy?

A
  1. Increased demand as baby will receive iron supply from mother
  2. Increase in plasma volume causes dilution
17
Q

What are 9 features of IDA?

A
  1. Fatigue
  2. Shortness of breath on exertion
  3. Palpitations
  4. Pallor
  5. Nail changes: koilonychia
  6. Hair loss
  7. Atrophic glossitis
  8. Post-cricoid webs (see picture)
  9. Angular stomatitis
18
Q

What are 6 investigations in suspected iron deficiency anaemia?

A
  1. Taking history - diet, medication, menstrual, weight loss, bowel habit
  2. FBC
  3. Serum ferritin
  4. Total iron-binding capacity (TIBC)/ transferrin
  5. Blood film
  6. Endoscopy to rule out malignancy in males and post-menopausal females
19
Q

What are 5 things to ask about in the history if anaemia is suspected?

A
  1. Changes in diet
  2. Medication history
  3. Menstrual history
  4. Weight loss
  5. Change in bowel habit
20
Q

What will FBC show in IDA?

A

hypochromic microcytic anaemia

21
Q

What is serum ferritin likely to show in IDA?

A

likely to be low as serum ferritin correlates with iron stores;

however, important to recognise that ferritin can be raised during states of inflammation so if raised doesn’t rule it out i.e. in co-existent inflammatory disease

22
Q

What is the total iron binding capacity likely to show in IDA?

A

will be high - high TIBC reflects low iron stores

23
Q

What will transferrin saturation be in IDA?

A

low

24
Q

What are 3 things that will be seen on a blood film in IDA?

A
  1. Anisopoikilocytosis (red blood cells of different sizes and shapes)
  2. Target cells
  3. ‘Pencil’ poikilocytes
25
Q

When is it important to perform endoscopy in iron deficiency anaemia?

A

males and post-menopausal females who present with unexplained iron-deficiency anaemia

26
Q

When should iron deficiency anaemia trigger a 2 week wait referral to gastroenterology?

A
  • Post-menopausal women: Hb <100
  • Post-menopausal men: Hb <110
27
Q

What are 3 aspects of the management of iron-deficiency anaemia?

A
  1. Underlying cause identified and managed (exclude malignancy)
  2. Oral ferrous sulfate
  3. Iron-rich diet: dark green leafy vegetables, meat, iron-fortified bread
28
Q

For how long should oral ferrous sulfate be continued to manage IDA?

A

continue to take for 3 months after the IDA has been corrected in order to replenish iron stores

29
Q

What are 4 common side effects of oral ferrous sulfate?

A
  1. nausea
  2. abdominal pain
  3. constipation
  4. diarrhoea
30
Q

How do the blood test results compare for IDA vs anaemia of chronic disease? 4 points

A
  1. Serum iron: IDA <8, AOCD <15
  2. TIBC: IDA high, AOCD low
  3. Transferrin saturation: low for both
  4. Ferritin: low for IDA, high for AOCD
31
Q

What are 4 situations when NICE suggests you UST refer urgently (within 2 weeks) to colorectal services for investigation?

A
  1. patients ≥40 years with unexplained weight loss AND abdominal pain
  2. patients ≥50 years with unexplained rectal bleeding
  3. patients ≥60 years with iron deficiency anaemia OR change in bowel habit
  4. tests show occult blood in their faeces (see below)
32
Q

What are 7 situations when a 2 week wait referral to colorectal services for investigation should be considered according to NICE?

A
  1. there is a rectal or abdominal mass
  2. there is an unexplained anal mass or anal ulceration
  3. patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
  • → abdominal pain
  • → change in bowel habit
  • → weight loss
  • → iron deficiency anaemia
33
Q

In addition to screening, when else is faecal occult blood testing (now faecal immunochemical test screening) offered?

A
  1. patients 50years or older with unexplaiend abdominal pain or weight loss
  2. patients <60 years with changes in their bowel habit or iron deficiency anaemia
  3. patients 60years or older who have anaemia even in the absence of iron deficiency
34
Q

If oral iron supplements do not resolve the situation what is the next line treatment?

A

IV iron e.g. Ferrinject

35
Q

What are 5 reasons why a patient may fail to respond to oral iron?

A
  1. Malabsorption
  2. Poor compliance
  3. Ongoing iron loss
  4. Concomitant anaemia of chronic disease
  5. Erroneous diagnosis
36
Q

What are 5 things which can guide the decision to resort to blood transfusion for anaemia?

A
  1. Anaemic heart failure
  2. Hb <5g/dL with symptoms
  3. Hb <4g/dL in any situation
  4. Acute blood loss - shock or signs of heart failure despite IV fluids
  5. Need for emergency major surgery with pre-operative Hb<7g/dL
37
Q

What are 3 ypes of transfusion reactions?

A
  1. Severe transfusion reaction: ABO incompatibility or bacterial contamination of the unit
  2. Simple febrile and allergic reactions: temp rise by 1 degree, rash/itching
  3. Delayed transfusion reaction: 5-10 days later, sensitisation to RBCs following previous transfusions/pregnancy

AIP: Shortness of breath (12 decks)

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