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Haematology > Anaemia and microcytic anaemias > Flashcards

Anaemia and microcytic anaemias Flashcards

1
Q

adult males normal HB

A

<130g/L

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2
Q

adult females normal HB

A

<120g/L

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3
Q

where does red cell rpoduction take place and how

A

bone marrow

severe eurythoid precursors cluster around a central nursing histiocyte

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4
Q

how can hb be measured using a spectrophotometric method

A 
burst red cell to create hb solution 
stabilise Hb molecules - cyanmetHb
measure optical density at 540nm
OD proportional to concern - beers law
Hb concentration calculated against known reference
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5
Q

how to measure haematocrit

A

ratio of whole blood that is red cells if the sample was left to settle

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6
Q

what is the response to anaemia

A

increase red cell production - reticulocytosis

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7
Q 
what are reituclocytes 
what do they still have remnants of
stain how 
blood film 
how long does up regulation take
A

red cells that have left the bone marrow, larger than av red cells

remnants of protein making machinery

stain purple/deeper red

blood film - polychromatic

up regulation of reticulocyte production by the bone marrow in response to anaemia takes a few days

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8
Q

what can automated analysers say about red cells

A

physical - size, light scattering properties

rapid and reproducible

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9
Q

what is measured and calculated in analysers

A

Hb conc
number of red cells
size of red cells - MCV

haemotacrit
mean cell hb
mean cell hb conc

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10
Q

what other things can be looked for

A

blood film - cell morphology

reticulocyte count - assess marrow response

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11
Q

pathophysiological classification of anaemia

A

decreased production

  • hyperproliferative (low amount of erythro)
  • maturation abnormality - erythro present but ineffective — cytoplasmic defects, nuclear defects

increased loss or destruction of red cells

  • bleeding
  • haemolysis
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12
Q

low MCV

A

microcytic

problems with haemoglobinisation

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13
Q

MCV high

A

macrocytic

problems with maturation

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14
Q

where does hb synthesis occur and what do defects result in

A

cytoplasm

small cells that are hypo chromic (lacking in colour)

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15
Q

what is needed to make hb

A

globes
haem - porphyrin ring, Fe 2+

shortages leads to small red cells w low Hb content

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16
Q

hypo chromic microcytic anaemias

A

deficient haemoglobin synthesis : cytoplasmic defect

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17
Q

causes of hypo chromic microcytic anaemias

A

haem deficiency

  • lack of iron for erythropoiesis: iron defic, chronic disease so normal body iron but lack of available iron
  • problems with porphyitin synthesis: lead poisoning, pyridoxine responsive anaemias
  • congenital sideroblastic anaemia

global defic
-thalassaemia (trait, intermedia, major)

18
Q

how does iron exist

A

Fe2+

oxidised - Fe3+

19
Q

why is iron essential

A

oxygen transport

electron transport

20
Q

why does iron need to be handled safely by the body

A

potentially toxic as generates are radicals

21
Q

adult hb units

A

4 global sub units each w a haem molecule
haem group contains a single Fe2+ ion
each group can bind to one o2 molecule

22
Q

fully saturated 1g of hb

A

will bind 1.34ml of o2

23
Q

where is most of the iron in the body

A

in hb

24
Q

how much iron is absorbed

A

a small amount

25
Q

iron turnover

A

fast - 4mg in pool and move 20mg/day

26
Q

what is circulating iron bound to

A

transferrin

27
Q

where is circulating iron transferred to

A

to the bone marrow macrophages that feed it to red cell precursors

28
Q

where is iron stored

A

in ferritin mainly in the liver

29
Q

tests to assess iron status

A

function iron - hb
transported iron - serum, transferrin, transferrin saturation
storage iron - serum ferrratin

30
Q

what is transferrin

A

protein with two binding sites for iron atoms

31
Q

what does transferrin do

A

transports iron from donor tissues (macrophages, intestinal cells and hepatocytes) to tissues expressing transferrin receptors (esp erythroid marrow)

32
Q

what does percentage sat of transferrin with iron measure

when is it reduced/increased

A

measures iron supply

reduced in iron deficiency, in anaemia of chronic disease

increased in genetic haemachromatosis

33
Q

what is ferritin

A

large intracellular protein

34
Q

spherical protein stores what

A

up to 4000 ferric ions

tiny amount of ferritin present in serum - reflect intracellular ferritin synthesis in response to iron status in host

35
Q

serum ferritin measures what

A

indirect measure of storage iron

36
Q

low ferritin

A

iron deficiency

37
Q

how can iron defic be confirmed

A

comb of anaemia (low functional iron) and reduced storage iron (low serum iron )

38
Q

causes of iron defic

A

not eating sufficient to meet physiological requirements

  • relative defic - preg
  • absolute defic - vegetarian

losing blood
not absorbing enough - coeliac, achlorhydria

39
Q

causes of chronic blood loss

A

menorrhagia - commonest
GI - tumours, ulcers, NSAIDs
haematuria

40
Q

av menstrual blood loss
av daily intake
iron status
heavy menstrual blood loss

A

30-40ml/month = 15-20mg/month

daily intake 1mg/daily

status precarious

> 60ml i.e. >30mg/month

41
Q

sequence of neg iron balance

A

exhaustion of stores
iron deficient

erythropoiesis - falling red cell MCV

microcytic anaemia

epithelial changes - skin,, koilynychia

42
Q

occult blood loss

A

small volume GI blood loss can occur without any symp or signs of bleeding

this can outstrip max dietary iron absorption or iron and result in anaemia

iron supplements

Haematology (26 decks)

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