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HEMATOLOGY > Anaemia and Microcytic anemia > Flashcards

Anaemia and Microcytic anemia Flashcards

1
Q

Define anaemia

A
  • reduced total RED CELL mass
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2
Q

What are the markers for anaemia?

A
  • HEMATOCRIT

- Hb conc.

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3
Q

When are you considered anaemic?

A
  • man: <130 g/L (Hct: 0.38-0.52)

- WOMAN: <120g/L (Hct: 0.37- 0.47)

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4
Q

What is the role of the macrophage to the red cell? -

A
  • provides iron to the RBC
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5
Q

How to measure Hb conc. using the spectrophotometric method?

A
  • lyse the red cells and create a Hb solution
  • stabilise the Hb molecules with a CHELATING agent
  • measure the OPTICAL density at 540nm *more OD = more Hb)
  • —conc is calculated against the KNOWN standard
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6
Q

How to measure hematocrit?

A
  • ratio/ % of the WHOLE blood that is RED when the sample settles
  • MODERN machines calculate by ADDING the calculated volume of the red cells
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7
Q

When are Hb/Hct NOT a good marker of anaemia?

A

when they are not in a steady state

  1. those who have a MASSIVE, RAPID blood loss
    - —-Hb will appear the SAME amount as prior the blood loss (untilplasma expansion)
  2. hemodilution (raised plasma volume will cause a proportionate reduction in Hb)
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8
Q

How does the bone marrow respond in anaemia?

What are they >

A
  • rise in RETICULOCYTES

- —they are red cells that have JUST left the BONE marrow

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9
Q

What do reticulocytes appear as?

A
  • larger than avg red cells
  • purple appearance (d.t RNA reminence)
  • POLYCHROMATIC in blood film
  • —remnants of protein making machinery
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10
Q

How long does it take the reticulocytes to appear in the blood smear?

A
  • a few days
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11
Q

What do automated analysers tell us about red cells?

A
  • cell size (MCV)
  • # OF RED CELLS (CONC)
  • Hb conc.
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12
Q

What are the fts of automated analysers?

A

light scattering properties

  • rapid
  • reproducible
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13
Q

2 Main pathophysiological paths of anaemia?

How does the retic counts differ from one another?

A
  • decr. prodn (LOW retic count)

- incr. destruct. or LOSS of red cells (HIGH retic. count)

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14
Q

What is another name for decr. prodn?

A
  • Hypoproliferative (reduced rate of erythropoiesis)

- maturation abnormality (ineffective erythropoiesis)

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15
Q

What causes incr. destr. of red cells?

A
  • bleeding

- hemolysis

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16
Q

Where may the maturation abnormality be present?

A
  • NUCLEAR defects (impaired cell division)

- CYTOPLASMIC DEFECTS (impaired hemoglobinisation)

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17
Q

If MCV is LOW, what may it indicate?

A
  • probable issue with hemoglobinisation
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18
Q

IF MCV is HIGH, what may it indicate?

A
  • issue with MATURATION
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19
Q

What does hypochromic, microcytic anaemia indicate?

A
  • deficient Hb synthesis

- cytoplasmic deficit

20
Q

What causes haem deficiency?

A
  1. LACK of IRON for erythropoiesis (d.t chronic disease/ iron def.)
  2. Problems with Porphyrin synthesis (V.RARE) (LEAD poisoning and pyridoxine responsive anaemia)
  3. Congenital sideroblastic anemia
21
Q

What is iron needed for?

A
  • ion transport (needed for ATP prodn in the Mitochondria)

- Oxygen transport (Hb, myoglobin)

22
Q

How many mg of iron is absorbed in a day?

A

1 mg

23
Q

Where is iron stored?

A

in a protein called ferritin IN THE LIVER

24
Q

Where is the circulating iron bound to an dwhere is ti transported to ?

A

Transferrin— transferred to the BONE marrow macrophages that FEED it to the red cell precursors

25
Q

WHen is transferrin saturation reduced?

And Incr.?

A
  • in iron def.
  • ## reduced in ANAEMIA of chronic disease (USE ferritin conc. instead)
  • INCREASED in genetic hemachromatosis
26
Q

What does trasnferrin do?

A
  • transports iron from DONOR tissues (macrophages/ intestinal cells and hepatocytes) to tissues expressing transferrin receptors (erythroid marrow)
27
Q

When does ferritin drop? -

A
  • WHEN there is NOT much of stored iron —-iron def.
28
Q

How much iron can ferritin store? -

A

up to 4000 ferric ions

29
Q

When may one have ABSOLUTE iron deficiency?

A
  • those on a VEG diet

normal in girls

30
Q

What causes iron deficienct?

A
  • GI blood loss (esp. in men )

- not absorbing enough (MALABSORPTION—COELIAC DISEASE and ACHLORHYDRIA)

31
Q

What causes chronic blood loss

A

Menorrhagia
Gastrointestinal
(Tumours/Ulcers/Non-steroidal anti-inflammatory agents)
Haematuria

32
Q

Epithelial changes in microcytic anemia (iron def.)?

A
  • skin changes

- koilonychia

33
Q

When is one considered to have menorrhagie?

A
  • those with menses blood loss >60ml

- —i.e >30mg iron loss in a month

34
Q

What is the normal blood loss in menses?

A
  • 30-40ml/month
35
Q

What is calculated in a red cell indices?

A
  • Hematocrit
  • mean cell HB
  • Mean cell Hb Conc.
36
Q

Where is Hb synthesized? What is required?

A

in the cytoplasm
—–results in SMALL cells

  1. globins, Haeme (porhyrin and iron -Fe2+)
37
Q

What occurs as a result of LOW raw material of Hb?

A
  • results in SMALL red cells with a LOW hb content

microcytic and hypochromic

38
Q

What causes globin deficiency>

A
  • thalassaemia
39
Q

Why is iron toxic for it to freely float around in the body?

A
  • generates FREE radicals ‘

- therefore needs a safe transport system

40
Q

Describe the structure of an adult Hb.

A

4 globin sub-units—each containing a SINGLE haem molecule

  • –a haem gr. contains a SINGLE FE2+ ion
  • –each haem gr can bind one Oxygen molecule
41
Q

So where is iron found and thus could be tested?

A 
FUNCTIONAL iron  (Hb) 
Transported iron ( serum iron/ transferrin/ transferrin saturation) 
Storage Iron (serum ferritin)
42
Q

How many binding sites for iron atoms on transferrin?

A

2 sites

43
Q

What is Ferritin?

What does its presence in the blood suggest>

A
  • large intracellular protein

- —-tiny amount of ferritin in serum =intracellular ferritin synthesis in resp. to iron status of the host.

44
Q

What is a indirect measure of iron storage?

A
  • serum ferritin
45
Q

SO iron deficiency could be a combination of _______ and ______

A

ANAEMIA

REDUCED storage iron (FERRITIN)

46
Q

Why does poor acid prodn in the stomach affect iron absorption? Name 2 conditions where acid prodn by the stomach is reduced.

A

Acid is needed to convert iron to its ferrous state (Fe2+)

  • post gastrectomy
  • use of PPIs
47
Q

How to differentiate mild thalassemia from iron def. anaemia?

A
  • RDW is NORMAL in thalassemia (genetic defect present in ALL cells)
  • —wider in iron def. anaemia (some cells are able to get iron; others are not)

HEMATOLOGY (20 decks)

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