Anaemia - General Flashcards
What are the main groups of causes of anaemia?
Deficiency in:
- Production - Bone marrow, deficiency (>90%)
- Destruction - blood loss, haemolysis
- Structure and function - membrane, enzymes, haemoglobin
What is anaemia?
Defined as low haemoglobin (Hb) concentration - may be due to low red cell mass or increased plasma volume
What are symptoms of anaemia?
Reflective of underlying cause, or anaemia itself:
- Fatigue
- Dyspnoea
- Faintness
- Palpitations
- Headache
- Tinnitus
- Anorexia
What symptoms might someone experience if they have anaemia with pre-existing cardiovascular disease?
Worsening:
- Angina
- Intermittent Claudication
What signs can occur in anaemia?
- Generalised/Conjunctival Pallor
- Tachycardia
- Hyperdynamic apical impulse
- ESM over apex
- Signs of Cardiac Failure
- Koilonychia - Iron deficiency anaemia
- Vitiligo - pernicious anaemia
- Jaundice - haemolytic anaemia
- Bone deformities - Thalassemia major
- Leg ulcers - sickle cell anaemia
What signs might you see which would point towards a diagnosis of iron deficiency anaemia?
All in very long standing disease
- Koilonychia
- Brittle nails/hair
- Atrophy of the papillae of the tongue
- Angular stomatitis
- A syndrome of dysphagia and glossitis
What signs might be seen in pernicious anaemia and anaemia caused by B12 deficiency?
- Lemon-yellow skin colour
- Glossitis
- Angular stomatitis
- Vitiligo
- Jaundice
- Paraesthesiae
- Peripheral Neuropathy
- Neuropsychiatric problems
What are the main types of anaemia?
- Microcytic hypochromic anaemia
- Normocytic, normochromic anaemia
- Macrocytic, hyperchromic anaemia
- Aplastic Anaemia
Top 7 causes…
What are causes of normochromic, normocytic anaemia?
Reticulocyte cound
- Acute blood loss
- Anaemia of Chronic Disease (70%)
- Bone marrow failure
- Renal Failure
- Hyperthyroidism
- Haemolysis
- Pregnancy
What type of anaemia can occur in haemolytic anaemias?
- Normochromic, normocytic anaemia
- Hyperchromic, macrocytic anaemia
What red cell indices are used to determine the type of anaemia that is occuring?
- Mean cell volume (MCV) - micro/normo/macrocytic
- Mean cell haemoglobin (MCH) - chromic part - represents haemoglobin concentration which gives blood cell colour
When would you consider giving blood transfusions?
If there is severe acute anaemia - tranfusion not necessary in those who have a Hb >70g/L. If there is acute haemorrhage, this limit is generally set at >80g/L
Chronic anaemia is better tolerated
How would you investigate someone who presented with symptoms of anaemia?
- Red cell indices
- WBC count
- Platelet count
- Reticulocyte count
- Blood film
What are causes of microcytic hypochromic anaemia?
Serum ferritin
In order or most common to least:
- Iron deficiency anaemia (low ferritin)
- Anaemia of Chronic Disease (30%) (normal/increased ferritin)
- Thalassaemia (normal/increased ferritin)
- Sideroblastic anaemia (normal/increased ferritin)
- Lead poisining (normal/increased ferritin)
Remember TAILS - Thalassemia, Anaemia of CD, Iron deficiency, Lead poisoning, Sideroblastic
What are causes of hyperchromic, macrocytic anaemia?
B12 folate/bone marrow
- B12/Folate Deficiency (megaloblastic)
- Alcohol excess/liver disease (all the rest are non megaloblastic)
- Reticulocytosis
- Cytotoxics
- Myelodysplastic syndromes
- Marrow infiltration/Myeloma
- Hypothyroidism
- Myeloproliferative disorder
- Aplastic anaemia
- Anti-folate drugs (e.g phenytoin)
