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IMED2002 UWA > Anaemia: General Concepts and Iron > Flashcards

Anaemia: General Concepts and Iron Flashcards

1
Q

What are the symptoms of anaemia?

A

Tired

Dizziness

lethargy

Shortness of breath

Headache

Tachycardia

Older people: heart failure and chest pain

Infants irritable and failure to thrive

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2
Q

What are the signs of anaemia?

A

Paleness

Increased CO (tachycardia and heart murmur)

Specific types of anaemia:
Jaundice (haemolytic anaemia and megaloblastic anaemia)

Koilonycha (spoon shaped nails)

Splenomegaly (especially in haemolytic anaemia)

Stool colour change

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3
Q

How is anaemia investigated?

A

A mean cell volume and blood film (MCV-mean cell volume)

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4
Q

What must be known before commencing treatment of anaemia?

A

The cause must be known

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5
Q

What is the factor looked at when making a diagnosis of anaemia?

A

Mean Cell Volume (MCV)

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6
Q

What stain is used for microscopic investigation of RBCs?

A

Romanovsky stain

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7
Q

What is investigated on stained blood film?

A

RBC morphology as well as other cell types for abnormalities

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8
Q

What other tests are guided by results of stained blood film?

A

Iron

Folate

Vitamin B12

Hb electrophoresis

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9
Q

What are the causes of anaemia?

A

Reduced BM production

Increased RBC loss

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10
Q

What are the causes of primary reduced bone marrow production?

A

BM failure: aplastic anaemia (bone marrow just doesn’t make RBCs usually after infection)

Red cell aplasia

Bone marrow dysfunction: myelodysplasia (in older people abnormal production of blood it is a preleukeumic situation.)

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11
Q

What are the causes of secondary reduced bone marrow production?

A

Insufficient nutrients: iron, folate, vitamin B12, EPO

Infection

Drugs

Marrow infiltration: leukaemia and cancer

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12
Q

What causes increased RBC loss?

A

Blood loss:

Acute incident which causes blood loss.

Chronic slow bleeding usually gastrointestinal (cancer; ulcer) or menorrhagia. May be secondary to anticoagulant drugs

Haemolysis: (premature RBC breakdown)

Inherited
Acquired
Defect of the cell or environment

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13
Q

Clinical clues to cause of blood loss?

A

Blood loss:
Menorrhagia
Malaena

Splenomegaly:
Chronic haemolysis
Extramedullary haemopoiesis

Bone marrow failure:
Bruising/bleeding or infection

Jaundice: Haemolysis

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14
Q

What is menorrhagia?

A

Abnormal bleeding during menstruation

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15
Q

What is malaena?

A

Production of dark sticky faeces containing partly digested blood as a result of internal bleeding

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16
Q

What is chronic splenic haemolysis?

A

Slow breakdown of RBCs in the spleen

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17
Q

What is normal MCV?

A

Normal MCV is 80 - 100 femtoliters, anything less is microcytic anaemia and anything larger is macrocytic

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18
Q

What anaemia is caused by lack of iron?

A

Iron deficiency microcytic anaemia

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19
Q

What anaemias are caused by microcytic ferritin normal/increased anaemia?

A

Thalassemia

Sideroblastic anaemia

Anaemia of chronic disease

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20
Q

What are the causes of macrocytic anaemia? What type of macrocytic anaemia do they cause?

A

Vitamin B12 and folate deficiency.

Low reticulocytic megaloblastic anaemia

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21
Q

What type of disorders cause normocytic anaemias?

A

Haemolytic anaemias as well as renal failure

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22
Q

Which cells of the body contain iron?

A

All cells in various amount.

2/3rds to 3/4ers in blood

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23
Q

What is iron important for?

A

RBCs

Myoglobin

Enzymes (cytochrome system in mitochondria)

Immune system

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24
Q

What is normal iron content in body?

A

4000mgs

25
Q

What is normal iron content for RBCs?

A

2500mgs

26
Q

What is normal iron content for myoglobin?

A

300mgs

27
Q

What is normal iron content for enzymes?

A

200mgs

28
Q

What is normal amount of iron for storage? Where does this storage take place

A

1000mgs (in liver, spleen, and bone marrow)

29
Q

What happens to the iron in RBCs after 120 days?

A

It is absorbed by macrophages and released to transferrin as needed.

30
Q

Where is excess iron stored?

A

In macrophages and in the liver as ferritin

31
Q

Where is iron typically lost?

A

Skin, gut, sweat - 1mg/day

Menses 1mg/day

32
Q

What causes iron deficiency?

A

Poor intake/absorption

Increased blood loss or utilization

33
Q

Who typically has low iron intake?

A

People of developing world

Most common form of Anaemia in paediatrics

34
Q

What causes poor iron absorption?

A

Stomach or bowel:

Gastrectomy

Coeliac disease

35
Q

What causes chronic blood loss?

A

GI problems: ulcers, carcinoma, varices, diverticulosis, haemorrhoids

Uterine bleeding (menorrhagia)

36
Q

What causes increased iron utilization?

A

Neonates

Puberty

Pregnancy (3mg/day required)

37
Q

What causes iron deficiency in ages 1 - 5 years?

A

Nutrition

38
Q

What causes iron deficiency in ages 5 - 15 years?

A

Increased utilization / growth

39
Q

What causes iron deficiency in ages 15 - 40 years?

A

Mestruation and pregnancy in females

Coeliac’s disease in males causes malabsorption

40
Q

What causes iron deficiency in ages >40 years?

A

GI blood loss

41
Q

What are the stages of iron deficiency?

A

Negative iron balance - reduced iron stores, normal iron in erythrocytes without anaemia.

Iron deficient erythropoiesis - reduced iron stores, mildly reduced erythron iron, without anaemia

Iron deficiency anaemia - reduced iron stores and erythron iron with anaemia

42
Q

What are some clinical features of iron deficiency anaemia?

A

Atrophic glossitis (smooth tongue without pappilae)

Angular cheilitis (redness and fissures at corners of the mouth)

Koilonychia (spoon nails)

43
Q

Which factors are low in iron deficiency anaemia?

A

Hb

Hct

MCV (microcytic anaemia)

MCH (less haemoglobin per cell)

RCC (less red cells)

44
Q

What kind of cells do we see in iron deficiency anaemia blood film?

A

Hypochromic microcytic cells

Pencil cells

Elliptocytes

45
Q

What happens to reticulocyte count in iron deficiency anaemia?

A

It is reduced

46
Q

What happens to platelet numbers in iron deficiency anaemia? Why?

A

It is increased causing mild thrombocytosis

Body responding to blood loss

47
Q

What are lab measures of iron status?

A

Serum iron

Serum transferrin

Transferrin saturation

Serum ferritin

48
Q

Is serum iron a reliable measure of iron stores?

A

No, it is highly variable

49
Q

What does serum transferring measure?

A

The amount of iron transporter

50
Q

What is transferrin saturation?

A

Amount of transferrin occupied by iron

51
Q

What is serum ferritin?

A

Reflects body stores

52
Q

What investigations should be done following a discovery of iron deficiency anaemia?

A

Malabsorption test for coeliac disease

Testing GI and uterine tract for blood loss

53
Q

How are the GI and uterine tract tested for blood loss?

A

Gastroscopy

Colonoscopy

Capsule endoscopy

Pelvic U/S

54
Q

What is done to manage iron deficiency?

A

Treat underlying cause (Blood loss or coeliac’s should be treated)

Iron replacement therapy (could be oral, intramuscular or intravenous if severe)

Blood transfusion (rarely required)

55
Q

When is iron replacement therapy stopped?

A

Until Hb is normalised as well as ferritin stores

56
Q

What are possible results of oral iron replacement therapies?

A

reticulocytes response begins in 7 days

Poor response may be seen in continued bleeding, malabsorption, poor compliance (patient forgets or refuses to take tablets) and incorrect diagnosis

57
Q

What are possible complications of Intravenous iron replacement therapies?

A

Same side effects as oral iron.

Ongoing blood loss that exceed capacity of oral iron

58
Q

What is the normal result of partially treated iron deficiency?

A

Dimorphic blood film showing some normal RBCs and some deficient RBCs

59
Q

What is the most important consideration for iron deficiency anaemia?

A

That the underlying cause is treated because iron deficiency is a secondary diagnosis

IMED2002 UWA (29 decks)

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