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IMED2002 > Anaemia, general concepts & iron deficiency anaemia > Flashcards

Anaemia, general concepts & iron deficiency anaemia Flashcards

1
Q

What is anaemia?

A

A reduction in the Hb concentration, below what is considered normal for the age, gender of the individual

Usually accompanied by a reduction in red cell count and haematocrit (percent of the blood that is cellular)

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2
Q

Is anaemia a disease?

A

No it is a manifestation of another process

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3
Q

What are some causes for anaemia?

A

1) reduced bone marrow production of RBCs
2) increased loss of RBCs (bleeding)
3) premature destruction of RBCs (before 120 days) (haemolysis)

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4
Q

Could it be that there is asymptomatic anaemia? What determines symptomatic anaemia?

A

Yes, as symptoms depend on age and speed of onset.
Chronic anaemia = slow onset, symptoms may go unnoticed (there may be compensation for the anaemia)
Rapid onset anaemia = symptoms

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5
Q

Anaemia is mostly due to…

A

iron deficiency

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6
Q

Clinical features of anaemia

A

Pale, oral mucosa, conjunctiva
Lethargy, tiredness; generalised weakness
Shortness of breath; tachycardia; palpitations

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7
Q

Which anaemia types cause jaundice?

A

Haemolytic anaemia, Megaloblastic anaemia

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8
Q

Koilonychia is a symptom of which anaemia type?

A

Iron deficiency

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9
Q

Cause of anaemia can be guided by the MCV and blood film. True or False

A

True

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10
Q

RCC is

A

red cell count

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11
Q

MCH is:

A

Mean cell Hb

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12
Q

which stain is used to investigate anaemia on blood film?

A

Romanovsky stain

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13
Q

What types of anaemia are microcytic

A

Iron deficiency
Thalassaemia (Haemoglobinopathy)
Anaemia of chronic disease

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14
Q

Which types of anaemia are normocytic?

A

Blood loss
Haemolytic (RBC membrane, Enzyme defects, Extrinsic)
Stem cell defects

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15
Q

Which types of anaemia are macrocytic?

A 
Megaloblastic
Excess alcohol  
Liver disease  
Reticulocytosis  
Drug therapy  
Marrow failure
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16
Q

What does a reticulocyte count tell us? Low or high

A

Immature RBC, in the blood, is larger

Low: failure of erythropoiesis

High: appropriate BM erythroid response

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17
Q

Reduced erythropoiesis has 2 causes:

A

Primary: bone marrow failure

Secondary: another cause

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18
Q

Increased loss of RBCs is because of:

A

Bleeding/haemorrage

Haemolysis

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19
Q

what is bone marrow failure called?

A

aplastic anaemia

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20
Q

The primary cause of reduced erythropoiesis is bone marrow failure… what are the types

A

Bone marrow failure: aplastic anaemia
Red cell aplasia
Bone marrow dysfunction: myelodysplasia

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21
Q

the secondary cause of reduced erythropoiesis is due to another cause, such as:

A

Insufficient nutrients: iron, folate, B12, EPO
Infection
Drugs
Bone marrow infiltration like leukaemia and cancer

22
Q

what are types of bleeding?

A

acute: identifiable, after an accident or haemorrhage
chronic: slow bleeding, may go unnoticed (GIT cancer, ulcer) or secondary to anticoagulant drugs

23
Q

clinical clues that bleeding is the cause of anaemia

A

Menorrhagia is menstrual bleeding that lasts more than 7 days.
Melena refers to black stools that occur as a result of gastrointestinal bleeding.

24
Q

clinical clues that haemolysis is the cause

25
clinical clues that chronic haemolysis or extramedullary hematopoiesis is the cause
splenomegaly
26
Bruising / bleeding or infection is the clue to BM failure True or False
true
27
body iron stores
4-5 grams
28
does iron exist in all cells, in varying amounts?
yes
29
most of the iron in our body is distributed where? and then?
red blood cells and then in storage (as ferritin in macrophages) which are located in the reticuloendothelial system and the bone marrow and then in myoglobin and then in enzymes
30
Iron cycle
Iron is taken through diet absorbed by GIT Absorbed iron transported to marrow bound to transferrin (Tf) Recycled by macrophages Excess stored in macrophages and liver as ferritin
31
how is iron lost and gained?
Through skin, gut, sweat (1 mg/day) Menses (1 mg/day) gained through diet 10% of 10 mg/day
32
does absorbed iron requirement change throughout life?
YES - it is needed more in pregnancies needed more in females>males peaks in adolescence
33
What is negative iron balance?
Reduced iron stores, normal RBC iron, no anaemia
34
What is iron deficient erythropoiesis?
Reduced iron stores, mildly reduced RBC iron, no anaemia
35
What is iron deficiency anaemia?
Reduced iron stores, reduced RBC iron, anaemia
36
What causes iron deficiency?
Reduced intake: Rare in the developed world The commonest form of anaemia in paediatrics Poor iron absorption / malabsorption Stomach or bowel: gastrectomy; coeliac disease ``` Chronic blood loss: GI: ulcers, carcinoma, varices, haemorrhoids. Uterine bleeding (menorrhagia) ``` Increased iron usage: Neonates; puberty; pregnancy (3mg/day)
37
Clinical features of iron deficiency anaemia:
``` Atrophic glossitis (smooth tongue without papillae) Angular cheilitis (redness & fissures at corners of the mouth) Koilonychia (spoon nails) ```
38
Clinical features of iron deficiency anaemia:
Anaemia (low Hb); reduced MCV (<80 fl) Blood film: hypochromic (pale) microcytic (small) red blood cells, pencil-shaped cells and elliptocytes More central valor in the RBC
39
Lab features of iron deficiency anaemia:
``` Mild thrombocytosis (increased platelet count) Reduced reticulocyte count (insufficient new RBC being made in BM) ``` Bone marrow: Reduced erythropoiesis Reduced iron stores
40
Is serum iron a good laboratory measure of iron status:
Highly variable. Not useful to assess iron stores
41
Other laboratory assessments for iron and results
``` Serum transferrin (Tf): A measure of iron transporter: increased (line up, queue, present) ``` Transferrin saturation: % of iron transporter occupied by iron: reduced Serum Ferritin: Reflects body iron stores: reduced
42
other investigations in iron deficiency
Dietary history Malabsorption: Coeliac serology Blood loss (gastrointestinal and uterine) Gastroscopy / endoscopy Colonoscopy Pelvic ultrasound
43
blood transfusion is primary method of treating iron deficiency anaemia true or false
false - transfusion is rarely required
44
What is the treatment for iron deficiency anaemia and what is the treatment duration and response:
Determine and treat the underlying cause Iron replacement therapy: Oral (tablets or syrup) Intravenous Intramuscular (rare) Duration: to normalise Hb and ferritin (stores) Response: increase in Hb; reticulocytosis (increased reticulocyte numbers)
45
Oral iron replacement
``` Oral iron: iron tablets Hb should increase by 10g/L per week S/E: nausea; constipation Intolerance; non-compliance issues ```
46
Parenteral Iron Replacement
Indications: intolerance, ineffective, poor compliance or large dose iron replacement required Faster replenishment of iron stores and Hb IV : e.g. ferric carboxymaltose: A rapid increase in ferritin But doesn’t correlate with body stores Same rate of increase in Hb as oral Fe
47
what does a dimorphic blood film look like
Both small pale cells (residual iron-deficient cells) and normal RBC
48
what is iron overload
Increased total body iron stores, more stored in macrophages
49
what causes iron overload?
Primary: genetic haemochromatosis (HFE gene) excessive intestinal absorption of dietary iron, resulting in a pathological increase in total body iron stores Ineffective erythropoiesis with increased iron absorption: thalassaemia Repeated blood transfusions: 200-250mg iron/bag
50
what are the clinical effects of iron overload
Organ dysfunction from iron deposition Heart, endocrine system, liver Abnormal liver function Abnormal endocrine function
51
Iron measurements in iron overload
Serum iron: increased Transferrin: decreased Transferrin saturation: increased Ferritin: increased
52
Treatment options for iron overload
Genetic: regular venesection to reduce the iron level (Venesection is the act of drawing or removing blood from the circulatory system ) Transfusion iron overload: iron chelation (iron bound to chelator which is lost through urine)

IMED2002 (12 decks)

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