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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

A

jaundice

25
Q

clinical clues that chronic haemolysis or extramedullary hematopoiesis is the cause

A

splenomegaly

26
Q

Bruising / bleeding or infection is the clue to BM failure True or False

A

true

27
Q

body iron stores

A

4-5 grams

28
Q

does iron exist in all cells, in varying amounts?

A

yes

29
Q

most of the iron in our body is distributed where? and then?

A

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
Q

Iron cycle

A

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
Q

how is iron lost and gained?

A

Through skin, gut, sweat (1 mg/day)
Menses (1 mg/day)

gained through diet 10% of 10 mg/day

32
Q

does absorbed iron requirement change throughout life?

A

YES - it is needed more in pregnancies
needed more in females>males
peaks in adolescence

33
Q

What is negative iron balance?

A

Reduced iron stores, normal RBC iron, no anaemia

34
Q

What is iron deficient erythropoiesis?

A

Reduced iron stores, mildly reduced RBC iron, no anaemia

35
Q

What is iron deficiency anaemia?

A

Reduced iron stores, reduced RBC iron, anaemia

36
Q

What causes iron deficiency?

A

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
Q

Clinical features of iron deficiency anaemia:

A 
Atrophic glossitis (smooth tongue without papillae)
Angular cheilitis (redness & fissures at corners of the mouth)
Koilonychia (spoon nails)
38
Q

Clinical features of iron deficiency anaemia:

A

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
Q

Lab features of iron deficiency anaemia:

A 
Mild thrombocytosis (increased platelet count)
Reduced reticulocyte count (insufficient new RBC being made in BM)

Bone marrow:
Reduced erythropoiesis
Reduced iron stores

40
Q

Is serum iron a good laboratory measure of iron status:

A

Highly variable. Not useful to assess iron stores

41
Q

Other laboratory assessments for iron and results

A 
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
Q

other investigations in iron deficiency

A

Dietary history

Malabsorption: Coeliac serology

Blood loss (gastrointestinal and uterine)

Gastroscopy / endoscopy

Colonoscopy

Pelvic ultrasound

43
Q

blood transfusion is primary method of treating iron deficiency anaemia
true or false

A

false - transfusion is rarely required

44
Q

What is the treatment for iron deficiency anaemia and what is the treatment duration and response:

A

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
Q

Oral iron replacement

A 
Oral iron:
iron tablets
Hb should increase by 10g/L per week
S/E: nausea; constipation
Intolerance; non-compliance issues
46
Q

Parenteral Iron Replacement

A

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
Q

what does a dimorphic blood film look like

A

Both small pale cells (residual iron-deficient cells) and normal RBC

48
Q

what is iron overload

A

Increased total body iron stores, more stored in macrophages

49
Q

what causes iron overload?

A

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
Q

what are the clinical effects of iron overload

A

Organ dysfunction from iron deposition
Heart, endocrine system, liver

Abnormal liver function
Abnormal endocrine function

51
Q

Iron measurements in iron overload

A

Serum iron: increased
Transferrin: decreased
Transferrin saturation: increased
Ferritin: increased

52
Q

Treatment options for iron overload

A

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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