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Blood Disorders > Anaemia, Haemolysis And Haematinic Deficiency > Flashcards

Anaemia, Haemolysis And Haematinic Deficiency Flashcards

1
Q

What is in the blood

A

Plasma
Platelets
White cell
Red cells

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2
Q

What is the normal life span of a rbc

A

120 days

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3
Q

What are the causes of microcytic anaemia

A

Iron deficiency anaemia

Thalassemia and thalassemia trait

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4
Q

What are the causes of normocytic anaemia

A

Anaemia of chronic disease
Acute blood loss
Bone marrow failure e.g aplastic anaemia
Mixed Haematinic deficiency

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5
Q

What are the causes of macrocytic anaemia

A 
Vitamin b12 and folate deficiency 
Alcoholism
Liver disease
Haemolytic anemia 
Hypothyroidism 
Drugs eg anti-epileptics
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6
Q

What are the categories of causes of anaemia

A

Acquired

Congenital

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7
Q

What are the congenital causes of anaemia

A

Membrane defect: hereditary spherocytosis, hereditary elliptocytossi
Haemoglobin defect: thalassemia and sickle cell anaemia
Enyzme defect: G6PD deficiency and pyruvate kinase deficiency

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8
Q

What are the acquried causes of anaemia

A

Deficiences: vitamin b12, folate, iron
Bone marrow pathology: aplastic anaemia, mylodysplasia, myeloma
Diplacement in the bone marrow: leukemia, other cancer
Chronic disease: renal failure (unable to make erythropoietin)
Haemolysis: immune and non immune

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9
Q

What happens in bleeding?

A
  1. Acute blood loss there is lack of RBC and plasma as they are bleedng whole blood
  2. Hb concentration remains the same
  3. Plasma volume expands to maintain the blood pressure and due to this there is a fall in hb concentration as the RBC become diluted in a bigger volume
  4. If you keep bleeding i.e chronically, bone marrow will make more RB and will use the iron stores
  5. Ferritin will drop
  6. As long as there is enough iron hb levels will be normal
  7. If chronic you will deplete the iron stores eventually so ferritin levels will drop
  8. This results in iron deficiency anaemia
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10
Q

Describe how iron is metabolised

A
  1. In the gut lumen Haem bound iron and non haem iron are absorbed differently
  2. No haem bound iron will be reduced from fe2+ to fe3+ for it to come into the enterocytes
  3. When it becomes into the enterocyte it is stored as ferritin
  4. Or the iron can be transported into the basolateral membrane i,.e blood by ferroportin
  5. Feroportin is controled by hepcidin
  6. Hepcidin is produced by the liver
  7. In iron deficiency there will not be hepcidin so the flow of iron will be free out from the enterocyte
  8. If there is anaemia of chronic disease, hepcicin levels will go up and block iron from getting into the body i.e there is iron but it cant go to where it should due to hepcidin
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11
Q

What are the symptoms and signs of iron deficiency anaemia

A 
Koilonchyia 
Restless leg
Pica
Breathelessness
Fatigue
Palpitatons 
Tinnitus
Pallor
Tachycardia
Flow murmur
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12
Q

What are the causes of iron deficiency

A

Poor intake from diet
Poor absorption: coeliac disease, crohns disease
Preganct: due to increased body requirements
Iron loss i.e bleeding due to: gi malignanct, ulcer, gastricits, menorrhagia, urinary, angiodysplasia

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13
Q

What will an iron deficiency anaemia show on a blood film

A

Microcytic hypochromic anaemia

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14
Q

What happens ot the total iron binding capacity in iron deficiency anaemia

A

High becuase it wants the body to pick up iron and take it to where it should be

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15
Q

What is the ferritin levels in anaemia of chronic disease

A

Normal

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16
Q

What is the management of iron deficiency anaemia

A
  1. Find the underlying cause

3. Treat the iron deficiency by iron tablets or iv iron

17
Q

What are the causes of folate deficiency

A
  1. Low intake
  2. Impaired absorption: duodenum pathology e.g coeliac or crohsn disease, drugs
  3. Increased requirement: pregnancy, haemolysis, inflammation
  4. Increased loss of folate: people on dialysis, durgs dihydrofolate reductase inhibitors
18
Q

What are the signs and symptoms of folate and b12 deficiency anemia

A 
Jaundice
Glossitis
Mild fever
Skin hyperpigmentation 
Infection and bleeding
Infertility 
Neural tube defect
19
Q

In the peripheral bloood what are the featues of b12 and folate deficiency

A

Hyperpigmented neutrophils

20
Q

How can we measure folate levels in the blood

A

Elisa technique
Serum
Red cells- low in b12 deficiency

21
Q

What are the 2 ways b12 can be absorbed

A
  1. Passively in the duodenum and ileum

2. actively by binding to intrinsic factor made from the stomach which then is absorbed in the ileum

22
Q

What are the neurological featues of b12 deficiency

A

Muscle weakness
Parathesia
Difficulty walking
Confusion, slowlness

23
Q

What are the causes of b12 deficiency

A

Poor intake
Malabsorption: gastric, ileum, drugs e,g metformin
Loss: nitrous oxide makes b12 inactive
Apparent deficiency: pregnancy

24
Q

How can we measure b12 levels in the body

A

B12 assay

Schilling test

25
Q

What is pernicious anaemia

A

An autoimmune disorder that causes destruction of intrinsic factor due to antibodies against parietal cells

26
Q

How do we diagnose pernicious anaemia

A

Measure intrinsic factor antibodies

27
Q

How do we replaces b12

A

1mg hydroxycarbalamin intrmuscular injection

28
Q

What test makes us think about immune causes of hamolytic anaemia

A

DAT (coombs test) that is positive

29
Q

What are the 2 types of autoimmune hameolytic anaemia

A

Warm- igg

Cold- igm

30
Q

What is the treatment of warm autoimmune haemolytic anaemia

A

Streoids
Splenectomy
Rituximab

31
Q

What is cold autoimmune haemolytic anaemia associated with

A

Ebv
Mycoplasma pneumonia
Lymphoma

32
Q

What is the treatment of cold autoimmune haemolytic anaemia

A

Transfuse with blood warmer
Treat underyling infection
- doest not respond to steroids

Blood Disorders (9 decks)

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