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Year 3 - Preparation for Clinical Practise > Anaemia in general medicine > Flashcards

Anaemia in general medicine Flashcards

1
Q

What is the definition of anaemia

A

LOW HAEMOGLOBIN (Hb) —-<135g/L IN MEN AND <115g/L IN FEMALES

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2
Q

What is anaemia due to

A
  • low red cell mass
  • increased plasma volume due to dilution
  • reduced production
  • increased loss
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3
Q

What are the symptoms of anaemia

A
  • FATIGUE
  • DYSPNOEA
  • FAINTNESS
  • PALPITATIONS
  • HEADACHES
  • TINNITUS
  • ANOREXIA
  • ANGINA (IN PRE-EXISTING CORONARY ARTERY DISEASE)
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4
Q

What are the signs of anaemia

A

Can be absent

  • pallor
  • hyper dynamic circulation - tachycardia, flow murmurs (ejection), cardiac enlargement
  • retinal haemorrhages
  • heart failure
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5
Q

What is the normal mean cell volume (MCV)

A

76—96 FEMTOLITRES (10 TO THE POWER OF 15==1 LITRE)

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6
Q

name the 3 causes of anaemia with low MCV

A
  • iron deficiency anaemia
  • thalassaemia
  • sideroblastic anaemia
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7
Q

What can cause normocytic anaemia

A
  • acute blood loss
  • anaemia of chronic disease
  • bone marrow failure
  • renal failure
  • hypothyroidism
  • haemolytic
  • pregnancy
  • mixed deficiency
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8
Q

What causes macrocytic anaemia

A
  • B12 or folate deficiency
  • alcohol abuse
  • liver disease
  • reitculocytosis
  • cytotoxic
  • meylodysplastic syndormes
  • marrow infiltration
  • hypothyroidism
  • anti-folate drugs
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9
Q

what type of MCV can haemolytic anaemia be

A
  • may be normocytic

- may be macrocytic as there are many young RBC in circulation

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10
Q

What should you look for in haemolytic anaemia

A
  • jaundice
  • reticulocytes
  • low haptoglobulin
  • high LDH
  • high urobilinogen
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11
Q

What can cause iron deficiency anaemia

A
  • blood loss (GI bleeding and menorrhagia)
  • poor diet
  • malabsorption
  • GI parasites such as hookworm
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12
Q

what causes koilonychia

A

iron deficiency anaemia

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13
Q

What causes atrophic glossitis

A
  • iron deficiency anaemia
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14
Q

What causes angular cheilosis

A
  • iron deficiency anaemia
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15
Q

what causes post-cricoid web (Plummer Vinson Syndrome)

A
  • iron deficiency anaemia
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16
Q

name a GI parasite that can cause iron deficiency anaemia

A
  • Tapeworm
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17
Q

What would the blood test should you for iron deficiency anaemia

A
  • LOW MCV
  • LOW MCH
  • LOW MCHC
  • low SE ferritin
  • low SE iron
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18
Q

what does a blood film look like in iron deficiency anaemia

A
  • Microcytic
  • hypo chromic anaemia
  • anisocytosis
  • poikilocytosis
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19
Q

What are the other tests that you can do for iron deficiency anaemia

A
  • coeliac screen

- gastroscopy and colonoscopy

20
Q

what is the difference between ansiocytosis and polkilocytosis

A
  • Anisocytosis - variation in RBC size

- Polkilocytosis = variation in shape

21
Q

What causes anaemia of chronic disease

A
  • any chronic condition such as infection, vasculitis, autoimmune, malignancy and renal failure
22
Q

What does sideroblastic anaemia look like

A
  • Low MCV
  • unresponsive to iron
  • ineffective erythropoiesis
  • increased iron absorption
  • iron loading in the marrow, endocrine, liver and heart
23
Q

What is sideroblastic anaemia

A

Sideroblastic anaemia is a disorder where the body produces enough iron but is unable to put it into the haemoglobin

24
Q

what can cause sideroblastic anaemia

A

Congenital

Acquired

  • myelodysplastic/myeloproliferative diseases
  • chemotherapy
  • anti-TB drugs
  • irradiation
  • alcohol
  • lead excess
25
Q

what is the treatment of sideroblastic anaemia

A
  • remove cause

- +/- pyridoxine

26
Q

macrocytosis can …

A

MACROCYTOSIS CAN OCCUR WITHOUT ANAEMIA (EG ALCOHOL EXCESS)

27
Q

What is a megaloblast

A
  • cell in which nuclear maturation is delayed compared with the cytoplasm
28
Q

What can cause megaloblastic anaemia

A
  • B12 and folate deficiency

- cytotoxic drugs

29
Q

What can cause non megaloblastic anaemia

A
  • alcohol excess
  • reticulocytosis
  • liver disease
  • hypothyroidism
  • pregnancy
30
Q

What are the two types of macrocytic anaemia

A
  • megaloblastic anaemia

- non-megaloblastic anaemia

31
Q

what are other causes of macrocytic anaemia

A
  • myelodysplasia
  • myeloma
  • myeloproliferative disorders
  • aplastic anaemia
32
Q

what could you find in a bone marrow biopsy

A
  • Megaloblastic marrow
  • normoblastic marrow - liver disease and hypothyroid
  • abnormal erythropoiesis (sideroblastic anaemia, leukaemia, aplasia)
  • increased erythropoiesis (haemolysis)
33
Q

What causes folate deficiency

A
  • poor diet
  • increased demand (pregnancy, increased cell turnover such as haemolysis)
  • malabsorption
  • alcohol
  • drugs - phenytoin and methotrexate
34
Q

How do you treat folate deficiency

A
  • treat underlying cause

- can give oral folic acid but make sure not B12 deficiency as this can cause subacute combined degeneration of the cord

35
Q

Why do you take folate in pregnancy

A
  • prevent spina bifida and anaemia
36
Q

What can cause B12 deficiency

A
  • diet
  • malabsorption - B12 binds intrinsic factor in the stomach, this enables absorption in the terminal ileum
  • congenial metabolic errors
37
Q

what are the clinical features of B12 deficiency

A
  • Pallor
  • slightly jaundice (haemolysis)
  • glossitis
  • angular cheilosis
38
Q

what are the clinical features of a B12 deficiency

A
  • Neuropsychiatric - depression and psychosis

- Neurological - paraesthesia, peripheral neuropathy

39
Q

What are the two types of haemolytic anaemia

A
  • Intravascular (within circulation)

- extravascular (in reticuloendothelial system e.g. macrophages of liver, spleen and bone marrow)

40
Q

When should you suspect haemolysis

A
  • anaemia with normal or high MCV
  • high bilirubin (unconjugated, pre-heaptic jaundice)
  • high urinary urobilinogen (no urinary conjugated bilirubin)
  • high serum LDH (released from red cells)
  • high reticulocytes
  • parasites on thick and thin films
  • splenomegaly (in extravascular)
  • intravascular - high free plasma haemoglobin, methaemalbuminaemia, haemoglobinuria, haemosiderinuria, reduced haptoglobin
  • family history, race, drugs, previous episodes, travel
41
Q

what does the blood film look like in haemolytic anaemia

A
  • HYPOCHROMIC MICROCYTIC ANAEMIA (THALASSAEMIA)
  • SICKLE CELLS
  • SCHISTOCYTES (MICROANGIOPATHIC HAMEOLYTIC ANAEMIA)
  • ABNORMAL CELLS (BLOOD MALIGNANCY)
  • SPHEROCYTES (HEREDITARY, OR AUTOIMMUNE HA)
  • ELLIPTOCYTES (HEREDITARY)
  • HEINZ BODIES (GLUCOSE-6-PHOSPHATE DEHYDROGENASE—G6PD DEFICIENCY)
42
Q

what tests should you do if you diagnosis of haemolytic anaemia is still in doubt

A
  • osmotic fragility tests (membrane abnormalities)
  • HGB electrophoresis (haemoglobinopathies)
  • diet antiglobulin test (DAT) - Coombs - to idnetify red cells coated with antibody or complement (immune cause)
  • enzyme assays
43
Q

List the Coombs positive causes of haemolytic anaemia

A
  • drugs
  • autoimmune
  • paroxysmal cold haemoglobinuria (viruses/syphilis)
  • isoimmune (active transfusion reaction)
44
Q

List the Coombs negative causes of haemolytic anaemia

A
  • autoimmune hepatitis
  • hep B and C
  • post vaccination
  • drugs
45
Q

name other causes of haemolytic anaemia

A

microangiopathic haemolytic anaemia
- mechanical damage - eclampsia, prosthetic heart valves

Infection
- malaria

Paroxysmal nocturnal haemoglobinuria

  • acquired stem cell disorder
  • haemolysis
  • marrow failure
  • thrombophilia
46
Q

What are hereditary causes of haemolytic anaemia

A
  • G6PD deficnecy - drugs such as aspirin, sulphonamides, fava beans(broad beans)
  • pyruvate kinase deficiency (causes reduced RBC survival, autosomal recessive)
  • Membrane defects - hereditary spherocytosis/ elliptocytosis/ ovalocytosis
  • Haemoglobinopathies - sickle cell and thalassamia

Year 3 - Preparation for Clinical Practise (33 decks)

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