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Anaemia - introduction + microcytic Flashcards

1
Q

What is the definition of anaemia?

A

haemoglobin (Hb) level <120 g/L (<12 g/dL) in females
<130 g/L (<13 g/dL) in males
<110 g/L (11 g/dL) in pregnant women

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2
Q

What is the most common cause of anaemia?

A

iron deficiency

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3
Q

what are the sx of anaemia?

A 
fatigue
SOB
faintness
palpitations 
headache
tinnitus 
anorexia
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4
Q

How can anaemia present in coronary artery disease?

A

angina

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5
Q

What are possible signs of anaemia?

A

Pallor

Hyperdynamic circulation e.g. tachycardia, flow murmurs, cardiac enlargement

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6
Q

What are the causes of microcytic anaemia?

A
  1. Iron deficiency anaemia
  2. Thalassaemia
  3. Sideroblastic anaemia
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7
Q

What are the causes of normocytic anaemia?

A
  1. acute blood loss
  2. anaemia of chronic disease
  3. BM failure
  4. RF
  5. Hypothyroidism
  6. Haemolytic anaemia
  7. Pregnancy
  8. aplastic
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8
Q

What are the causes of microcytic anaemia?

A
  1. B12 or folate deficiency
  2. Alcohol XS
  3. Reticulocytosis
  4. Cytotoxics
  5. Myelodysplastic syndromes
  6. Marrow infiltration
  7. Hypothyroidism
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9
Q

What MCV level is microcytic anaemia?

A

<80fl

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10
Q

What MCV level is macrocytic anaemia?

A

> 100fL

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11
Q

what are the causes of iron deficiency anaemia?

A
  1. inadequate iron intake - malabsorption e.g. coeliac
  2. increased iron loss - menorrhagia, GI bleeding
  3. XS iron requirements
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12
Q

What are the key diagnostic features of iron deficiency anaemia?

A
  • fatigue
  • pica
  • nail changes - thinning, flattening, koilonychia (rare)
  • hair loss
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13
Q

What investigations would you do to confirm iron deficiency anaemia?

A
  1. FBC - Hb, MCV, MCH, MCHC, platelets
  2. peripheral blood smear
  3. serum ferritin, iron
  4. Transferrin
  5. low reticulocyte
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14
Q

What investigations may u consider to identify the cause of iron deficiency anaemia?

A
  1. Coeliac serology - IgA tissue transglutaminase + total IgA
  2. H. Pylori testing - IgG abs or faecal antigen, confirm w urease breath test or endoscopy w biopsy
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15
Q

What is the treatment of iron deficiency anaemia?

A
  1. oral iron - ferrous sulphate (2-3mg/kg/day in 2-4 doses)

2. ascorbic acid if response to oral iron is poor

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16
Q

How long should rx of IDA be continued after Hb correction?

A

3-6 months

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17
Q

When are transfusions recommended in IDA?

A

If haemodynamically unstable - symptomatic at rest w SOB, CP, presyncope

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18
Q

What are there causes of anaemia of chronic disease?

A

autoimmune disorders
malignancy
acute/chronic infection
critical illness, trauma

19
Q

What tests would u do in ACD?

A
  1. FBC
  2. Blood smear
  3. B12, folate
  4. TSH
  5. Tests for haemolytic
20
Q

what is the treatment of ACD?

A
  1. Rx underlying disease

2. Transfusion

21
Q

what is sideroblastic anaemia?

A

ineffective erythropoiesis

leading to ↑iron absorption, iron loading in marrow ± hae- mosiderosis

22
Q

what is haemosiderosis

A

endocrine liver and heart damage due to iron deposition

23
Q

What are the causes of sideroblastic anaemia?

A
  1. congenital

2. acquired - myelodysplasia, alcohol XS, anti-TB meds, lead XS

24
Q

What tests would you do for sideroblastic anaemia and what would you find?

A

Blood film - hypochromic microcytic anaemia

BM - sideroblastis + ↑ iron stores

25
What is the rx of sideroblastic anaemia?
supportive rx cause pyridoxine may help
26
What serum ferritin levels are diagnostic of IDA?
<12 ng/ml
27
What would you see on peripheral blood smear in IDA?
Microcytic hypochromic pencil red cells
28
What is the pathology underlying beta-thalassaemia?
mutation(s) of the beta-globin gene leading to decreased or absent synthesis of beta-globin, resulting in ineffective erythropoiesis
29
How is beta thalassaemia further subdivided?
1. Minor - heterozygous 2. Intermedia 3. Major - homozygous
30
How does beta thalassaemia minor present?
asymptomatic, carrier state | mild/absent anaemia
31
How does beta thalassaemia intermedia present?
mod anaemia not requiring transfusions | splenomegaly
32
How does beta thalassaemia major present?
``` severe anaemia in 1st year of life failure to thrive hepatosplenomegaly recurrent infections skull bossing osteopenia ```
33
What may appear on skull XR in beta thalassaemia major?
Hair on end sign
34
what is the inheritance pattern of beta thalassaemia?
autosomal recessive
35
What is seen on blood film in beta thalassaemia?
microcytic anaemia tear drops target cells microspherocytes
36
What is the treatment of beta thalassaemia trait?
genetic counselling | avoid iron supplementation
37
What is the treatment of beta thalassaemia major?
regular red cell transfusions (keep Hb >100g/dl) Iron chelation - desferrioxamine Splenectomy if massive
38
What is the treatment of beta thalassaemia intermedia?
transfusions if profound anaemia
39
What is the risk of repeated transfusions? what can be done to reduce the risk?
damage of endocrine glands, liver, pancreas and heart death in 2nd decade from HF Reduce: iron chelation, ascorbic acid
40
What chromosomes are affected in alpha and beta thalassaemia?
beta - 11 | alpha - 16
41
How can alpha thalassaemia present?
asymptomatic carrier state to incompatible with life
42
How does AT present if all 4 alpha genes are deleted?
death in utero - Bart's hydrops
43
How does AT present if 3 alpha genes are deleted?
moderate anaemia | features of haemolytic - hepatosplenomegaly, leg ulcers, jaundice
44
How does AT present if 2 genes are deleted?
asymptomatic carrier satte w hypochromic microcytic blood film but normal Hb

Haematology (18 decks)

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