Anaemia - normocytic + macrocytic Flashcards
What is aplastic anaemia?
BM stops making cells leading to pancytopenia
What are the causes of aplastic anaemia?
- autoimmune - paroxysmal nocturnal haemoglobinuria
- drugs - chloramphenicol + NSAIDS + TOXINS
- viruses - HEPATITIS
- irradiation
- congenital - fanconi anaemia
What tests would u do for aplastic anaemia? what may u find
- FBC
2. hypo cellular marrow w no abnormal cell
How may someone present w aplastic anaemia?
Hx of recurrent infection
Fatigue
Pallor
Hx of bleeding or easy bruising
What is involved in treatment of aplastic anaemia?
Supportive if asymptomatic
Immunosuppression - lymphocyte Ig, antithymocyte globulin, methylpred, ciclosporin
Severe - allogeneic marrow transplant HLA matched
How would u differentiate between IDA and AOCD?
TIBC is high in IDA
Ferritin is low in IDA and high in AOCD
What is the most common cause of anaemia in renal failure?
reduced erythropoietin levels
at what GFR does anaemia become apparent in CKD?
<35
What are complications of anaemia of chronic disease?
worsening of pre-existing heart failure due to increased CO necessitated by anaemia
What causes hypochromic cells?
reduced Hb in the cell leading to reduced mean corpuscular Hb conc (MCHC)
when should you suspect marrow failure in normocytic anaemia?
if WCC or platelets decreased
What can the causes of macrocytic anaemia be divided into?
- Megaloblastic - vit B12 deficiency + folate deficiency
- Normoblastic:
- alcohol
- liver disease
- hypothyroidism
- reticulocytosis e.g. haemolysis
- myelodysplasia
- cytotoxics
What are megaloblasts?
cell in which nuclear maturation is delayed compared with the cytoplasm
What is the function of vitamin B12
synthesises thymidine so DNA - maturation of rbc in BM
synthesis of myelin
What are the causes of vitamin B12 deficiency?
- Diet
- Malabsorption - lack of IF (pernicious anaemia) or terminal ileal resection, Crohns, post gastrectomy
- Congenital metabolic errors
What foods is vitamin B12 found in?
meat fish dairy
How and where is vitamin B12 absorbed?
binds to intrinsic factor (parietal cells in stomach produce) and absorbed in terminal ileum
What are the general features of vitamin B12 deficiency?
- Sx of anaemia
- Lemon tinge to skin due to combination of pallor and mild jaundice (haemolysis)
- Glossitis - beefy red sore tongue
- Angular cheilosis
What neurological sx does B12 deficiency cause?
paraesthesia, peripheral neuropathy
neuropsychiatric - irritability depression, psychosis
What is the management of symptomatic vitamin B12 deficiency?
If severe - IM cyanocobalamin or hydroxocobalamin (these are both vit B12 injections) + folic acid
What is the management of asymptomatic b12 deficiency?
- Dietary supplementation + multivits
what is pernicious anaemia?
autoimmune condition in which atrophic gastritis leads to lack of IF secretion from parietal cells in the stomach
In what groups of ppl is pernicious anaemia more common?
females
>40yrs
blood group A
what other conditions is pernicious anaemia associated w?
thyroid disease
vitiligo
Addisons