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Medicine Year 1 - Semester 2 - Part 2 > Anaemia - Presentation, Diagnosis and Management > Flashcards

Anaemia - Presentation, Diagnosis and Management Flashcards

1
Q

What is anaemia ?

A

A condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.

BELOW 2SD from the mean

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2
Q

State the range of haemoglobin in adult males

A

135-175 g/l

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3
Q

State the range of haemoglobin in females

A

120-155 g/l

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4
Q

State some symptoms of anaemia

A

Tired all the time
Short of breath
Muscle pain on exertion
Dizzy
Angina

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5
Q

State some clinical signs of anaemia

A

Pallor in skin and conjunctiva

Tachycardia
Rapid breathing

Peripheral oedema - i.e. leg swelling (if severe anaemia)

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6
Q

Why is tachycardia a symptom of anaemia ?

A

Cardiac output increases by rises in rate and stroke volume, so more oxygen is delivered.

More symptoms if a sudden fall in Hb

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7
Q

Describe the oxygen dissociation curve for those with anaemia

A

Right shift
(reduced affinity)

Increased temperature
Increased 2,3 DPG
Increased [H+]

More oxygen extracted from the blood

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8
Q

State the 4 ways in which anaemia can be classified

A

Under-production or increased loss of RBCs

Congenital or acquired

Acute or chronic

By MCV (mean cell volume) - micro/normo/macro-cytic

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9
Q

Microcytic anaemia

A

Iron deficiency anaemia, Thalassaemia

MCV 60-80fl

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10
Q

Normocytic anaemia

A

Blood Loss, Anaemia of Chronic disease, renal impairment

MCV 80-100fl

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11
Q

Macrocytic anaemia

A

Megaloblastic anaemia, B12/folate deficiency, Myelodysplasia

MCV 100-120fl

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12
Q

MCV

A

Mean cell volume

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13
Q

MCH

A

Mean cell haemoglobin

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14
Q

MCHC

A

Mean cell haemoglobin concentration

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15
Q

RDW

A

Red cell distribution width

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16
Q

What is RDW a measure of ?

A

The spread of RBC size

e.g. Retics / Transfusion

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17
Q

MCV 60-80fl

A

Iron deficiency anaemia, Thalassaemia

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18
Q

MCV 80-100fl

A

Blood Loss, Anaemia of Chronic disease, renal impairment

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19
Q

MCV 100-120fl

A

Megaloblastic anaemia, B12/folate deficiency, Myelodysplasia

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20
Q

Describe iron deficiency anaemia

A

Reduction in MCV to 65-80
Reduction in Hb
Low ferritin
Low transferrin saturation with iron

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21
Q

Causes of iron deficiency anaemia (4)

A

Poor iron intake

Blood loss (menstrual/ GI tract)

Malabsorption (coeliac disease)

Increased need of iron (for growth spurt/ pregnancy)

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22
Q

State some clinical features of iron deficiency anaemia

A

Pale
Tachycardia
Koilonychia
Hair loss
Pica
Glossitis/ angular stomatitis

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23
Q

Symptoms of iron deficiency anaemia

A

Weight loss
Abdominal pain
Bowel change
Heavy periods

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24
Q

Describe investigations for iron deficiency anaemia

A

Confirmed by LOW ferritin and typical FBC

Screen for coeliac disease (IgA tGA)

Upper and lower endoscopy

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25
Oral treatment for iron deficiency anaemia
Treat the underlying cause Oral - replacement with sufficient iron for a long enough period (200mg of ferrous sulphate 1x a day -> 65mg elemental iron per dose)
26
Why should patients be given oral iron after correction of anaemia ?
IN order to build up iron stores, patients require 3 months of iron.
27
When is parenteral treatment used over oral treatment for iron deficiency anaemia ?
If oral treatment is ineffective or poorly tolerated
28
Parenteral treatment for iron deficiency anaemia
(used to be intramuscular - painful, multiple doses, stains skin) Now administered intravenously
29
Side effects of iron treatment (IV)
Flu like symptoms Hypersensitivity reactions Anaphylaxis
30
What is the parenteral treatment for iron deficiency anaemia ?
Ferric carboxymaltose - ferinject - over 15-30min : 2 doses Iron dextran - cosmofer - over 4-6hrs after a test dose
31
Describe B12 deficiency anaemia
MCV 100-120 Raised bilirubin and LDH levels (due to ineffective erythropoiesis)
32
Results of B12 deficiency anaemia | What conditions can it cause ?
Can cause peripheral neuropathy - demyelination and posterior column damage B12 reference range is lower in pregnancy/ oral contraceptive/ on metformin
33
Pernicious anaemia
Lack of intrinsic factor (gastric atrophy and auto antibodies to parietal cells and intrinsic factor - preventing absorption) Inability to absorb B12 from the small intestine Insufficient creation of healthy RBCs
34
Treatment for B12 deficiency anaemia
Hydroxocobalamin 1mg intra-muscular alternate days for 5 doses 3 monthly if confirmed ongoing need - pernicious anaemia
35
What is the treatment for B12 deficiency anaemia caused by a vegan diet ?
Cyanocobalamin orally
36
Pancytopenia
Deficiency of all three cellular components of the blood (red cells, white cells, and platelets).
37
Describe the development of folate deficiency
Limited stores of folate and so can develop in weeks. Poor oral intake Increased use
38
Appearance of folate deficiency
Blood count and film appearance is the same as B12 deficiency
39
What are causes of poor intake / increased use of folate ?
Pregnancy Haemolysis Malabsorption Drugs - anti epileptics / trimethoprim
40
Treatment of folate deficiency
Oral folic acid - 5mg per day
41
Function of pre-conception folic acid
0.4mg/day Reduces neural tube defects
42
Describe anaemia caused by blood loss
Each 500ml loss gives approx drop of Hb by 10-15 g/l Drop after fluid replacement or re-distribution Reticulocyte response within hours Hb will be normal after blood loss
43
Describe anaemia of chronic disease
Normocytic anaemia associated with chronic inflammatory disease.
44
Causes of anaemia of chronic disease
Plentiful iron stores but poor transfer to RBC due to hepcidin and cytokines.
45
Treatment of anaemia of chronic disease
Treating the underlying condition
46
Likelihood of getting anaemia of chronic disease (factors that increase)
History of chronic disease Inflammatory markers increased e.g. CRP/ESR
47
Describe anaemia of renal failure
Drop in Hb once creatine clearance drops below 20-30 ml/min chronically
48
Cause of anaemia of renal failure
Mainly due to a lack of erythropoietin (drives blood production) Contribution from blood loss at dialysis, inflammatory disease.
49
Treatment of anaemia of renal failure
Responds well to erythropoietin e.g. weekly / alternate weeks s/c
50
Describe anaemia - haemolysis
Increased RBC destruction, marrow can increase production 5-10 fold
51
Causes of anaemia - haemolysis
Issues to do with : - RBC membrane - RBC enzymes - Globin chains in Hb
52
Types of anaemia-haemolysis
Acute Chronic Congenital Acquired
53
Describe haemolysis to do with RBC membrane issue | State conditions
Congenital spherocytosis Auto-immune haemolysis
54
Congenital spherocytosis
Autosomal dominant defect in spectrin causing spherical cells - less able to deform, so shortened survival
55
Auto-immune haemolysis
Auto-antibodies against RBC surface antigens Fc portion recognised by macrophages in spleen
56
How is auto-immune haemolysis treated ?
Steroids / Splenectomy / Rituximab
57
Describe haemolysis to do with RBC enzyme issue
RBC enzyme deficiency - G6PD / pyruvate kinase Disseminated intravascular coagulation Prosthetic heart valve
58
Results of RBC enzyme deficiency
Causes shortened RBC survival
59
Describe haemolysis to do with globin chains in Hb issue
Haemoglobinopathy Chronic anaemia and bone/liver/lung/brain ''crisis" Shortened RBC survival
60
How is anaemia - abnormal haemoglobin treated ?
Treated by : - supportive care - hydroxycarbamide : to increase HbF production - monoclonal antibody : to prevent red cell-endothelial adhesion - stem cell transplant
61
Causes of thalassaemia (anaemia)
Imbalance of globin chain production
62
Describe beta thalassaemia
As HbF (2alpha, 2gamma) declines after birth - progressive anaemia
63
Treatment of thalassaemia
Supportive care Transfusion Stem cell transplant
64
Preventative measures for thalassaemia
Antenatal screening for Hb-opathy and thalassaemia
65
What is myeloma ?
B cell malignancy of mature plasma cells - produce monoclonal immunoglobulin or light chains
66
What does myeloma present as ?
Presents as a chance finding: - Anaemia - Renal failure - Hypercalcaemia - Bone pain - Fracture
67
Treatment of myeloma
Supportive care Chemotherapy Radiotherapy
68
How is acute leukaemia diagnosed and treated ?
Diagnosed by sampling marrow - pelvis/sternum Treated by chemotherapy/immunotherapy
69
Results of anaemia-marrow filtration
Other solid tumours can spread to the marrow e.g. prostate, breast, small cell lung
70
Examples of haematological malignancy
Lymphoma Acute leukaemia
71
Describe myelodysplasia
Marrow becomes increasingly inefficient at producing red cells, white cells and platelets. Tendency to progress to acute leukaemia. Treated by supportive care, chemotherapy or stem cell transplant in some.
72
Describe aplastic anaemia - aka pancytopenia
Expected results post-chemotherapy, but can be drug induced. e.g. NSAIDs Treated by supportive care, anti-thymocyte globulin, stem cell transplant
73
A FBC on a patient with anaemia has a significantly raised reticulocyte count. What is a specific feature of reticulocytes ?
They indicate the marrows response to anaemia
74
Anaemia of chronic disease is common both in primary and secondary care. What is the most effective treatment for this condition ?
Treating the underlying condition

Medicine Year 1 - Semester 2 - Part 2 (53 decks)

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