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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
Q

Oral treatment for iron deficiency anaemia

A

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)

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26
Q

Why should patients be given oral iron after correction of anaemia ?

A

IN order to build up iron stores, patients require 3 months of iron.

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27
Q

When is parenteral treatment used over oral treatment for iron deficiency anaemia ?

A

If oral treatment is ineffective or poorly tolerated

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28
Q

Parenteral treatment for iron deficiency anaemia

A

(used to be intramuscular - painful, multiple doses, stains skin)

Now administered intravenously

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29
Q

Side effects of iron treatment (IV)

A

Flu like symptoms
Hypersensitivity reactions
Anaphylaxis

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30
Q

What is the parenteral treatment for iron deficiency anaemia ?

A

Ferric carboxymaltose - ferinject - over 15-30min : 2 doses

Iron dextran - cosmofer - over 4-6hrs after a test dose

31
Q

Describe B12 deficiency anaemia

A

MCV 100-120

Raised bilirubin and LDH levels (due to ineffective erythropoiesis)

32
Q

Results of B12 deficiency anaemia

What conditions can it cause ?

A

Can cause peripheral neuropathy - demyelination and posterior column damage

B12 reference range is lower in pregnancy/ oral contraceptive/ on metformin

33
Q

Pernicious anaemia

A

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
Q

Treatment for B12 deficiency anaemia

A

Hydroxocobalamin

1mg intra-muscular alternate days for 5 doses

3 monthly if confirmed ongoing need - pernicious anaemia

35
Q

What is the treatment for B12 deficiency anaemia caused by a vegan diet ?

A

Cyanocobalamin orally

36
Q

Pancytopenia

A

Deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

37
Q

Describe the development of folate deficiency

A

Limited stores of folate and so can develop in weeks.

Poor oral intake
Increased use

38
Q

Appearance of folate deficiency

A

Blood count and film appearance is the same as B12 deficiency

39
Q

What are causes of poor intake / increased use of folate ?

A

Pregnancy
Haemolysis
Malabsorption
Drugs - anti epileptics / trimethoprim

40
Q

Treatment of folate deficiency

A

Oral folic acid - 5mg per day

41
Q

Function of pre-conception folic acid

A

0.4mg/day
Reduces neural tube defects

42
Q

Describe anaemia caused by blood loss

A

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
Q

Describe anaemia of chronic disease

A

Normocytic anaemia associated with chronic inflammatory disease.

44
Q

Causes of anaemia of chronic disease

A

Plentiful iron stores but poor transfer to RBC due to hepcidin and cytokines.

45
Q

Treatment of anaemia of chronic disease

A

Treating the underlying condition

46
Q

Likelihood of getting anaemia of chronic disease

(factors that increase)

A

History of chronic disease
Inflammatory markers increased e.g. CRP/ESR

47
Q

Describe anaemia of renal failure

A

Drop in Hb once creatine clearance drops below 20-30 ml/min chronically

48
Q

Cause of anaemia of renal failure

A

Mainly due to a lack of erythropoietin (drives blood production)

Contribution from blood loss at dialysis, inflammatory disease.

49
Q

Treatment of anaemia of renal failure

A

Responds well to erythropoietin

e.g. weekly / alternate weeks s/c

50
Q

Describe anaemia - haemolysis

A

Increased RBC destruction, marrow can increase production 5-10 fold

51
Q

Causes of anaemia - haemolysis

A

Issues to do with :

  • RBC membrane
  • RBC enzymes
  • Globin chains in Hb
52
Q

Types of anaemia-haemolysis

A

Acute
Chronic
Congenital
Acquired

53
Q

Describe haemolysis to do with RBC membrane issue

State conditions

A

Congenital spherocytosis

Auto-immune haemolysis

54
Q

Congenital spherocytosis

A

Autosomal dominant defect in spectrin causing spherical cells - less able to deform, so shortened survival

55
Q

Auto-immune haemolysis

A

Auto-antibodies against RBC surface antigens

Fc portion recognised by macrophages in spleen

56
Q

How is auto-immune haemolysis treated ?

A

Steroids / Splenectomy / Rituximab

57
Q

Describe haemolysis to do with RBC enzyme issue

A

RBC enzyme deficiency - G6PD / pyruvate kinase

Disseminated intravascular coagulation

Prosthetic heart valve

58
Q

Results of RBC enzyme deficiency

A

Causes shortened RBC survival

59
Q

Describe haemolysis to do with globin chains in Hb issue

A

Haemoglobinopathy

Chronic anaemia and bone/liver/lung/brain ‘‘crisis”

Shortened RBC survival

60
Q

How is anaemia - abnormal haemoglobin treated ?

A

Treated by :

  • supportive care
  • hydroxycarbamide : to increase HbF production
  • monoclonal antibody : to prevent red cell-endothelial adhesion
  • stem cell transplant
61
Q

Causes of thalassaemia (anaemia)

A

Imbalance of globin chain production

62
Q

Describe beta thalassaemia

A

As HbF (2alpha, 2gamma) declines after birth - progressive anaemia

63
Q

Treatment of thalassaemia

A

Supportive care
Transfusion
Stem cell transplant

64
Q

Preventative measures for thalassaemia

A

Antenatal screening for Hb-opathy and thalassaemia

65
Q

What is myeloma ?

A

B cell malignancy of mature plasma cells - produce monoclonal immunoglobulin or light chains

66
Q

What does myeloma present as ?

A

Presents as a chance finding:

  • Anaemia
  • Renal failure
  • Hypercalcaemia
  • Bone pain
  • Fracture
67
Q

Treatment of myeloma

A

Supportive care
Chemotherapy
Radiotherapy

68
Q

How is acute leukaemia diagnosed and treated ?

A

Diagnosed by sampling marrow - pelvis/sternum

Treated by chemotherapy/immunotherapy

69
Q

Results of anaemia-marrow filtration

A

Other solid tumours can spread to the marrow e.g. prostate, breast, small cell lung

70
Q

Examples of haematological malignancy

A

Lymphoma
Acute leukaemia

71
Q

Describe myelodysplasia

A

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
Q

Describe aplastic anaemia - aka pancytopenia

A

Expected results post-chemotherapy, but can be drug induced.

e.g. NSAIDs

Treated by supportive care, anti-thymocyte globulin, stem cell transplant

73
Q

A FBC on a patient with anaemia has a significantly raised reticulocyte count.

What is a specific feature of reticulocytes ?

A

They indicate the marrows response to anaemia

74
Q

Anaemia of chronic disease is common both in primary and secondary care.

What is the most effective treatment for this condition ?

A

Treating the underlying condition

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

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