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Haematology Revision > Anaemia's > Flashcards

Anaemia's Flashcards

1
Q

What is the definition of anaemia

A

A low Hb concentration in the blood

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2
Q

What are the 2 broad categories than can cause anaemia?

A

Low red cell mass or an increase in plasma volume

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3
Q

What is the defined value for anaemia in men and women?

A

<135g/L for men

<115g/L for women

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4
Q

What are the 3 morphological descriptions of anaemia?

A

Hypochromic Microcytic
Normochromic normocytic
Macrocytic

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5
Q

What are the differentiating features of the different types of anaemia?

A

Whether it is bone marrow failure, the functionality of the RBCs is wrong or there are being destroyed too quickly

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6
Q

What does MCV and MCH stand for?

A

Mean cell volume

Mean cell haemoglobin

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7
Q

What is a red cell indices?

A

Measurement of the red cell size and haemoglobin content

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8
Q

What are the general features of anaemia?

A 
Fatigue
Pallor
SOB
Ankle swelling 
Dizziness
Tinnitius 
Chest pain if severe
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9
Q

What features of anaemia point to an underlying cause?

A

Bleeding: Menorrhagia, dyspepsia and PR bleeding
Malabsorption: diarrhoea and weight loss
Jaundice, splenohepatomegaly

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10
Q

If the MCV indicates Hypochromic Microcytic anaemia then what is your next test?

A

Serum Ferratin

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11
Q

If the serum ferritin is LOW then what condition is this indicative of?

A

Iron deficiency anaemia

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12
Q

If the serum ferritin is high then what is this indicative of?

A

Thalassaemia and secondary anaemia

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13
Q

If the MCV indicates Normochromic Normocytic anaemia then what next diagnostic test will you do?

A

The reticulocyte count

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14
Q

If the reticulocyte count is low/normal in NN then what conditions is this suggestive of?

A

Secondary anaemia, bone marrow infiltration and hypoplasia

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15
Q

If the reticulocyte count is high then what is this indicative of?

A

Haemolytic anaemia or blood loss

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16
Q

If you think the condition is haemolytic anaemia then what next test would you perform?

A

DAGT - Coomb’s test

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17
Q

If Coomb’s is positive in NN anaemia then what does this indicate?

A

Immune mediated haemolytic disease

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18
Q

What are the Auto-antibody tests and what conditions do they concur to?

A

Warm auto-AB: auto-immune, drugs and CLL
Cold auto-AB: CHAD, infection and lymphoma
Allo Auto-AB: Transuction reaction

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19
Q

If the MCV indicates a Microcytic anaemia then what are your investigations?

A

B12/folate count

Bone marrow function and blood film

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20
Q

If the B12/folate/ Bm test indicates a megoblastic anaemia what 2 conditions might be causing this?

A

b12( or folate deficiency(diet, haemolysis or coeliac)

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21
Q

If the B12/folate/ Bm test indicates a megoblastic anaemia what 2 conditions might be causing this?

A

b12 (pernicious anaemia) or folate deficiency (diet, haemolysis or coeliac)

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22
Q

If the test indicates non-megobastic then what is the cause of the anaemia?

A

Marrow infiltration, drug induced

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23
Q

What is the MOST common cause of microcytic anaemia

A

Iron deficiency anaemia

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24
Q

What are the normal Hb levels in a male 12-70 and then over 70?

A

140-180

116-143

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25
Q

What are the normal Hb levels for a woman 12-70 and over 70?

A

120-160

108-143

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26
Q

Is iron deficiency a diagnosis?

A

No this is a syndrome that is caused by something else

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27
Q

Is this a common cause of anaemia?

A

Yes, the most common

28
Q

What are the causes of Fe deficiency anaemia?

A

Blood loss ie menorrhagia, or GI blood loss

Poor diet, malabsorption ie coeliac or gastrectomy, worms

29
Q

Where in the GI tract is iron absorbed?

A

The duodenum

30
Q

What is Fe bound to in the bloodstream?

A

Transferrin

31
Q

What us hepcadin and what is it made in repose to?

A

It controls iron metabolism by binding to feroportin and stopping Fe moving into the circulation, released in response to inflammation

32
Q

What are the key history questions in anaemia?

A

heavy periods?

Melenea, PR bleeding, Diet, NSAIDs and pregnancy

33
Q

What are the examination findings in anaemia?

A 
Kolinychia
Tongue pallor
Atrophic glossitis(smooth painful tongue)
angular stomatitis 
Lymphadenopathy 
Bimanual PV and smear if menorrhagia
34
Q

What is the dignostic test for iron deficiency anaemia?

A

MCV = Hypochrmoic microcytic

Serum Ferritin = diagnostics in low

35
Q

WHAT ARE THE INVESTIGATIONS TO DETERMINE THE CAUSE IF IDA?

A

Endoscopy and barium studies

36
Q

What is the treatment of IDA?

A

Diet, oral iron, Sx if bleeding

Transfusion if severe

37
Q

What is haemolytic anaemia?

A

This is the breakdown of RBC’s before their normal 120 day lifespan causing reduced iron

38
Q

Because there is increased cell degradation what happens to the action of the bone marrow?

A

The reticulocytes in the bone marrow increase to make more RBC’s

39
Q

What are the 2 spaces where the destruction of red blood cells can occur?

A

Intravascular ie within the circulation and extravascular ie within the spleen, liver and bone marrow

40
Q

What are the 2 etiological groups in HA?

A

Congenital and aquired

41
Q

What are the classical symptoms of HA?

A

Jaundice, dark urine, previous anaemia, fatigue, pallor etc

42
Q

what are the examination findings in HA?

A

Hepatosplenomegaly
Gallstones due to increased bilirubin
Leg ulcers

43
Q

What are the findings in the FBC in HA?

A

Low Hb = Normochromic normocytic, do a reticulocyte count, if it is high then this is HA
Also: raised indirect bilirubin, LDH, heptoglobulin and urinary urobilinogen

44
Q

If the reticulocyte count is high, what next test are you going to do?

A

DAGT and then the Autoantibody testing

45
Q

If there is intravascular haemolyisis then what are the clinical findings

A 
Schistocytes (red cell fragments)
↑ FREE PLASMA HAEMOGLOBIN
METHAEMALBUMINAEMIA
HAEMOGLOBINURIA 
HAEMOSIDERINURIA
46
Q

What is the treatment of HA?

A

Support the bone marrow if folate and treat the underlying cause

47
Q

What is a DAGT?

A

Detects antibody or complement on red cell membrane (reagent contains either anti-human IgG or anti-complement and binds to these on the red cell surface causing agglutination in vitro, providing an immune basis for haemolysis

48
Q

What are the conditions underlying hereditary HA?

A

hereditary Spherocytosis
Glucose-6-phosphate dehydrogenase deficiency
Haemoglobinopathy

49
Q

What are the conditions underling acquired HA?

A 
Autoimmune haemolytic anaemia
INTRAVASCULAR 
Mechanical e.g. heart valve 
Severe infection e.g. sepsis, cells burst due to toxin
Drugs
50
Q

What is secondary anaemia?

A

This is anaemia of chronic disease

51
Q

What are the 2 types that make up secondary anaemia?

A

70% normochromic normocytic

30% hypo chromic microcytic

52
Q

What are the 3 main causes pathophysiologically of SecA?

A

Defective iron utilisation(due to increased hepatic in imflam), cytokine induced shortening of the RBC’s lifespan and decreased production of RBC’s

53
Q

Name 5 Causes of SecA

A 
Chronic Infection 
Vasculitis
Rheumatoid
Malignancy 
Renal failure
54
Q

What are your diagnostic tests for SecA?

A

MCV = Normochromic Normocytic and then your reticulocyte count will either be normal or low

55
Q

What is the management of Secondary anaemia?

A

Treat the underlying cause

56
Q

What is B12 deficiency other wise known as?

A

Pernicious anaemia

57
Q

What are the causes of PA?

A

Autoimmune disease
Antibodies against Intrinsic factor and gastric parietal cells
Malabsorption of B12
Gastric/ileal disease

58
Q

What are the causes of folate deficiency?

A

Dietary
Increased requirements it haemolysis
GI pathology ie coeliac disease

59
Q

What is the cardinal feature of megoblastic anaemias?

A

Lemon yellow tinge of the skin

60
Q

What are the features of B12/Folate deficiency anaemia?

A

Irritability, depression, psychosis and dementia
Parasthesia and peripheral neuropathy
Degeneration fo the spinal cord
Classic triad of Extensor planters/ absent ankle jerks and absent knee jerks

61
Q

What are your diagnostic tests for megobalstic anaemia?

A

CV = Macrocytic and then fo a B12/folate level

LFT, bilirubin, LDH

62
Q

What are the diagnostic investigations for Perncious anaemia(autoimmune atrophic gastritis)?

A

Intrinsic factor antibodies

Parietal cell antibodies

63
Q

What is the management of Folate deficiency?

A

Adress the diet and malabsorption

Oral folic acid

64
Q

What is the treatment of B12 deficiency?

A

B12 IM injection (loading dose then 3 monthly maintenance)

65
Q

Where is B12 absorbed?

A

Distal ileum

66
Q

What are some of the other causes of macrocytosis?

A 
Alcohol
Drugs: Methotrexate, anti-retrovirals, hydroxycarbamide
Disordered LFT's 
Hypothyroidism 
Myelodysplasia
67
Q

What is sideroblasic anaemia?

A

Microcytic anaemia due to defect in the mitochondrial steps of haem synthesis

Haematology Revision (8 decks)

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