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Year 3 > Anaemia TCD > Flashcards

Anaemia TCD Flashcards

1
Q

What is the four step approach in treating anaemia of any kind?

A
  • Establish the type of anaemia
  • Find the immediate cause of the anaemia
  • Treat the anaemia
  • Investigate and treat the underlying disease process that has caused the anaemia
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2
Q

What are microcytic anaemias normally associated with?

A

Hypochromia - The red blood cells have less haemoglobin in them than normal

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3
Q

What are the two classification groups of haemolytic anaemias?

A

Congenital and acquired

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4
Q

What actually in anaemia?

A

A drop below the normal range in haemoglobin for the patient taking into account age, sex and gender and race

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5
Q

What are some symptoms of anaemia?

A

Tiredness, weakness, headaches, feeling cold, shortness of breath, chest pain, yellow or pale skin

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6
Q

What is the name for prescribed iron?

A

ferrous sulphate

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7
Q

What is the name of anaemia due to blood loss?

A

Normocytic normochromic anaemia

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8
Q

Loss of 1000ml of blood equates to a loss of how much iron?

A

500mg

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9
Q

What sort of anaemia does a lack of B12 give you?

A

Macrocytic normochromic anaemia. B12 is taken up in the ilium.

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10
Q

Most normocytic anaemias, what is the haemoglobin concentration?

A

normochromic

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11
Q

What is haemoglobin measured as?

A

A concentration, so if a patient has lost a lot of blood, the haemoglobin level will come back normal. So always consider acute blood loss

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12
Q

Signs of acute anaemia

A

Tachycardia
Low BP
Pale and clammy
Reduced BP

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13
Q

What are the three types of normocytic normochromic anaemia?

A

Acute blood loss
Anaemia of chronic disease or secondary anaemia
Anaemia of renal failure - deficiency of erythropoietin

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14
Q

What causes microcytic anaemias?

A

Anything that slows down haemoglobin production in the cell (Not actually factually accurate) e.g iron deficiency, thalassaemia, severe protein deficiency, sideroblastic anaemia (congenital)

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15
Q

What causes macrocytic anaemia?

A

Anything that delays DNA snythesis, chemotherapy, B12 deficiency, folate.

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16
Q

Commonest cause of iron deficiency in two year olds

A

Milk in diet- contains no iron and interferes with iron absorption

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17
Q

Causes of iron deficiency anaemia

A

Not enough iron in diet
Malabsorption - coeliac, milk, tea
Blood loss - GI malignancy
Rapid growth, menarch

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18
Q

If older male patient or post menopausal woman that have iron deficiency anaemia what do you need to rule out, always?

A

Colonic and Gastric cancers must be considered the likely cause until excluded

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19
Q

When can’t ferritin be used?

A

In patients with chronic rheumatoid artheritis

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20
Q

signs of iron deficiency anaemia

A 
headache on activity 
craving for non food items to eat - wall paper
sore or smooth tongues 
Brittle nails and hair loss 
Spoons shaped nails or koilonychia
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21
Q

Pernicious anaemia diagnosis

A

B12 deficiency and gastric parietal cell auto antibodies

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22
Q

B12 and folate deficiency signs

A 
Insidious onset
Mild jaundice 
Glossitis 
Angular cheilitis
Neuropathy 
 - dementia, ataxia and paraplegia
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23
Q

What is the commonest red cell disorder in northern Europeans?

A

Hereditary Spherocytosis - Autosomal dominant

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24
Q

Some facts about sickle cell disease

A

Can be a co-dominant. Infarction of the spleen leading to the patient being prone to infection. - Keep hydrated and warm. Take penicillin and pneumovax. Acute chest syndrome and stoke is more common. Regular transfusions decrease the risk of strokes.

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25
What is the haematocrit?
The amount of red blood cells in a sample of blood
26
How many globin chains are in haemaglobin?
Two pairs - four in total. Each chain has one haem group with a ferrous Fe2+ ion in.
27
What is one example of an increase in plasma volume causing dilutional anaemia with a normal RCC and haematocrit
massive splenomegaly
28
Microcytosis in the absence of anaemia
Alpha or beta thalassaemia minor
29
What are the two types of dietary iron and which is best absorbed?
Non-haem iron from cereals and vegetables and haem iron from Hb and myoglobin. Haem iron is best absorbed.
30
How is iron carried in the blood?
Attached to transferrin
31
Tests for iron deficiency anaemia
Serum ferritin - Low. However inflammation and malignant disease increase levels. Serum iron - Low. Total Iron Binding Capacity TIBC - High
32
Investigations for iron deficiency anaemia in women pre menopause
Serology for coeliac disease or endoscopic investigations if there are intestinal symptoms or a family history of colorectal cancer
33
Findings in bone marrow of a patient with sideroblastic anaemia?
ring sideroblasts - erythroblasts with iron deposited in mitochondria
34
Findings from tests for anaemia of chronic disease?
Low serum iron, low serum iron-binding capacity and increased or normal serum ferritin
35
Does hepcidin increase or decrease iron absorption from the duodenum into the blood?
Decreases iron absoption by binding to ferrroportin, leading to the cells degrading.
36
What is the commonest cause of megaloblastic anaemia?
B12 and folate deficiency
37
What are neutrophils like in megaloblastic anaemia?
Hypersegmented neutrophil nucclei with six lobes and thrombocytopenia
38
How is B12 carried in the blood and where is it stored?
Carried via transcobalamin II and stored in the liver.
39
What percentage of patients with perinicous anaemia have intrisic facor antibodies?
50%
40
Treatment of pernicious anaemia
intramuscular hydroxocobalamin or oral B12 2mg daily
41
Signs of intravascular haemolysis
Raised levels of plasma Hb Positive schumm's test (methaemalbumin) Very low or absent haptoglonins Haemosiderinuria (Hb and haemosiderin)
42
Hereditary spherocytosis is a deficiency in what?
Spectrin leading to increased sodium in the RBC
43
Giveaway sign for haemolytic anaemias
jaundice
44
What is Hb A
alpha2beta2 Hb, 97% of adult Hb
45
What is Hb A2?
alpha2delta2, 2% of adult Hb, increase in B-thalassaemia
46
What is Hb F?
Alpha2gamma2, Normal Hb in feotus from 3rd to 9th month, increased in B-thalassaemia
47
What is Barts Hb?
Gamma4, A-thalassaemia, it is incompatible with life
48
What is Hb H?
beta4, biologically useless, found in A-thalassaemia
49
What happens in Alpha-Thalassaemia?
There is a reduction in Alpha globin chains. As there are four genes for alpha haemoglobin, symptoms can vary from mild to incompatible with life.
50
What happens in Beta-Thalassaemia and what are the types?
Reduction in Beta globin chains. Three main clinical forms - Beta-thalassaemia minor (trait). Asymptomatic heterozygous carrier state. - Beta-thalassaemia intermedia. - Beta-thalassaemia major.
51
What is beta-thalassaemia intermedia?
Moderate type, Hb 70-100 g/L. Does not require blood transfusions. Splenomegaly, bone deformities, recurrent leg ulcers and gallstones.
52
Blood film findings in homozygous thalassaemia?
hypochromic/microcytic anaemia, raised reticulocyte count and nucleated red cells in the peripheral circulation.
53
How do you diagnose thalassaemias?
Hb electrophoresis.
54
Treatment of thalassaemia
Blood transfusions to stop ineffective erythropoiesis. Give long term folic acid and ascorbic acid 200 mg daily to increase urinary extraction of iron.
55
What is inherited in Sickle cell syndrome?
sickle B-globin gene. in deoxygenated states the Hb S molecules are insoluble and polymerize. Cuases the production of Hb SS
56
What vaccinations do sickle cell patients need?
Pneumococcal and influenza. Daily penicillin 500 mg orally.
57
How are automimmune haemolytic anaemias diagnosed?
Coomb's test for antibodies.
58
What does examination of haemolytic anaemia show?
Haemolysis can be recognised by the presence of anaemia, which is usually macrocytic, with elevated reticulocytes count (>2%) and jaundice with unconjugated hyperbilirubinaemia.
59
What should a woman with menorrhagia and iron deficiency anaemia be tested for?
vWD as 15% of woman with menorrhagia have it.
60
What can normocytic anaemias be sub classified into?
Hyperproliferative (raised reticulocytes, caused by acute blood loss and haemolysis) Hypoproliferative (No rise in reticulocytes Diseases of decreased RBC production)
61
What can macrocytic anaemias be sub classified into?
Megaloblastic - deficiency in DNA production, presents of magaloblasts (large immature RBCs) and hypersegmented neutrophils Non-megaloblastic - DNA production normal and no hypersegmented neutrophils
62
Are B12 and folate deficiencies megaloblastic?
Yes
63
What type of anaemia does chronic lymphocytic leukaemia cause?
Warm autoimmune anaemia

Year 3 (26 decks)

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