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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
Q

What is the haematocrit?

A

The amount of red blood cells in a sample of blood

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26
Q

How many globin chains are in haemaglobin?

A

Two pairs - four in total. Each chain has one haem group with a ferrous Fe2+ ion in.

27
Q

What is one example of an increase in plasma volume causing dilutional anaemia with a normal RCC and haematocrit

A

massive splenomegaly

28
Q

Microcytosis in the absence of anaemia

A

Alpha or beta thalassaemia minor

29
Q

What are the two types of dietary iron and which is best absorbed?

A

Non-haem iron from cereals and vegetables and haem iron from Hb and myoglobin. Haem iron is best absorbed.

30
Q

How is iron carried in the blood?

A

Attached to transferrin

31
Q

Tests for iron deficiency anaemia

A

Serum ferritin - Low. However inflammation and malignant disease increase levels.
Serum iron - Low.
Total Iron Binding Capacity TIBC - High

32
Q

Investigations for iron deficiency anaemia in women pre menopause

A

Serology for coeliac disease or endoscopic investigations if there are intestinal symptoms or a family history of colorectal cancer

33
Q

Findings in bone marrow of a patient with sideroblastic anaemia?

A

ring sideroblasts - erythroblasts with iron deposited in mitochondria

34
Q

Findings from tests for anaemia of chronic disease?

A

Low serum iron, low serum iron-binding capacity and increased or normal serum ferritin

35
Q

Does hepcidin increase or decrease iron absorption from the duodenum into the blood?

A

Decreases iron absoption by binding to ferrroportin, leading to the cells degrading.

36
Q

What is the commonest cause of megaloblastic anaemia?

A

B12 and folate deficiency

37
Q

What are neutrophils like in megaloblastic anaemia?

A

Hypersegmented neutrophil nucclei with six lobes and thrombocytopenia

38
Q

How is B12 carried in the blood and where is it stored?

A

Carried via transcobalamin II and stored in the liver.

39
Q

What percentage of patients with perinicous anaemia have intrisic facor antibodies?

A

50%

40
Q

Treatment of pernicious anaemia

A

intramuscular hydroxocobalamin or oral B12 2mg daily

41
Q

Signs of intravascular haemolysis

A

Raised levels of plasma Hb
Positive schumm’s test (methaemalbumin)
Very low or absent haptoglonins
Haemosiderinuria (Hb and haemosiderin)

42
Q

Hereditary spherocytosis is a deficiency in what?

A

Spectrin leading to increased sodium in the RBC

43
Q

Giveaway sign for haemolytic anaemias

A

jaundice

44
Q

What is Hb A

A

alpha2beta2 Hb, 97% of adult Hb

45
Q

What is Hb A2?

A

alpha2delta2, 2% of adult Hb, increase in B-thalassaemia

46
Q

What is Hb F?

A

Alpha2gamma2, Normal Hb in feotus from 3rd to 9th month, increased in B-thalassaemia

47
Q

What is Barts Hb?

A

Gamma4, A-thalassaemia, it is incompatible with life

48
Q

What is Hb H?

A

beta4, biologically useless, found in A-thalassaemia

49
Q

What happens in Alpha-Thalassaemia?

A

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
Q

What happens in Beta-Thalassaemia and what are the types?

A

Reduction in Beta globin chains. Three main clinical forms

  • Beta-thalassaemia minor (trait). Asymptomatic heterozygous carrier state.
  • Beta-thalassaemia intermedia.
  • Beta-thalassaemia major.
51
Q

What is beta-thalassaemia intermedia?

A

Moderate type, Hb 70-100 g/L. Does not require blood transfusions. Splenomegaly, bone deformities, recurrent leg ulcers and gallstones.

52
Q

Blood film findings in homozygous thalassaemia?

A

hypochromic/microcytic anaemia, raised reticulocyte count and nucleated red cells in the peripheral circulation.

53
Q

How do you diagnose thalassaemias?

A

Hb electrophoresis.

54
Q

Treatment of thalassaemia

A

Blood transfusions to stop ineffective erythropoiesis. Give long term folic acid and ascorbic acid 200 mg daily to increase urinary extraction of iron.

55
Q

What is inherited in Sickle cell syndrome?

A

sickle B-globin gene. in deoxygenated states the Hb S molecules are insoluble and polymerize. Cuases the production of Hb SS

56
Q

What vaccinations do sickle cell patients need?

A

Pneumococcal and influenza. Daily penicillin 500 mg orally.

57
Q

How are automimmune haemolytic anaemias diagnosed?

A

Coomb’s test for antibodies.

58
Q

What does examination of haemolytic anaemia show?

A

Haemolysis can be recognised by the presence of anaemia, which is usually macrocytic, with elevated reticulocytes count (>2%) and jaundice with unconjugated hyperbilirubinaemia.

59
Q

What should a woman with menorrhagia and iron deficiency anaemia be tested for?

A

vWD as 15% of woman with menorrhagia have it.

60
Q

What can normocytic anaemias be sub classified into?

A

Hyperproliferative (raised reticulocytes, caused by acute blood loss and haemolysis)

Hypoproliferative (No rise in reticulocytes Diseases of decreased RBC production)

61
Q

What can macrocytic anaemias be sub classified into?

A

Megaloblastic - deficiency in DNA production, presents of magaloblasts (large immature RBCs) and hypersegmented neutrophils

Non-megaloblastic - DNA production normal and no hypersegmented neutrophils

62
Q

Are B12 and folate deficiencies megaloblastic?

A

Yes

63
Q

What type of anaemia does chronic lymphocytic leukaemia cause?

A

Warm autoimmune anaemia

Year 3 (26 decks)

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