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Endo, Cardio and Neuro > Anaemia & Transfusion > Flashcards

Anaemia & Transfusion Flashcards

1
Q

what is anaemia?

A

reduced count of red blood cells in the body

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2
Q

what are the broad causes of anaemia

A

reduction in production of red cells/haem in bone marow
reduced survival of red cells in the circulation
loss of blood from the body
pooling of cells in the spleen

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3
Q

what are the types of anaemia based on size?

A

microcytic anaemia (normally hypochromic too)
macrocytic anaemia
normocytic anaemia

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4
Q

what are the causes of microcytic anemia?

A

defect in haem synthesis - iron deficiency, anaemia of chronic disease
defect in globin synthesis - a thalassemia, b thalassemia

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5
Q

how do blood results help you differentiate anaemia of chronic disease and iron deficiency anaemia?

A

AoCD - high ferritin, low/norm transferrin, high ESR

ID- low ferritin, high transferrin, may have high ESR

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6
Q

how can you differentiate iron deficiency anaemia from thalassemia trait?

A

ID- low Hb, MCV, MCHC, RBC, normal electrophoresis, low ferritin
TT - normal Hb, lower MCV, MCH, relatively preserved MCHC increased RBC, HbA2 raised in b-trait, normal ferritin

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7
Q

what are the common causes of macrocytic anaemia?

A

lack of vit B12/folic acid
drugs interfering with DNA synthesis
liver disease, ethanol toxicity
haemolytic anaemia

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8
Q

what are the causes of haemolytic anaemia?

A

all result in shortened erythrocyte survival
damage to RBC membrane - hereditary spherocytosis, autoimmune
loss of haem structure and function - sickle cell
cellular metabolism - G6PD deficiency

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9
Q

what is hereditary spherocytosis?

A

inherited defect of red blood cell membrane, have abnormal shape and decreased flexibility
haemolytic anaemia

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10
Q

symptoms of hereditary spherocytosis?

A

jaundice (UNconjugated bili)
gallstones
increased red cell fragility

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11
Q

what are the clinical test results for hereditary spherocytosis

A

increased red cell fragility in osmotic fragility test
blood film - spherocytes, increased reticulocytes (polychromatic cells)
high UNconjugated bilirubin
blood results - high LDH, hyperbilirubinaemia (UNconju), increased MCV, reduced haptoglobins, high reticulocyte count

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12
Q

what does high unconjugated bilirubin mean?

A

prehepatic cause of jaundice

caused by haemolysis

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13
Q

what does high conjugated billirubin mean?

A

decreased bilirubin elimination by hepatocytes

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14
Q

common complication of haemolytic anaemia

A

gallstones
increased breakdown of haemoglobin to bilirubin
can cause post hepatic jaundice (conjugated)

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15
Q

treatment for hereditary spherocytosis

A

folic acid (increased demand)
splenectomy
blood transfusion

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16
Q

name acquired causes of haemolytic anaemia

A 
snake venom
malaria
drug induced
haemolytic uraemic syndrome
autoimmune
alloimmune (after blood transfusion)
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17
Q

name hereditary causes of haemolytic anaemia

A

hereditary spherocytosis
sickle cell
g6pd deficiency (pentose shunt pathway defect)
pyruvate kinase deficiency (glycolytic pathway defect)

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18
Q

how to confirm if haemolytic anaemia is immune or not

A

direct antiglobulin test DAT

positive = immune basis

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19
Q

what is autoimmune haemolytic anaemia?

A

autoantibodies against own RBC via type II hypersensitivity reaction
idiopathic or associated w SLE, lymphoma etc

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20
Q

clinical presentation of autoimmune haemolytic anaemia

A

DAT positive

normocytic anaemia with high bilirubin UNconjugated
high LDH, reticulocytes,
MCV borderline raised - not high

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21
Q

what is G6PD deficiency

A

deficiency of glucose-6-phosphate dehydrogenase deficiency, x linked recessive
increased sensitivity to oxidative stress (pentose shunt pathway is normally protective)
acute haemolytic anaemia (usually triggered)

22
Q

clinical presentation of G6PD deficiency

A

jaundice - unconjugated
recticulocytosis and high MCV
blood film - ghost cells, hemighosts, heinz bodies, irregularly contracted cells

23
Q

what are heinz bodies?

A

oxidised and precipitated haemoglobin embedded in membrane on RBCs
(weird dark spots on membrane)

24
Q

what are ghost cells and hemighost cells?

A

present in G6PD deficiency
ghost - translucent cells
hemighost - half white half normal cells (irregularly contracted)

25
Q

what advice should be given to G6PD deficiency patients?

A

avoid oxidant drugs
avoid broad beans
avoid naphthalene
awareness that infection may cause haemolysis

26
Q

what is iron deficiency anaemia?

A

insufficient iron for haemoglobin synthesis

can be insufficient intake/uptake, blood loss, increased requirements

27
Q

increased blood loss iron deficiency causes

A

most common in adults
hookworm
menstrual
gastrointestinal bleed - often occult

28
Q

insufficient intake /uptake causes iron deficiency anaemia

A

dietary - veggies

malabsorption - coeliac, h.pylori gastritis

29
Q

increased iron requirements anaemia causes

A

pregnancy

infancy

30
Q

symptoms of iron deficiency anaemia

A 
fatigue
weakness
pallor
shortness of breath
headache
dizziness
spoon nails
glossitis
pallor of eyelid inside
31
Q

what are the FBC results for iron deficiency anaemia?

A

low Hb, MCV, MCHC and MCH
low ferritin, serum iron
high transferrin
no HbA2 increase

32
Q

blood film for iron deficiency anaemia

A

microcytosis
hypochromia
pencil cells/elliptocytes
target cells

33
Q

questions to ask someone with iron deficiency anaemia

A 
diet
gastrointestinal symptoms - dysphagia, malaena, change in bowel habits, dyspepsia
menstrual history
weight loss
medication history - aspirin, NSAIDs
34
Q

investigations for someone with iron deficiency anaemia, weight loss, abdo pain

A

blood in stool - faecal immunochemical test
GI investigations - upper endoscopy, colonoscopy
coeliac antibody testing

35
Q

what is anaemia of chronic disease?

A

anaemia resulting from chronic inflammation

36
Q

common causes of anaemia of chronic disease?

A

TB, HIV,
rheumatoid arthiritis
malignancy

37
Q

what is the FBC results of anaemia of chronic disease?

A

low Hb, MCV
low transferrin and ferritin
high ESR

38
Q

blood film for anaemia of chronic disease?

A

hypochromia
microcytosis
rouleaux

39
Q

pathophysiology of anaemia of chronic disease?

A

hepcidin blocks absorption and release of iron stores
hepcidin increased by inflammation (IL6, TNFa)
proinflammatory cytokines interfere with action and release of erythropoetin

40
Q

what is megaloblastic anaemia?

A

large nucleated red blood cell with immature nucleus compared to cytoplasm

41
Q

common causes of megaloblastic anaemia?

A

vit B12, folate deficiency

agents impairing DNA synthesis - azathioprine chemotherapy, folate antagonists, bone marrow cancers

42
Q

pathophysiology of megaloblastic anaemia?

A

failed DNA synthesis leads to asynchronous maturation of nucleus and cytoplasm in RBCs

43
Q

what is vitamin B12 required for?

A

DNA synthesis

integrity of nervous system

44
Q

what is folate required for?

A

DNA synthesis

homocysteine metabolism

45
Q

FBC results for megaloblastic anaemia?

A

low Hb, high MCV
high LDH, reticulocytosis
low B12 /folate

46
Q

blood film results for megaloblastic anaemia?

A

poikilocytosis

hypersegmented neutrophils

47
Q

causes of B12 deficiency

A

reduced intake - veganism, dieting
GI issues - gastrectomy, pernicious anaemia, h.pylori
bowel issues - crohns, ileal resection, tapeworm, coeliac

48
Q

mechanism of pernicious anaemia

A

lack of intrinsic factor from parietal cells

therefore B12/IF complex not absorbed in distal ileum

49
Q

causes of folate deficiency

A

diet
malabsorption - jejunal resection, coeliac
increased demand - pregnancy, lactation, haemolysis (cell turnover)

50
Q

treatment of B12 and folate deficiency

A

oral supplements

B12 hydroxycobalamin IM injections

51
Q

neurological defects associated with megaloblastic anaemia?

A

B12 - dementia, subacute combined degeneration of spinal cord
folate - neural tube defects

Endo, Cardio and Neuro (22 decks)

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