Anaemia (zero to finals) Flashcards
What is haemoglobin?
A protein found in red blood cells. Haemoglobin is responsible for picking up oxygen in the lungs and transporting it to the body’s cells.
Iron is essential in creating haemoglobin and forms part of it’s structure.
What is anaemia?
Defined as a low concentration of haemoglobin in the blood.
This is the consequence of an underlying disease, not a disease itself.
What is mean cell volume (MCV)?
Refers to the size of the red blood cells and is highly relevant in anaemic patients.
What are the normal haemoglobin and MCV ranges for men and women?
Haemoglobin:
Men: 130-180g/l
Women: 120-165g/l
MCV (mean cell volume):
Men: 80-100 femtolitres
Women: 80-100 femtolitres
What are the main 3 categories for anaemia and what are they based on?
Anaemia is divided into 3 main categories based on the MCV:
Microcytic anaemia (low MCV)
Normocytic anaemia (normal MCV)
Macrocytic anaemia (high MCV)
The mnemonic for remembering the causes of microcytic anaemia is “TAILS”, what does this stand for?
T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia
What is sideroblastic anaemia?
A disorder where the body produces enough iron but is unable to put it into the haemoglobin.
Why does anaemia of chronic disease often occur with chronic kidney disease, how is this treated?
Occurs due to reduced production of erythropoietin by the kidneys, the hormone responsible for stimulating red blood cell production.
Treatment is with erythropoietin.
What are the 3A’s and 2H’s for the causes of normocytic anaemia?
A – Acute blood loss
A – Anaemia of chronic disease
A – Aplastic anaemia
H – Haemolytic anaemia
H – Hypothyroidism
What are the 2 main types of macrocytic anaemia?
Can be normoblastic or megaloblastic
What does megaloblastic anaemia occur as a result of?
Megaloblastic anaemia results from impaired DNA synthesis, preventing the cells from dividing normally.
Rather than dividing, they grow into large, abnormal cells.
2 major causes of megaloblastic anaemia?
B12 deficiency
Folate deficiency
Main causes of normoblastic macrocytic anaemia?
Alcohol
Reticulocytosis (usually from haemolytic anaemia or blood loss)
Hypothyroidism
Liver disease
Drugs, such as azathioprine
What is reticulocytosis?
Reticulocytosis refers to an increased concentration of reticulocytes (immature red blood cells).
This happens when there is a rapid turnover of red blood cells, such as with haemolytic anaemia or blood loss.
What are the main generic symptoms of anaemia?
Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions, such as angina, heart failure or peripheral arterial disease
What are some symptoms that are specific to iron-deficiency anaemia?
Pica (dietary cravings for abnormal things, such as dirt or soil)
Hair loss
What are generic signs of anaemia?
Pale skin
Conjunctival pallor
Tachycardia
Raised respiratory rate
What is koilonychia and what can it indicate?
Koilonychia refers to spoon-shaped nails and can indicate iron deficiency anaemia
What is angular cheilitis and what can it indicate?
A common inflammatory skin condition. It affects one or both corners of your mouth and causes irritated, cracked sores.
Angular cheilitis can indicate iron deficiency anaemia
What is atrophic glossitis and what can it indicate?
Atrophic glossitis is a smooth tongue due to atrophy of the papillae and can indicate iron deficiency anaemia
What can brittle hair and nails be an indication of?
Iron deficiency anaemia
What can jaundice be an indication of?
Haemolytic anaemia
What can bone disorders be an indication of and why?
Thalassaemia
Ineffective erythropoiesis causes bone marrow expansion.
This causes the bones to widen. This can result in abnormal bone structure, especially in your face and skull.
Bone marrow expansion also makes bones thin and brittle, increasing the chance of broken bones.
Oedema, hypertension and excoriations can be an indication of what underlying disease?
Oedema, hypertension and excoriations on the skin can indicate chronic kidney disease
What is full blood count used for in anaemia?
Assess MCV and haemoglobin levels
What is reticulocyte count used for in anaemia?
Indicates red blood cell production
What are liver function tests used for and what could it be raised?
For liver disease and bilirubin (raised in haemolysis/haemolytic anaemia)
What can ferritin blood test be used to check for?
Iron
What can direct Coombs test assess for?
Autoimmune haemolytic anaemia
What are intrinsic factor antibodies used to assess for?
Pernicious anaemia
What can haemoglobin electrophoresis test for?
Thalassaemia and sickle cell anaemia
What is pernicious anaemia?
Pernicious anaemia is an autoimmune condition involving antibodies against the parietal cells or intrinsic factor
If Coombs test is positive, what could it indicate?
Can indicate haemolytic anaemia, which is when the bloodstream doesn’t contain enough red blood cells due to premature death.
What are the 2 main types of Coombs (antiglobulin tests)?
Direct and indirect Coombs test
What is the direct Coombs test?
Detects antibodies or complement proteins that are already bound to the surface of red blood cells.
What is the procedure for direct Coombs test?
Blood from the patient is taken, and the red blood cells are washed to remove any unattached antibodies.
Antiglobulin reagent (Coombs reagent) is then added to see if it binds to any antibodies or complement proteins already on the patient’s red blood cells.
What can the direct Coombs test be used for?
Used in diagnosing autoimmune hemolytic anaemia, haemolytic disease of the newborn, and some drug-induced haemolytic anaemias.
What is the indirect Coombs test?
Detects antibodies circulating in the plasma that may attack red blood cells in the future.
What is the procedure for indirect Coombs test?
Blood from the patient is taken, and the plasma (liquid portion of blood) is separated.
This plasma is then mixed with donor red blood cells known to have certain antigens.
Antiglobulin (Coombs) reagent is added to see if antibodies in the patient’s plasma react with the donor red blood cells.
What can the indirect Coombs test be used for?
Used in blood typing, crossmatching for blood transfusions, and detecting antibodies in conditions like Rh incompatibility between a pregnant woman and her foetus.
What is the role of gastric parietal cells?
play a role in gastric homeostasis, as well as in the absorption of vitamin B12 (cobalamin) due to the release of intrinsic factor (IF).
What are intrinsic factors?
A glycoprotein produced by the parietal cells (oxyntic cells) located at the gastric body and fundus. Intrinsic factor plays a crucial role in the transportation and absorption of the vital micronutrient vitamin B12 (cobalamin, Cbl) by the terminal (distal) ileum
Causes of normocytic anaemia (mnemonic ABCD)?
Acute blood loss
Bone marrow failure
Chronic disease
Destruction (haemolysis)
Non-megaloblastic causes of macrocytic anaemia (mnemonic HAND LAMP)?
Hypothyroidism
Aplastic anaemia
Neonates
Drugs
Liver disease
Alcohol
Myelodysplasia (cancer where immature blood cells in bone marrow don’t mature)
Pregnancy
Megaloblastic causes of macrocytic anaemia?
B12 deficiency (e.g. pernicious anaemia)
Folate deficiency (e.g. dietary insufficiency - leafy green vegetables and beef liver)
