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Haematology > Anaemias > Flashcards

Anaemias Flashcards

1
Q

What is anaemia?

A

Defined as a decrease in haemoglobin or red blood cells.

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2
Q

How does anaemia present?

A
  • Fatigue
  • Dyspnoea/orthopnoea
  • Palpitations, tachycardia
  • Headache
  • Confusion, lack of concentration
  • Skin/conjunctival pallor
  • Dry skin, thin hair, nail ridges
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3
Q

What is aplastic anaemia?

A
  • Pancytopenia due to bone marrow damage
  • Presents with low reticulocytes, neutropenia and thrombocytopenia
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4
Q

What are the classifications for aplastic anaemia?

A
  • Non-severe:
    • Does not fit criteria for severe/very severe
  • Severe:
    • Neutrophils < 0.5 x 109/L
    • Platelets < 20 x 109/L
    • Reticulocytes < 20 x 109/L
  • Very severe:
    • Same as severe
    • BUT neutrophils < 0.2 x 109/L
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5
Q

What is myelodysplastic syndrome?

A
  • It is a group of clonal haematopoietic stem cell disorders that cause:
    • Dysplastic HSC
    • Peripheral pancytopenia
    • Hyper/Hypocellular bone marrow
  • Can progress to acute myeloid lymphoma
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6
Q

What is microcytic anaemia? 5 examples

A
  • When the MCV is below the normal (80-100)
  • Examples:
    • Thalassemia
    • Anaemia of chronic disease
    • Iron deficiency
    • Lead poisoning
    • Sideroblastic
  • REMEMBER: TAILS
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7
Q

What is normocytic anaemia? 4 examples

A
  • When the MCV is normal
  • Examples:
    • Acute blood loss
    • Bone marrow failure
    • Chronic disease
    • Destruction (haemolytic anaemia)
  • REMEMBER: ABCD
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8
Q

What is macrocytic anaemia? 6 examples

A
  • When MCV is greater than the normal
  • Examples:
    • Foetus (pregnancy)
    • Alcohol
    • Thyroid (hypothyroidism)
    • Reticulocytosis
    • B12/Folate (causes megaloblastic macrocytic anaemia)
    • Cirrhosis
  • REMEMBER: FAT Red Blood Cell
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9
Q

If someone is suffering from iron toxicity? What must be given?

A
  • Immediately give:
    • Desferrioxamine (binds to iron in bowel)
    • Deferiprone (complexes with ferric iron)
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10
Q

What are three causes of iron deficiency anaemia?

A
  • Increased demand for iron (pregnancy, frequent blood donations, childhood)
  • Chronic bleeding (menorrhagia, peptic ulcers, haemorrhoids)
  • Inadequate absorption (poor diet, coeliac)

NOTE: it makes up 30% of all anaemia diagnoses

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11
Q

How does iron deficiency anaemia present?

A
  • Glossitis, stomatitis
  • Koilonychia
  • Dry/pale skin, hair loss
  • PICA (eating/craving weird things)
  • Splenomegaly
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12
Q

What will be noticed on an iron deficient blood film and iron study?

A
  • Blood film:
    • Hypochromic microcytic
    • Poikilocytosis (varied cell shape)
    • Elliptocytes (pencil-shaped cells)
    • Anisocytosis (variation in size)
  • Iron studies:
    • Decreased serum iron, serum ferritin
    • Increased transferrin, decreased transferring saturation
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13
Q

What is the pathophysiology of B12 deficient anaemia?

A
  • Usually due to malabsorption:
    • Pernicious anaemia (antibody against intrinsic factor or parietal cells present)
    • Gastrectomy
    • Inflammatory bowel disease
  • Inadequate intake (vegan diet)
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14
Q

How does B12 deficiency anaemia present clinically?

A
  • Anaemia symptoms (lethargy, pallor, etc)
  • Glossitis
  • Neurological issues (peripheral neuropathy, numbness, dementia)
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15
Q

How do you diagnose B12 deficiency anaemia?

A
  • FBC:
    • Decreased haemoglobin
  • Blood film:
    • Megaloblastic macrocytic
    • Oval macrocytes
    • Pancytopenia
    • Poikilocytosis
  • Autoantibody screen
  • Schilling test (measures B12 absorption with and without intrinsic factor)
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16
Q

How do you treat B12 deficiency anaemia?

A
  • Treat with hydroxocobalamin
    • ​Pernicious anaemia requires lifelong treatment
17
Q

What is the aetiology of folate (B9) deficiency?

A
  • Dietary deficiency:
    • Chronic alcoholics
    • Poor + elderly
    • Overcooking vegetables
  • Malabsorption
  • Increased requirement (pregnancy, chronic haemolysis)
  • Phenytoin - AE is that it decreases folate absorption
  • Methotrexate toxicity - AE is that it is a folate antagonist
18
Q

How does folate deficiency present?

A

Present similar to B12 deficiency, but without the neurological defects. It can cause neural tube defects in pregnancy though.

19
Q

What are haemolytic anaemias? Provide examples

A
  • This is when RBCs are destroyed faster than they can be made
  • Examples:
    • Thalassemia
    • G6PD deficiency
    • Sickle cell anaemia
    • Hereditary elliptocytosis
    • Microangiopathic haemolysis
    • Autoimmune haemolysis
    • Hereditary spherocytosis
20
Q

What is the pathophysiology of G6DP deficiency anaemia?

A
  • X-linked glucose-6-phosphate dehydrogenase deficiency -> RBCs more prone to oxidative stress -> haemolysis
21
Q

How doe G6PD deficiency anaemia present?

A
  • Commonly aSx
  • Dark red/black urine (haemoglobinuria)
  • Prolonged/Severe neonatal jaundice
22
Q

What can trigger G6PD deficiency?

A
  • Fava beans/Broad beans
  • Acute illness/infection
  • Medications
23
Q

What is sideroblastic anaemia?

A

When the body fails to produce haem

24
Q

What is thalassemia? What are the three types?

A
  • Congenital alpha or beta Hb chain deletions
  • Types:
    • Thalassemia trait: aSx, microcytosis
    • Thalassemia intermedia: intermittent haemolysis
    • Thalassemia major: 2 beta chains deleted
25
Q

How do you diagnose thalassemia?

A
  • Haemoglobin electrophoresis
  • Blood film:
    • Microcytic hypochromic
    • Target cells
    • Anisocytosis
    • Poikilocytosis
26
Q

What is sickle cell anaemia?

A
  • When the RBCs are sickle shaped
  • Repeated sickling of RBC weakens the membranes, leading to:
    • Anaemia
    • Spillage of haemoglobin (decrease in haptoglobin, increase in unconjugated bilirubin - causes jaundice and gall stones)
  • Sickle cell shape also causes vaso-occlusion
27
Q

What are the consequences of vaso-occlusion in sickle cell anaemia?

A
  • Bones: dactylitis, avascular necrosis
  • Splenic infarct
  • Brain: stroke
  • Lungs: acute chest syndrome
  • Kidneys: haematuria, proteinuria
  • Penis: priapism (painful, prolonged erection)
28
Q

How do you manage sickle cell anaemia?

A
  • O2 + fluids
  • Opioids for the pain
  • Infection prophylaxis:
    • Penicillin + polysaccharide vaccine against strep. pneumoniae
  • Blood transfusion
  • Bone marrow transplant
  • Hydroxyurea to increase gamma-globin and increase foetal Hb

Haematology (5 decks)

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