Anaemias Flashcards
What is anaemia?
Defined as a decrease in haemoglobin or red blood cells.
How does anaemia present?
- Fatigue
- Dyspnoea/orthopnoea
- Palpitations, tachycardia
- Headache
- Confusion, lack of concentration
- Skin/conjunctival pallor
- Dry skin, thin hair, nail ridges
What is aplastic anaemia?
- Pancytopenia due to bone marrow damage
- Presents with low reticulocytes, neutropenia and thrombocytopenia
What are the classifications for aplastic anaemia?
- 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
What is myelodysplastic syndrome?
- 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
What is microcytic anaemia? 5 examples
- When the MCV is below the normal (80-100)
- Examples:
- Thalassemia
- Anaemia of chronic disease
- Iron deficiency
- Lead poisoning
- Sideroblastic
- REMEMBER: TAILS
What is normocytic anaemia? 4 examples
- When the MCV is normal
- Examples:
- Acute blood loss
- Bone marrow failure
- Chronic disease
- Destruction (haemolytic anaemia)
- REMEMBER: ABCD
What is macrocytic anaemia? 6 examples
- 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
If someone is suffering from iron toxicity? What must be given?
- Immediately give:
- Desferrioxamine (binds to iron in bowel)
- Deferiprone (complexes with ferric iron)
What are three causes of iron deficiency anaemia?
- 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
How does iron deficiency anaemia present?
- Glossitis, stomatitis
- Koilonychia
- Dry/pale skin, hair loss
- PICA (eating/craving weird things)
- Splenomegaly
What will be noticed on an iron deficient blood film and iron study?
- 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
What is the pathophysiology of B12 deficient anaemia?
- Usually due to malabsorption:
- Pernicious anaemia (antibody against intrinsic factor or parietal cells present)
- Gastrectomy
- Inflammatory bowel disease
- Inadequate intake (vegan diet)
How does B12 deficiency anaemia present clinically?
- Anaemia symptoms (lethargy, pallor, etc)
- Glossitis
- Neurological issues (peripheral neuropathy, numbness, dementia)
How do you diagnose B12 deficiency anaemia?
- FBC:
- Decreased haemoglobin
- Blood film:
- Megaloblastic macrocytic
- Oval macrocytes
- Pancytopenia
- Poikilocytosis
- Autoantibody screen
- Schilling test (measures B12 absorption with and without intrinsic factor)
How do you treat B12 deficiency anaemia?
- Treat with hydroxocobalamin
- Pernicious anaemia requires lifelong treatment
What is the aetiology of folate (B9) deficiency?
- 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
How does folate deficiency present?
Present similar to B12 deficiency, but without the neurological defects. It can cause neural tube defects in pregnancy though.
What are haemolytic anaemias? Provide examples
- 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
What is the pathophysiology of G6DP deficiency anaemia?
- X-linked glucose-6-phosphate dehydrogenase deficiency -> RBCs more prone to oxidative stress -> haemolysis
How doe G6PD deficiency anaemia present?
- Commonly aSx
- Dark red/black urine (haemoglobinuria)
- Prolonged/Severe neonatal jaundice
What can trigger G6PD deficiency?
- Fava beans/Broad beans
- Acute illness/infection
- Medications
What is sideroblastic anaemia?
When the body fails to produce haem
What is thalassemia? What are the three types?
- Congenital alpha or beta Hb chain deletions
- Types:
- Thalassemia trait: aSx, microcytosis
- Thalassemia intermedia: intermittent haemolysis
- Thalassemia major: 2 beta chains deleted
