ANAEMIAS AND BLOOD TRANSFUSIONS Flashcards
Where is bone marrow found
It occupies the medullary cavity of long bones and trabeculae spongy bone
What is bone marrow composed of
Red and yellow marrow
What is red marrow
Flat bones and ends of long bones that are responsible for making blood cells
What is yellow marrow
Middle of flat bones mainly made up of fat cells
Describe normal red cells
- Biconcave disks
2. Not nucleated
What do normal red cells do
They transport oxygen via haemoglobin
Where are normal red cells made
They are produced in the marrow under the control of the hormone erythropoietin
Where is erythropoietin made
Made in the kidneys in repose to tissue hypoxia
What is anaemia defined as
A reduction in the haemoglobin concentration of the blood
What is the normal range of haemoglobin
135-180 g/l for males
115-155 g/l for females
What is haemoglobin made up of
A module of “haem” (iron) and globin (a protein)
Before treating anaemia what must we do
Determine the cause
What can anaemia be caused by
- Blood loss
- vitamin or mineral Deficiency
- Impaired bone marrow function
- Haemolysis
Name some common vitamin deficiency’s that can lead to anaemia
- Vit b12
- Iron
- Folate
What can impaire bone marrow function
- Chemotherapy
- aplastic anaemia
- bone marrow infiltration with malignant cells
How do we investigate the underlying cause of anaemia
- Full blood count (FBC)
2. Blood films
What do blood film tell us
Gives the Hb concentration and red cell parameters such as Mean Corpuscular Volume) (MVC)and mean cell Hb
List the different types of anaemia
- Hypo-chromic microcytic anaemia
- Microcytic anaemia
- Normochromic normocytic anaemia
- Thalassemia
What is hypochromic microcytic anaemia
Pale small red blood cells
What can Hypo-chromic microcytic anaemia be caused by
- Iron deficiency
2. thalassaemia
How much iron does the normal adult body contain
3-5 grams
How many grams of iron do adult males and females need
1mg/day for men
2mg/day for women
When might women need to increase their iron content
When they are pregnant they’ll need 3-4mg/day
Where in out diet can we get iron from
- broccoli,
- beans/peas,
- potatoes with skins,
- spinach,
- iron fortified cereals, raisins,
- watermelon,
- dried apricots,
- meat,
- egg yolk,
- sea food
What can iron deficiency be caused by
- Blood loss
- Pregnancy
- Malabsorption
- Dietary
What can blood loss be caused by
- Peptic ulcers
- GI cancers
- menorrhagia,
- hookworm
List some clinical features of iron deficiency
- Fatigue, poor concentration
- Breathlessness on excretion
- Pallor
- Glossitis and angular stomatitis
- Koilonychia (concave nails)
What is the clinical presentation of iron deficiency dependant on
Severity and speed
How can we diagnosis iron deficiency
- Full blood count
- Blood film
- Plasma ferritin
- Bone marrow iron stores
What will the FBC of a patient with Hypo-chromic microcytic anaemia look like
Anaemia with low mean corpuscular volume and mean cell Hb
What will the blood film of a patient with Hypo-chromic microcytic anaemia look like
Small pale red cells that are hypochromic/Microcytic
What will the plasma ferritin of a patient with Hypo-chromic microcytic anaemia look like
Reduced
What is the normal plasma ferritin level
12-250 MCH/L
How do we treat iron deficiency anaemia
- Iron replacement with oral ferrous sulphate tablets
- IV iron if intolerant to oral iron
- Blood transfusion
What is macrocytic anaemia
Vitamin b12 or folate deficiency characterised by megaloblastic anaemia
Why is folate important
Needed for the synthesis of purine and pyramidine bases needed for DNA
Why is B12 important
Essential fro cell folate utilisation
What can happen if folate or B12 is deficient
staves DNA of bases and affects all rapidly dividing cells especially blood cells in marrow §
Where can we find B12 in our diet
Animal food sources
How much Vitamin B12 do we need
1-2mcg daily
How much vitamin B12 does our body store
1mg (enough for 5 years)
What can B12 related anaemias include
- Pernicious anaemia
- Disease/resection of the terminal ileum
- Dietary
Where is folate found
Green leafy vegetables and fruit
How much folate do we need daily
150mcg daily
How much folate does our body store
100mg
What can folate related anaemias be caused by
- Dietary deficiency
- Malabsorption
- Increased demands
List some clinical features of Microcytic anaemia
- Fatigue
- Weakness
- Breathlessness on Exertion
- Glossitis
- Neuropathies
- Aphthous stomatitis
- oral dysaesthesias
How do we treat Microcytic anaemia
supplements orally or as IM injections
What can macrocytic anaemia be caused by
- Vitamin b12 or folate deficiency
- myelodysplasia,
- haemolysis,
4, drug and alcohol, pregnancy - hypothyroidism
What does normochromic mean
Normal coloured
What does normocytic mean
Normal size
What is normochromic normocytic anaemia caused by
Chronic disease
What is thalassemia
A group of inherited conditions affecting haemoglobin characterised by the reduction or absent production of Hb
what can a reduction or absence of the production of Hb result in
Inability to carry sufficient oxygen in the blood
List some of the symptoms of thalassemia
- Shortness of breath
- Fatigue
- Fainting attacks
Name the 2 variants of thalassemia
- Trait thalassaemia = asymptomatic
2. Major thalassaemia = severe symptomatic disease
How many blood groups are there
more than 300
What systems do we use in to check blood groups
- ABO system
2. Rhesus system
What is the ABO blood system good fro
Important to match donation and patient
Name the most common blood group
O
Name the different blood groups from most common to rarest
0
A
B
AB
What is fatal haemolytic transfusion reactions caused by
Human error
How common is fatal haemolytic transfusion reactions
1 in 600,000 to 1 in 1,000,000
