Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MedEd + PathSoc + Laz's Qs + Romesh Path > Anaemias - macro and microcytic > Flashcards

Anaemias - macro and microcytic Flashcards

1
Q

What does anaemia mean?
What are the tresholds for this in men and women?

A

Reduced ability to deliver oxygen due to a lower number of RBCs or a decreased amount of haemoglobin.

Men Hb < 130 g/ml
Women Hb < 120g/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three main mechanisms of anaemia? + examples of each?

A

Blood loss ​- Trauma or GI bleeding ​

Decreased RBC production ​- IDA, B12 deficiency, Thalassaemia, Malignancy

Increased RBC destruction - Haemolytic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can anaemia be classified?

A

Microcytic ​

Normocytic ​

Macrocytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main differentials in a microcytic anaemia? Hence what Ix are important?

A

IDA
Thalassaemia
Sideroblastic anaemia

Ix:

  • Peripheral blood smear
  • Iron Studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of IDA?

A

Occult blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the findings of IDA on:
Peripheral blood smear
Iron studies
FBC

A

Peripheral blood smear:
- Pencil cels

Iron studies:

  • Low iron
  • Low ferritin (storage marker for iron hence low)
  • High transferrin (compensatory rise - made in liver, may be low in liver disease)
  • Raised TIBC (rises when iron needs to be maintained by body)

FBC:
- Reactive thrombocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the realationship between ferritin and transferrin?

A

Ferritin stores iron and releases it in a controlled fashion

Serum Transferrin increases in IDA, as the liver increases transferrin production to bind to as much available iron it can to compensate for low iron levels

NB: in liver disease transferrin can be low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mx of IDA?

A

Investigate underlying cause, iron supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What conditions can show ‘pencil cells’ on peripheral blood smear?

A

IDA, Thalassemia and PK deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different types of thalassaemia?

A

a-thalassaemia

b-thalassaemia

thalassaemia trait (can be a- or b-)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the key ix findings of thalassaemia?

A

Peripheral blood smear:

  • Basophillic stippling (aggregation of ribsomal material in cytoplasm - seen as purple dots in rbcs)
  • Target cells (RBCs with a central area of staining)

Iron studies:
- Iron, ferritin, transferrin and TIBC = All normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What conditions can show target cells on peripheral blood smear?

A

Thalassaemia, hyposplenism, hepatic failure, haemoglobinopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What poisoning can cause basophillic stippling as well (as in thalassaemia)?

A

Lead poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mx of thalassaemia?

A

Iron supplementation, regular transfusions, iron chelation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the levels of Hb, serum iron, TIBC / Transferrin, transferrin saturation and ferritin in:

IDA
Anaemia of Chronic Disease
Thalassaemia trait

A

IDA:
Hb - Low
Serum iron - Low
Ferritin - Low
TIBC / Transferrin - Raised
Transferrin saturation - Low

Anaemia of Chronic Disease:
Hb - Low
Serum iron - Low
Ferritin - Normal or High (in acute phase)
TIBC / Transferrin - Normal / Low
Transferrin saturation - Normal

Thalassaemia trait:
Hb - Normal / low
Serum iron - Normal
Ferritin - Normal
TIBC / Transferrin - Normal
Transferrin saturation - Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is sideroblastic anaemia? How can this be caused

A

Sideroblastic anemia: iron is available but the body cannot incorporate it into hemoglobin.

This forms iron laden mitochondria

This can be congenital or accquired (alcohol, lead poisoning)

17
Q

Key features in Ix of sideroblastic anaemia?

A

Peripheral blood smear – basophilic stippling

Iron studies – ↑iron, ↑ferritin, ↓transferrin, ↓TIBC

Bone marrow – ringed sideroblasts

18
Q

Mx of sideroblastic anaemia?

A

Treat underlying cause, regular transfusions

19
Q

What are some key differentials to be considered in macrocytic anaemia? Hence what ix should be offered?

A

Megaloblastic anaemia: vitamin B12 deficiency, folate deficiency
Non-megaloblastic: Alcohol, Hypothyroidism, pregnancy

Key investigations

  • Peripheral blood smear
  • LFTs
  • TFTs
20
Q

How can alcohol and hypothyroidism cause a macrocytic anaemia?

A

Alcohol - Deposition of cholesterol into erythrocyte membranes causing their SA to rise (raised MCV)

Hypothyroidism - Thyroxine important of EPO production hence without it -> anaemia

21
Q

What are the dietary sources of B12 and Folate?

A

Vitamin B12: meat, fish, eggs, dairy products

Folate: leafy green vegetables, such as cabbage and kale.

22
Q

How to differentiate between the different causes of megaloblastic anaemia?

A

Duration – months for folate deficiency, years for vitamin B12 deficiency

Clinical findings – vitamin B12 deficiency associated with neurological changes

Serum methylmalonic acid – elevated in vitamin B12 deficiency

Schilling test – positive in vitamin B12 deficiency 2º to pernicious anaemia (not really used much anymore)

Drug history – phenytoin inhibits folate absorption

23
Q

Which type of anaemia is methylmalmonic acid elevated in and why?

A

Megaloblastic anaemia due to B12 deficiency

Methylmalonic acid is converted to succinyl-CoA using vitamin B12 as a cofactor

Vitamin B12 deficiency, therefore, can lead to increased levels of serum methylmalonic acid

24
Q

How to tell the difference between the different causes of non-megaloblastic anaemia?

A

Causes: Alcohol, hypothyroidism, pregnancy

History – features of hypothyroidism

Clinical findings – hepatomegaly, gynaecomastia, abdominal veins, ascites, jaundice

LFTs – ↑AST, ↑ALT, ↑GGT, AST:ALT >2:1 (alcoholic)

TFTs – ↑TSH, ↓T3/T4, anti-thyroid peroxidase antibodies

25
Q

Mx of non-megaloblastic anaemia?

A

Treat underlying cause

26
Q

What protein is classically mutated in hereditary spherocytosis?

A

Spectrin

27
Q

Long-term alcoholic

A blood film is ordered and reveals the presence of immature red blood cells with inclusions of iron deposits in a ring formation.

What type of anemia does this patient have?

A

Sideroblastic anaemia

28
Q

What is the most common cause of iron deficiency anaemia in the developing world?

A

Hookworm

29
Q

Ix of unexplained IDA?

A

Unexplained IDA should have OGD, Colonoscopy, Urine dip and investigations for coeliac disease

30
Q

A 56 year old man is reviewed by his GP after his blood tests suggested a new microcytic anaemia.

His ferritin and serum iron is low.

What is the next most appropriate blood test to request?

A

Anti Tissue Transglutaminase Antibodies

31
Q

What is the most sensitive biomarker for iron deficiency anaemia?

A

Serum Ferritin

MedEd + PathSoc + Laz's Qs + Romesh Path (99 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions