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Anemia Flashcards

1
Q

Definition of anemia

A

WHO:

Anemia is a condition in which the no. of RBCs/ their O2 carrying capacity is insufficient to meet physiologic needs which vary by age, sex, altitude, smoking and pregnancy status

Clinical practice

Hemoglobin below normal reference range for age and sex

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2
Q

Traits of RBC

A

Pink - hemoglobin

No nucleus - fill up w/ more Hb

Biconcave - for gas exchange

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3
Q

How long do RBCs circulate in the blood?

A

120 days

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4
Q

How are old RBCs broken down?

A

Macrophages

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5
Q

What are signs of anemia related to?

A

Lack of O2 in tissues

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6
Q

Symptoms of anemia

A

Fatigue

Weakness

Dyspnea

Palpitations

Dizziness

(only some listed)

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7
Q

Signs of anemia

A

Pallor

Tachycardia

Bounding pulse

Hemic murmur

Cardiac failure

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8
Q

When does conjunctival pallor happen?

A

When Hb < 9

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9
Q

When does skin crease pallor happen?

A

When Hb < 7

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10
Q

What are the parameters you look at to check for anemia?

A

MCV (size)

MCH (colour)

RDW (size distribution - how size of cells vary)

Red cell count

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11
Q

What are the 3 main cell lines use in investigations?

A

Hb

White cell

Platelet

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12
Q

How does folate deficiency affect cells?

A

Big cells

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13
Q

How does Fe deficiency affect cells?

A

Small pale cells

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14
Q

What is an easy way to classify anemia?

A

MCV

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15
Q

What does microcytic RBCs indicate?

A

Issue with ferritin

Low ferritin
- Fe deficiency

Normal/high ferritin
- thalassaemia
- inflammation anemia
- sideroblastic anemia

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16
Q

What do normocytic RBCs indicate?

A

Increased production
- acute bleeding
- haemolysis

Decreased production
- renal anemia
- inflammatory anemia
- marrow disease

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17
Q

What do macrocytic RBCs indicate?

A

Issue with folate/B12

Megaloblastic anemia
- B12/folate deficiency

Non-megaloblastic anemia
- reticulocytosis
- alcohol
- liver disease

18
Q

How is anemia classified if MCV is normal?

A

By mechanism of anemia (reduced production/ increased destruction or loss)

19
Q

What is observed when there is reduced production of RBCs?

A

Reduced reticulocytes

20
Q

Eg of anemia due to reduced production?

A

Haematinic deficiencies
- Fe, B12/folate deficiency

Reduced globin chain
- thalassaemia

Bone marrow failure
- suppression -> inflammation
- infiltration -> malignancy
- defective production -> AA, myelodysplasia

Insufficient EPO

Inability to utilise Fe

21
Q

What is observed when there is increased destruction/loss of RBCs?

A

Increased reticulocytes

22
Q

Eg of anemia due to increased destruction (hemolysis)

A

Immune
- AIHA
- CHAD
- PCH

Non-immune
- haemoglobinopathy
- membrane
- enzyme
- mechanical
- infections

23
Q

Eg of anemia due to increased loss (bleeding)

A

Menorrhagia

Surgery/trauma

GIT

Genitourinary

24
Q

Impt initial work up for anemia after hist/examination

A

Full blood count (FBC)

MCV

Reticulocyte count

Peripheral blood film

25
Q

What is special about ferritin?

A

It’s an acute phase reactant, increases w/ infection/ inflammation -> high ferritin does not always exclude Fe deficiency

26
Q

Eg of causes of increased Fe requirement

A

Pregnancy

27
Q

Eg of causes of increased Fe loss

A

GI bleed

Menstruation

28
Q

Eg of causes of decreased Fe intake

A

Vegetarianism/ veganism

Drugs that reduce stomach acidity

Lack of balanced diet

29
Q

Possible side effects of Fe supplements

A

Upset stomach

Nausea

Diarrhea

Faintness

Vomiting

Dark stools

Constipation

30
Q

Why will platelet count increase during Fe deficiency?

A

No Fe -> hematopoiesis divert to make more platelet as they come from same lineage

31
Q

What causes megaloblastic anemia?

A

B12/ folate deficiency

32
Q

Clinical presentation of megaloblastic anemia

A

Gastrointestinal
- glossitis

Neurology
- subacute combined degeneration of spinal cord (B12 deficiency) -> numbness, weakness

Psychiatric
- personality changes
- psychosis
- memory loss

33
Q

Causes of B12 deficiency

A

Mainly due to malabsorption

34
Q

Causes of folate deficiency

A

Low diet/ increased demands

35
Q

Treatment of B12 deficiency

A

IM B12 injections
- if neurological involvement -> every other day till no further improvement
- otherwise -> 6 injections over 2 weeks then monthly

Oral B12 tablets
- if Hb normalised

36
Q

Treatment of folate deficiency

A

Oral folate replacement

37
Q

What does spherocytes in PBF suggest?

A

Anemia is due to immune cause

38
Q

What do bite / blister cells in PBF suggest?

A

Anemia is due to oxidative hemolysis

39
Q

What do cell fragments in PBF suggest?

A

Anemia is due to MAHA / mechanical

40
Q

How to know if the anemia is immune-mediated?

A

Use Direct Coombs test

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