Anemia Flashcards
Causes of folate deficiency
Lack of veg + fruit diet. Small bowel disease. Pregnancy. Old age. Poverty. Antiepileptic drugs (Phenytoin)
Causes of iron deficiency
GI bleed, NSAIDs, anticoagulants, poor diet, pregnancy, menses
Causes of B12 deficiency
Lack of meat (vegetarians), ileal resection, pernicious anemia, gastric surgery, H2 rec blockers/ PPIs, metformin
Other than iron def, what are the next main DDx of microcytic hypochromic anemia?
“TIS”: Thalassemia trait, iron def, sideroblastic
Features of iron deficiency anemia?
Angular cheilitis/stomatitis, glossitis, koilonychia, pica
Se Ferritin levels for microcytic anemias: iron def, sideroblastic, thalassemia
Iron def: low se Ferr
Sideroblastic: high/N
Thalassemia: high/N
Mx of iron def anemia + SE
Ferrous sulphate. SE: black stools, constipation
How to diagnose thalassemia
Hb electrophoresis = elevated HbA2.
Microcytic hypochromic anemia.
Abnormal RBCs= tear drop, target
Why is iron supplement contraindicated in thalassemia
Abnormal erythropoiesis suppresses hepcidin –> allowing unregulated iron absorption –> secondary haemochromatosis.
Treatment of thalassemia
Blood transfusions (Hb + packed red cells) + desferrioxamine (iron chelator)
MAHA features on blood film
Schistocytes
Causes of MAHA
HUS; DIC; TTP
Clinical features of HUS - N.B. do not give Abx. Mx with fluids + blood transfusion
Child with recent E.coli infection, bloody diarrhea, abdo pain, anemia, haematuria, HTN
Platelets and INR/APTT levels in DIC
Low platelets. high INR/APTT
Management of DIC (caused by cancer or infection)
Do not do anything if not actively bleeding. If actively bleeding, give cryoprecipitate (fibrinogen) + FFP (clotting factors)
Immune mediated haemolytic anemia caused by auto-ab e.g. in CLL, penicillin. Investigations?
Blood film: spherocytes
Direct Coombs test: test for human Ig
Indirect Coombs test: test for autoAbs against recipient’s blood
Mx: IVIg –> prednisolone
Clinical features of B12 deficiency
Sensory ataxia, peripheral neuropathy, glossitis, vitiligo
Mx: IM B12 (hydroxocobalamin)
Causes of normocytic anemia
Acute blood loss BM suppression (lymphoma, aplastic anemia) Chronic disease (inflammation, malignancy, CKD) Destruction (haemolysis - G6PD def, spherocytosis)
Causes of prolonged INR + normal APTT
Warfarin, Antiphospholipid syndrome
Prolonged APTT + normal INR
Heparin, Haemophilia, VwD, Lupus anticoagulant
Management of VwD
Desmopressin (DDAVP infusion)
Difference between ITP + TTP
ITP is idiopathic due to antiplatelet Abs.
TTP is due to genetic deficiency of ADAMTS13; often coupled with HUS. “FAT RN”: fever, anemia, thrombocytopenia, renal failure, neuro (confusion)
Treatment of ITP
Corticosteroids
Tumorlysis syndrome: which electrolytes are affected
Dead cells release uric acid, PO4, K+
