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Haematology > Approach to Anaemia > Flashcards

Approach to Anaemia Flashcards

1
Q

What is anaemia defined as?

A

Reduction in Hb concentration below that which is optimum for that person or reduction in Hb concentration <95% range for population

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2
Q

When is anaemia likely to present?

A

When Hb <130g/l in men and <120g/l in women

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3
Q

What are some investigations that can be done for anaemia?

A

History/examination, FBC indices, reticulocyte count, blood film, haematinics, bone marrow biopsy, specialised test

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4
Q

What are the classes of anaemia?

A

Decreased production and increased loss or destruction of red cells

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5
Q

What are the types of anaemia that cause decreased production?

A

Hypoproliferative = reduced amount of erythropoiesis

Maturation abnormality = erythropoiesis present but ineffective

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6
Q

What are the causes of maturation abnormality that lead to decreased production?

A

Cytoplasmic defects = impaired haemoglobinisation

Nuclear defects = impaired cell division

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7
Q

What are some causes of increased loss or destruction of red cells?

A

Bleeding and haemolysis

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8
Q

What is reticulocyte count a useful marker of?

A

Red cell production

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9
Q

What is increased red cell production a sign of?

A

Regenerative anaemia = increased loss of red cells

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10
Q

What should be looked for if reticulocytosis is present?

A

Red cell breakdown products

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11
Q

How can reticulocyte count and breakdown products be used to identify bleeding as a cause of anaemia?

A

Reticulocytosis present but no red cell breakdown products = red cells are gone so nothing to breakdown

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12
Q

How can reticulocyte count and breakdown products be used to identify haemolysis as a cause of anaemia?

A

Reticulocytosis present with increased red cell breakdown products = increased unconjugated serum bilirubin and urinary urobilinogen

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13
Q

Why does reticulocytosis cause splenomegaly?

A

Work hypertrophy of macrophage rich tissues occurs

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14
Q

How much can normal marrow increase red cell production?

A

By 3-4 fold

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15
Q

What is anaemia with a lesser reticulocyte response a sign of?

A

At least partly due to impaired red cell production = reticulocyte should be appropriately increased for degree of anaemia

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16
Q

What is MCH a measure of?

A

Cell haemoglobin content

17
Q

What is the underlying mechanism of hypochromatic microcytic anaemia?

A

Due to problems with haemoglobin formation

18
Q

What is the most common cause of hypochromatic microcytic anaemia?

A

Iron deficiency = may be due to anaemia of chronic disease reducing iron availability to red cells

19
Q

What are some other causes of hypochromatic microcytic anaemia?

A

Rarely haem defects = lead poisoning, congenital sideroblastic anaemia
Globin defects = thalassaemias

20
Q

What is the underlying mechanism of macrocytic anaemia?

A

Due to nuclear maturation defects causing failure of cell division

21
Q

What are some causes of macrocytic anaemia?

A

B12/folate deficiency = causes megaloblastic anaemia

Myelodysplasia and drugs (chemotherapy)

22
Q

Why is there apparent agglutination in macrocytic anaemias?

A

Due to reticulocytosis

23
Q

What are some causes of macrocytosis without significant anaemia?

A

Hypothyroidism, alcohol, liver disease

24
Q

What type of anaemia causes normochromic normocytic anaemia?

A

Hypoproliferative

25
Q

What are the causes of normochromic normocytic anaemia?

A

Marrow failure = drugs, anaplastic anaemia (may be macrocytic)
Hypometabolic = may be macrocytic
Renal impairment and chronic disease
Marrow infiltration = metastases, fibrosis

26
Q

What causes renal anaemia?

A

Failure of erythropoietin production by the kidneys

27
Q

What is the second most common cause of anaemia?

A

Anaemia of chronic disease

28
Q

What drives the mechanisms behind anaemia of chronic disease?

A

Inflammatory cytokines = induced by chronic disease process

29
Q

What is the pathogenesis of anaemia of chronic disease?

A

Blunted erythropoietin response by kidney - impaired iron availability to erythroid precursors - inhibition of proliferation - reduced red cell survival

30
Q

What would cause anaemia of chronic disease to be microcytic?

A

If predominant mechanism is through hepcidin stimulation = reduced iron release from macrophages so low transferrin saturation despite normal ferritin

31
Q

What is the biochemistry of iron deficiency anaemia?

A

Reduced serum iron, ferritin and MCV
Normal transferrin
Reduced % transferrin saturation

32
Q

What is the biochemistry of anaemia of chronic disease?

A

Reduced serum iron and % transferrin saturation

Normal transferrin, ferritin and MCV

Haematology (24 decks)

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