Approach to Anaemia (Diagnosis) Flashcards
Define anaemia (2 defininitions)
Reduction in haemoglobin concentration below that which is optimum for that individual
Reduction in haemoglobin concentration below 95% for the population
How can anaemia be classified in a broad sense?
Decreased production or increased loss/destruction
Causes of decreased production of rbcs
Hypoproliferation
Maturation abnormality
Causes of increase loss/destruction red cells
Bleeding, haemolysis
Describe a reticulocyte
Larger a mature RBC, devoid of nucleus, slightly darker than mature RBC (still have rRNA)
When is reticulocyte count increased?
In anaemic patient if the bone marrow is functioning normally. (haemolysis, blood loss)
What are the signs in the blood of increased red cell catabolism?
Increase unconjugated serum bilirubin
Increased urinary urobilinogen
What are the clinical signs of increased red cell catabolism?
Anaemia and jaundice sometimes with splenomegaly
How is red cell MCV classified?
Microcytic, normocytic, macrocytic
How is red cell colour on blood film classified?
Hypochromic, normochromic
Describe iron deficiency anaemia
Cytoplasmic maturation defect. Microcytic and hypochromic
Describe B12/folate deficiency anaemia
Nuclear maturation defect. Macrocytic megaloblastic anaemia
What are the causes of normochromic normocytic anaemia?
Acute blood loss/ early iron deficiency Renal failure Hypometabolic state Marrow failure Chronic inflammatory, infective, malignant disorders
What are the pathophysiological processes involved in anaemia of chronic disease?
Blunted EPO response
Impaired iron availability to erythroid precursors
Inhibition of erythroid precursor proliferation and differentiation
Reduced red cell survival
How to tell the difference between iron deficiency anaemia and anaemia of chronic disease?
reduced serum iron vs - normal increased transferrin vs normal or reduced reduced % transferrin saturation vs - reduced ferritin vs normal or increased Reduced MCV vs Normal
