Approach to Anaemia Diagnosis Flashcards
what is anaemia
reduction in Hb concentration below that which is optimum for that individual
reduction in Hb concentration below 95% range for the population
investigations for anaemia
history/examination/clinical context full blood count reticulocyte count blood film features haematinics (ferritin,B12,folate) bone marrow biopsy specialised test (HbA2, HPLC)
causes of decreased production anaemia
reduced production of normal RBCs (eg. renal anaemia with not enough epo)
Maturation abnormality - normal production of abnormal cells (impaired haemoglobin or impaired cell division)
what is suggested if there is an anaemia with a high reticulocyte count
haemolysis or blood loss
- look for red cell breakdown products
what is suggestive of BLEEDING
high reticulocyte count
anaemia
no evidence of red cell breakdown products
what is ‘work hypertrophy”
when you get splenomegaly because the spleen is working hard breaking down RBCs
what does automated cell counting allow you to do
MCV - cell size
MCH - cell Hb content
causes of hypochromic microcytic anaemia
iron deficiency
-most common cause - find out why
heme defects (rare)
- lead poisoning
- congenital sideroblastic anaemia
globin defects
-thalassaemias
causes of macrocytic anaemias
Nuclear maturation defects
- nutitional (B12/folate)
- myelodysplasia
- drugs
Apparent (false)
- agglutination before going through machine
- increased reticulocytes
causes of macrocytosis without anaemia
hypothyroidism
alcohol
liver disease
what is normochromic normocytic anaemia
Hypoproliferative anaemia
-producing normal cells just not enoug
causes of normochromic normocytic anaemia
- marrow failure
- hypometabolic
- marrow infiltration
- renal impairment
- chronic disease
what is renal anaemia
Anaemia of CKD due to failure of erythropoietin production
what is anaemia of chronic disease
multifactorial pathophysiology with inflammation
v common
inflammation causes cytokine release
this increases hepcidin synthesis
hepcidin prevents the release of iron from duodenal cells
leads to low serum iron
also blunted depo response
inhibition of proliferation
reduced red cell survival
why can anaemia of chronic disease sometimes by microcytic
if the predominant mechanism is through hepcidin stimulation
- reduced iron
- low transferrin saturation/normal or raised ferritin
- responds to IV iron
