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HAEMATOLOGY > Approach to Anaemia Diagnosis > Flashcards

Approach to Anaemia Diagnosis Flashcards

1
Q

What is anaemia?

A

Reduced haemoglobin concentration that is not optimal for that individual

(usually <95% range for the population)

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2
Q

What are the normal Hb concentrations in children?

A

6 months - 6 years = 110g/L

6-14 years = 120 g/L

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3
Q

What is the difference in normal Hb concentrations between females who are and are not pregnant?

A

Not pregnant - 120

Pregnant - 110

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4
Q

What would you identify in a patient’s blood count if the anaemia is part of a wider bone marrow production problem?

A

Check rest of the blood count for pancytopenia

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5
Q

How can anaemia be classified

A

Decreased production

  • Hypoproliferative (decreased erythropoiesis)
  • Maturation abnormality (cytoplasm/nuclear)

Loss/destruction of RBCs

  • Bleeding
  • Haemolysis
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6
Q

What type of blood count can show there is increased red cell production due to stress on bone marrow?

A

Reticulocyte count

- shows RBCs trying to regenerate due to depletion

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7
Q

Loss or destruction of RBCs will induce a reticulocytosis. What should you look for to distinguish between these two causes for a high retic. count?

A

Blood breakdown products

  • bilirubin
  • urinary urobilinogen
  • this tells you haemolysis is occurring
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8
Q

By how much can the bone marrow increase its normal level of cell production?

A

3-4 fold

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9
Q

By how much can reticulocyte count be increased from normal in times of need?

A

6-8 fold

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10
Q

What are the causes of a hypochromic microcytic anaemia?

A

Iron deficiency
Thalassemia (globin deficiency)
Prophyrin ring abnormality (lead poisoning)

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11
Q

Why does iron deficiency cause cells to be small?

A
  • Less iron to make Hb
  • Hb doesnt attach to RBC => required concentration of Hb NOT reached
  • Hb conc. would normally cause the nucleus to leave the cell
  • instead nucleus causes further cell divisions that make the cell smaller than normal
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12
Q

What are the potential causes of a macrocytic anaemia?

A
  • Nuclear maturation defects - failure of cell division
  • Nutritional - B12/folate (megaloblastic anaemias)
  • Myelodysplasia
  • Drugs eg chemotherapy (attempt to slow cell division)
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13
Q

What can cause an apparent or false macrocytosis?

A
  • Agglutination => RBCs clump and are counted as one

- Reticulocytosis => larger than average mature RBC

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14
Q

What can cause a macrocytosis without significant anaemia?

A
  • Hypothyroidism
  • Alcohol
  • Liver disease
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15
Q

WHat are the causes of a normocytic anaemia?

A 
Hypoproliferative
=> Marrow failure
=> Hypometabolic (e.g. anorexia)
=> Marrow infiltration (malignancy)
=> Renal impairment
=> Anaemia of Chronic disease (inflammatory, infection, malignancy)
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16
Q

What is meant by a renal anaemia?

A

Anaemia due to reduced erythropoietin production

this may be considered an anaemia of chronic disease of the kidney

17
Q

Explain how an anaemia of chronic disease occurs.

A
  • disease flares
  • inflammation occurs (+ cytokines released)
  • increases hepcidin
  • this binds to ferroportin and stops iron being released from cells
  • iron therefore cant be used to make Hb
    => patient becomes anaemic
18
Q

Why may some patients with an anaemia of chronic disease have a microcytic picture?

A
  • reduced release of iron from macrophages ie failure of Hb synthesis
    => cells undergo extra divisions without Hb attached
  • low transferrin saturation BUT normal/raised ferritin
  • These pts may respond to IV iron
19
Q

Why are many reticulocyte counts not actually carried out in practice?

A
  • Many anaemias hypoproliferative
  • acute blood loss can usually be seen, which will in turn generate a high reticulocyte count
  • a reticulocyte count can be used if suspecting haemolysis in a patient
20
Q

HOw can patients have and MCV in normal range yet still have a microcytic anaemia?

A

Microcytosis can be a relative rather than absolute term

  • iron deficient pts have normal range MCV (BUT not normal for the individual - it may be significantly lower than a previous result)
21
Q

Why may it be difficult to distinguish what is causing a patient’s anaemia?

A
  • more than one factor is present that could be the cause

E.g.

  • Rheumatoid arthritis patient (anaemia of chronic disease)
  • Taking Methotrexate (folate antagonist)
  • Taking NSAID causes occult GI blood loss secondary to gastropathy (iron deficiency)
22
Q

HOw can iron deficiency anaemia and anaemia of chronic diseas be distinguished by blood tests?

A

Iron deficiency:

  • Normal/Increased amount of transferrin
  • reduced ferritin stores

Anaemia of Chronic Disease:

  • Normal/reduced transferrin
  • Normal/Increased iron stores
23
Q

In what order should you do investigations for anaemia?

A
  • Name (gives indication of ethnicity)
  • Age
  • Presenting complaint and clinical findings
  • FBC - check Hb, MCV, any other cytopenias?
  • Reticulocyte count (if required)
  • Blood film
  • Haematinics (ferritin/B12/folate)
  • Special tests, bone marrow

HAEMATOLOGY (24 decks)

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