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Haematology > Approach to diagnosing anaemia > Flashcards

Approach to diagnosing anaemia Flashcards

1
Q

what is anaemia

A

reduction in Hb concentration for what is normal to that individual

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2
Q

what tools can be used to diagnose anaemia

A 
History and examination 
FBC
Blood film 
Reticulocytes 
Haematinics - B12/folate/ferritin
Bone marrow biopsy 
specialised tests eg HLPC in thalassaemia
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3
Q

how can anaemia be classified according to bone marrow function

A

measure reticulocytes

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4
Q

what does reticulocytosis in context of anaemia mean for bone marrow

A

bone marrow is active and trying to compensate for red cell loss or destruction

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5
Q

what does a low reticulocyte count in context of anaemia mean for bone marrow

A

there is a defect in bone marrow and it cannot compensate

there is reduced red cell production

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6
Q

what are causes of anaemia with reticulocytosis

A

haemorrhage

haemolysis

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7
Q

how can you differentiate between haemolysis and haemorrhage

A 
haemorrhage = reticulocytosis only 
haemolysis = reticulocytosis AND breakdown products
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8
Q

what are the 2 main categories that cause anaemia with a low reticulocyte count

A

hypoproliferative

maturation abnormality

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9
Q

what are causes of maturation abnormality in anaemia

A

cytoplasmic defect - impaired haemoglobinisation

nuclear defect - impaired DNA synthesis and nuclear maturation

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10
Q

what size are cells with impaired haemoglobinisation

A

small/low MCV/microcytic

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11
Q

what size are cells with impaired DNA synthesis

A

large/high MCV/macrocytic

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12
Q

what size are cells that cause hypoproliferative anaemia

A

normocytic

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13
Q

why are cells with impaired haemoglobinisation microcytic?

A

Because they cannot make Hb, they dont reach the threshold needed to trigger enucleation.
Therefore, the cells keep dividing meaning they keep getting smaller hence microcytic cells

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14
Q

why are cells with impaired DNA synthesis macrocytic?

A

Cells have abnormal nuclei and so cell division is abnormal meaning there are fewer divisions resulting in fewer cells that are large. Failure to become smaller cells.

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15
Q

if reticulocytes are low, what is the next step investigation

A

red cell indices: MCV, MCH

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16
Q

what are causes of microcytic anaemia

A

insufficient Hb synthesis

Haem or globin

17
Q

causes of haem deficiency

A

Fe deficiency: diet, bleeding, malabsorption

Porphyrin deficiency: genetic

18
Q

causes of globin deficiency

A

Thalassaemias

alpha: trait, HbH, Hb Barts Hydrops fetalis
beta: trait, intermedia, major

19
Q

what are causes of macrocytosis

A

alcohol
liver disease
hypothyroidism

20
Q

what are causes of megaloblastic macrocytic anaemia

A

B12/folate deficiency
drugs
inherited

21
Q

causes of non-megaloblastic macrocytic anaemia

A

marrow failure:
myelodysplasia - mutation in stem cells
aplastic anaemia

22
Q

causes of spurious macrocytosis

A

reticulocytosis

cold agglutins

23
Q

causes of hypoproliferative normocytic anaemia

A 
marrow failure 
hypometabolic
marrow infiltration 
renal impairment 
anaemia of chronic disease
24
Q

what is renal anaemia

A

anaemia of chronic disease due to failure of EPO production

25
Q

is there a single pathological mechanism for anaemia of chronic disease

A

no, multifactorial

26
Q

what is the central process behind anaemia of chronic disease

A

inflammation

27
Q

what are the mechanisms of anaemia of chronic disease

A

inflammation activates monocytes and T cells which produce pro inflammatory cytokines:

  • increased hepatic synthesis of hepcidin causes degradation of ferroportin and so iron is trapped
  • EPO production is reduced
  • erythroid proliferation in marrow is inhibited
  • haemophagocytosis by macrophages in induced
28
Q

anaemia of chronic disease can sometimes be microcytic, true or false

A

true

if the predominant mechanism is increased hepcidin

29
Q 
what will the following results show in iron deficiency anaemia:
serum iron 
transferrin 
% transferrin saturation 
ferritin 
MCV
A 
serum iron - low 
transferrin - normal/low 
% transferrin saturation - low
ferritin - low 
MCV - low (can be normal)
30
Q 
what will the following results show in anaemia of chronic disease:
serum iron 
transferrin 
% transferrin saturation 
ferritin 
MCV
A 
serum iron - low 
transferrin - normal/low
% transferrin saturation - low 
ferritin - high/normal 
MCV - normal (can be low)
31
Q

what are the steps to approaching anaemia in blood results

A 
name, age, ethnicity, PC
FBC - red cells, Hb, WBC, platelets
Red cell indices - MCV, MCH
Reticulocytes 
Blood film 
Haematinics 
Special tests / biopsy

Haematology (26 decks)

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