Classification of Anaemia: Macrocytic, Normocytic, Microcytic types Flashcards
What is anaemia?
A finding that indicates significant reduction in volume of red blood cells and Hb concentration, resulting in levels lower than normal
The range depends on the patient’s sex and age.
What are common symptoms of anaemia?
- Fatigue
- Weakness
- Dizziness/light-headedness
- Dyspnea (shortness of breath)
- Cold hands and feet
These symptoms are common and non-specific.
What are less common but more severe symptoms of anaemia?
- Tachypnea (rapid, shallow breathing)
- Tachycardia (palpitations)
- Muscle aches and cramps
- Angina or heart failure due to underlying coronary artery disease
- Pallor (abnormally pale complexion)
- Hypotension
- Reticulocytosis
- Bruising more easily
- Dizziness when standing up
- Pale mucous membranes
These symptoms indicate a more severe condition.
What is reticulocytosis?
Occurs when there is destruction/loss of RBCs or increased production by bone marrow
Indicates a response to anaemia or blood loss.
What are the three common reasons why anaemia occurs?
- Reduced number of erythrocytes
- Reduced total concentration of Hb
- Abnormally low haematocrit/packed cell volume
Haematocrit refers to the volume percentage/ratio of erythrocytes in blood.
True or False: Acute onset of anaemia typically has milder symptoms than chronic onset.
False
Acute onset will have more marked symptoms than chronic onset as the body had time to adapt.
Fill in the blank: The volume percentage/ratio of erythrocytes in blood is called _______.
[haematocrit]
Haematocrit is an important measure in diagnosing anaemia.
What can cause tachycardia in anaemia?
Increased demand for oxygen due to reduced oxygen-carrying capacity of blood
This can lead to palpitations.
What does pallor indicate in a patient with anaemia?
Abnormally pale complexion, often visible under fingernails and mucous membranes
Pallor is a common clinical sign of anaemia.
What is the effect of anaemia on muscle function?
Muscle aches and cramps may occur due to inadequate oxygen delivery
This is often a result of reduced erythrocytes or hemoglobin.
What is the relationship between hypotension and anaemia?
Hypotension can occur due to reduced blood volume or cardiac output
This is a more severe symptom of anaemia.
What are the two main types of haemolytic anaemia?
Haemolytic anaemia is classified into two types: due to reduced erythrocyte production or increased destruction.
How can aplastic anaemia be confirmed?
Aplastic anaemia can be confirmed with a bone marrow biopsy.
What is Diamond-Blackfan anaemia?
Diamond-Blackfan anaemia is a rare congenital type of aplastic anaemia characterized by defective stem cells.
What can cause acquired defective stem cells?
Acquired defective stem cells can be due to the use of drugs, alcohol, or infections.
What factors can lead to an unhealthy microenvironment in the bone marrow?
An unhealthy microenvironment can result from damage due to radiation, infections, or lack of space due to scar tissue (fibrosis) or primary or secondary tumours.
How can anaemia be classified by MCV value?
Anaemia can be classified into macrocytic, normocytic, and microcytic based on MCV value.
How is MCV determined?
MCV is found by comparing the patient’s blood film to another blood film of cells that are similar in size to normocytic RBCs.
What is macrocytic anaemia?
Macrocytic anaemia is when MCV is higher than the upper limit of the normal range.
How can macrocytic anaemia be classified?
It can be classified into megaloblastic and non-megaloblastic anaemia.
What characterizes megaloblastic anaemia?
Megaloblastic anaemia is characterized by unusually large, structurally abnormal blood cells (megaloblasts) that do not function normally, produced due to impaired DNA synthesis.
What are common causes of megaloblastic anaemia?
Common causes include B12 (pernicious) or B9 (folate) deficiency anaemia, which are needed for DNA synthesis.
What can cause impaired erythrocyte maturation?
A lack of B12 or folate can cause impaired erythrocyte maturation.
What tests are used to diagnose macrocytic anaemia?
Diagnosis can involve blood smear, bone marrow examination, reticulocyte count, serum B12 and folate levels, RBC folate, serum homocysteine, and methylmalonate.
What is non-megaloblastic anaemia?
Non-megaloblastic anaemia can occur due to liver disorders, hemolysis, blood loss, drugs, alcohol, reticulocytosis, myelodysplasia, and hypothyroidism.
What is an example of a condition that can lead to non-megaloblastic anaemia?
Myelodysplastic syndrome (MDS) is a group of blood cancers characterized by impaired blood cell maturation.
What is normocytic anaemia?
Normocytic anaemia is when MCV is within the normal range.
What are some causes of normocytic anaemia?
Causes include anemia of chronic disease (ACD), acute blood loss, mixed B12/folate and iron deficiency, and bone marrow disorders.
What is a specific example of normocytic anaemia?
Chronic renal failure can lead to normocytic anaemia due to reduced erythropoietin levels.
What is microcytic anaemia?
MCV is less than the lower limit of the normal range.
Examples include iron deficiency anaemia (IDA), thalassaemia, anaemia of chronic disease (ACD), lead poisoning, and sideroblastic anaemia.
What is sideroblastic anaemia?
A disorder where the body produces enough iron but is unable to incorporate it into haemoglobin.
It can be congenital (usually microcytic) or acquired (usually macrocytic).
What is the hallmark finding in a bone marrow biopsy for sideroblastic anaemia?
Ringed sideroblasts, which are immature red blood cells with nuclei or centres surrounded by rings of iron.
What is the hallmark blood film finding in sideroblastic anaemia?
Erythrocytes with basophilic stippling and Pappenheimer bodies.
What are Pappenheimer bodies?
Cytoplasmic granules of iron found in erythrocytes.
What are the hallmark iron studies findings in sideroblastic anaemia?
Elevated iron, ferritin, transferrin, and sometimes an elevated reticulocyte count.
What is the benefit of iron replacement therapy?
Can treat iron-deficiency anaemia.
What are the complications of iron replacement therapy?
Can cause hypersensitivity reactions and anaphylaxis, especially in patients with known allergies, atopic conditions, inflammatory conditions.
Who should not use iron replacement therapy?
Contraindicated for pregnant women in the 1st trimester, patients with severe renal or hepatic conditions, infections.
What are the side effects of iron replacement therapy?
Headache, flushing, dizziness, nausea and vomiting, hypertension, arthralgia, myalgia.
What is the benefit of B12 replacement therapy?
Can treat pernicious anaemia, normocytic anaemia.
What are the complications of B12 replacement therapy?
Can cause anaphylaxis in patients with cobalt allergy.
What are the side effects of B12 replacement therapy?
Injection site reaction, nausea and vomiting, headaches, dizziness, flushing.
What is the benefit of folate replacement therapy?
Can treat folate-deficiency anaemia, normocytic anaemia.
What are the complications of folate replacement therapy?
Can cause anaphylaxis.
What are the side effects of folate replacement therapy?
Injection site reaction, loss of appetite, bloating, flatulence, nausea.
What is a big risk factor for sideroblastic anaemia?
Frequent alcohol intake
