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CP > Common Causes of Anaemia and Thrombocytopenia > Flashcards

Common Causes of Anaemia and Thrombocytopenia Flashcards

1
Q

What are examples of Macrocytic anaemia?

A

B12, Folate, metabolic (e.g. thyroid/liver disease)
Marrow damage (alcohol, drugs, marrow diseases)
Haemolysis (due to reticulocytosis)

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2
Q

What are examples of normocytic anaemia?

A

Anaemia of chronic disease / inflammatory

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3
Q

What are examples of microcytic anaemia?

A

Iron deficiency
Haemoglobin disorders
(sometimes chronic disease)

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4
Q

What lab tests can be used to establish low iron?

A

FBC
Fettitin
% hypochromic cells

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5
Q

What are the main causes of iron deficiency?

A

Blood loss from anywhere
Increased demand - pregnancy/growth
reduced intake- diet/malabsorption

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6
Q

What are the main causes of iron deficiency in children?

A

diet
growth
malabsorption

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7
Q

What are the main causes of iron deficiency in young women?

A

Menstrual loss/problems
Pregnancy
Diet

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8
Q

What are the main causes of iron deficiency in older people?

A

Bleeding

GI problems e.g. ulcer, malignancy, diverticulitis

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9
Q

What forms of iron treatment are available?

A

Oral iron - Often unreliable
IM iron - painful,out of date
IV iron - increasingly used

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10
Q

What is megaloblastic anaemia caused by?

A

characteristic cell morphology caused by impaired DNA synthesis

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11
Q

How do B12 + Folate cause anaemia?

A

DNA consists of purine/pyrimidine bases
folates are required for their synthesis
B12 is essential for cell folate generation
So low Folate or B12 starves DNA of bases

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12
Q

What are food sources of B12?

A

animal sources

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13
Q

Where is B12 absorbed in the body?

A

vitamin B12 binds to haptocorrin - produced by the salivary glands and the parietal cells in the stomach
in duodenum, pancreatic proteases degrades the haptocorrin and vitamin B12
Then binds to Intrinsic Factor produced by parietal cells
in the mucosal cells of the distal ileum the vitamin B12-Intrinsic Factor complex is recognised by special receptors
Vitamin B12 then enters the blood bound to transcobalamin = active B12

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14
Q

Can B12 be stored and for how long?

A

Yes can store

sufficient for some years

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15
Q

Who tends to suffer from B12 deficiency?

A

Nutritional - vegans
Gastric problems - Pernicious anaemia,
gastrectomy
Small bowel problems - Terminal ileal resection, Crohns, stagnant loops, jejunal diverticulosis, tropical sprue, Fish tapeworm

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16
Q

What sources of food contain lots of folic acid?

A 
Must be consumed!
green vegetable
beans
peas
nuts
liver
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17
Q

Where is folic acid absorbed?

A

upper small bowel

18
Q

How long does the body store folic acid?

A

4 months

19
Q

What can cause folic acid deficiency?

A

Mainly dietary/malnutrition
Malabsorption/small bowel disease
Increased usage: pregnany, haemolysis, inflammatory disorders
Drugs/alcohol/ITU (intensive therapy unit)

20
Q

What clinical features are present in someone with B12/folate deficiency?

A

Megaloblastic anaemia
Can have pancytopenia if more severe - deficiency of red cells, white cells and platelets
Mild jaundice
Glossitis (inflammation of the tongue)/angular stomatitis (inflammation of corners of the mouth)
anorexia/weight loss
sterility - incapability to reproduction

21
Q

What are the lab features B12/folate deficiency?

A 
Blood count and film, marrow sometimes
Bilirubin and Lactate Dehydrogenase 
B12 and folate levels
Antibodies
B12 absorption tests +/- IF
GI investigations e.g. crohns, blind loop
22
Q

What is pernicious anaemia?

A

Autoimmune disease
Antibodies to parietal cells/intrinsic factor
Atrophic gastritis with achlorhydria - absence of hydrochloric acid in the gastric secretions
Don’t form intrinsic factor
Incidence of stomach cancer

23
Q

What is subacute combined degeneration of the cord (SACDC)?

A

Any cause of severe B12 deficiency - Anaemia not an absolute requirement
Demyelination of dorsal + lateral columns
Peripheral nerve damage

24
Q

How does subacute combined degeneration of the cord (SACDC) present?

A

Peripheral neuropathy/Paraesthesiae
Numbness and distal weakness
Unsteady walking
Dementia

25
Q

What is the treatment for B12 and folate deficiency?

A

Give both B12 + Folate until B12 deficiency excluded
B12 x5 then 3 monthly for life
Folic acid 5mg daily to build stores

26
Q

What are the causes of haemolysis (simply)?

A

Things wrong inside the red cell
Things wrong with the red cell membrane
Things wrong external to the red cell

27
Q

What are common causes of haemolysis inside the cell?

A 
Haemoglobinopathy (Sickle cell)
Enzyme defects (G6PD)
28
Q

What are common causes of haemolysis with the membrane?

A

Hereditary Spherocytosis/elliptocytosis (RBC the wrong shape)

29
Q

What are common causes of haemolysis outside the cell?

A

Antibodies (warm/cold)
Drugs/toxins
Heart valves
Vascular/vasculitis/‘microangiopathy

30
Q

What tests show the presence of haemolysis?

A

Anaemic (can be compendated for)
High MCV, macrocytic
High Reticulocytes - an immature red blood cell without a nucleus having a granular appearance
Blood film (fragments/spherocytes)
Raised bilirubin, LDH (lactate dehydrogenase)
Low haptoglobins - protein that binds to haemoglobin
Urinary Haemosiderin - brown urine

31
Q

What is the treatment for autoimmune haemolytic anaemia?

A

steroids
immunosuppression
Transfusion can be tricky as hard to cross match

32
Q

Why is there reduced red cell production in anaemia of chronic disease?

A

Inflammatory cytokines control mechanism of absorption of iron - Hepcidine is the key regulator of iron absorption and release from macrophages
Abnormal iron metabolism
poor erythropoetin response
blunted marrow response

33
Q

What are the features of anaemia of chronic disease?

A 
No other causes of anaemia - diagnosis of exclusion
A suitable medical history
Usually mild anaemia, normal MCV
Often raised inflammatory markers
Normal/high ferritin + low serum iron
Normal % Saturation transferrin
34
Q

What is the treatment for anaemia of chronic disease?

A

The cause if possible
Erythropoetin
Iron? IV?
Transfusion?

35
Q

What is immune thrombocytopenic purpura (ITP)?

A 
isolated low platelet count 
characteristic purpuric rash
increased tendency to bleed
immune disorder
Occurs on its own or as part of: Other autoimmune diseases, Lymphomas, CLL, HIV
Can be acute/chronic/relapsing
36
Q

What are the clinical features of immune thrombocytopenic purpura (ITP)?

A 
Bruising
characteristic purpuric rash
increased tendency to bleed
low platelet count
No definitive test
37
Q

What is the treatment for immune thrombocytopenic purpura (ITP)?

A 
Steroid - first line 
IV immunoglobulin
Other immunosuppressives
splenectomy
Newer thrombo-mimetics: Eltrombopag, Romiplostin
38
Q

What is the outcome after treatment for immune thrombocytopenic purpura (ITP)?

A

Usually rapid responses
Can relapse after therapy
Rarely life-threatening
commonly recurrent

39
Q

What is Thrombotic thrombocytopenia purpura (TTP)?

A

blood clots form in small blood vessels throughout the body
Rare but urgent diagnosis
Most are immune

40
Q

Apart from thrombosis forming, what other symptoms are present in thrombocytopenia?

A

Fever
Neurological symptoms
Haemolysis

41
Q

What urgent therapy is used in Thrombotic thrombocytopenia purpura (TTP)?

A

Plasma exchange with FFP/plasma
Steroids
Outcomes vary – can see relapses

CP (50 decks)

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