CP45 - Common causes of anaemia and thrombocytopenia

Question 1

what are some causes of anaemia excluding blood loss

Answer 1

haematinic deficiency

secondary to chronic disease

haemolysis

alcohol, drug, toxin - to damage bone marrow

renal impairment - EPO

primary haematological/marrow disease - malignant, haemoglobin disorder (sickle), aplasia, congenital

Question 2

what are the different type of MCV

Answer 2

marcocytic, normocytic, microcytic

Question 3

what are some conditions which might have macrocytic anaemia?

Answer 3

B12, folate, metabolic (thyroid/liver disease)

marrow damage (booze, drugs, marrow diseases)

haemolysis (due to reticulocytosis)

Question 4

what are some conditions which might have normocytic anaemia?

Answer 4

anaemia of chronic disease/inflammatory

Question 5

what are some conditions which might have microcytic anaemia?

Answer 5

iron deficiency, haemoglobin disorders

Question 6

where is iron stored in the body?

Answer 6

absorbed in the duodenum, stored in ferritin/haemosiderin, transported by transferrin

Question 7

what is some test for establishing low iron

Answer 7

ferritin, MCV, %hypochromic cells, serum iron, marrow

Question 8

what does MCH

Answer 8

mean cell haemoglobin

Question 9

what is the general stratergy for establishing the main causes of iron deficiency

Answer 9

blood loss

increased demand (pregnancy/growth)

reduced absorption

Question 10

what are some treatment for iron deficiency

Answer 10

oral iron, IM iron, IV iron

Question 11

what is megaloblastic anaemia

Answer 11

a characteristic cell morphology caused by imparied DNA synthesis - cause High MCV

Question 12

what are the causes of megaloblastic anaemia

Answer 12

B12 and/or folic acid deficiency

alcohol

drugs - cytotoxic, folate antagonists

haematological malignancy,

congenital - Transcobalamin deficiency
orotic aciduria

Question 13

purine

Answer 13

A & G - PAG

Question 14

what is required for the synthesis of purine

Answer 14

folates

Question 15

what is required for folate generation?

Answer 15

B12

B12 - folate - purine - DNA damage

Question 16

how is B12 absorbed ?

Answer 16

gastric parietal cells produce acid contain intrinsic factors which binds to B12 and then internalises B12 in the terminal ileum

Question 17

who is common to get b12 deficiency

Answer 17

vegan - b12 only present in animal products

Question 18

what can cause B12 deficiency

Answer 18

gastric problem - pernicious anaemia (autoimmune), gastrectomy

small bowel problems - terminal ileal resection/Crohns, fish tapeworms

Question 19

where in folic acid present

Answer 19

mainly in green veg, beans

Question 20

where is folic acid absorbed

Answer 20

upper small bowel

Question 21

what is the commonest cause of folic deficiency

Answer 21

dietary, malnutrition, malabsorption, increased usage - pregnancy, haemolysis, severely ill

Question 22

common features for B12 or folate deficiency

Answer 22

Megaloblastic anaemia

Can have pancytopenia if more severe

Mild jaundice

Glossitis / angular stomatitis

anorexia / wt loss
sterility

Question 23

what is pancytopenia

Answer 23

deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

Question 24

what are some lab features for B12 + folate deficiency

Answer 24

bilirubin and LDH - haemolysis

low B12 and folate levels

antibodies

GI problems

Question 25

what is pernicious anaemia

Answer 25

autoimmune specific to parietal cells/intrinsic factors - increase stomach Ca

Question 26

what does SACDC stands for

Answer 26

subacute combined degeneration of the cord B12 deficiency - damages to the brain and CNS

Question 27

How does SACDC usually present

Answer 27

peripheral nerve damages

Question 28

what causes SACDC

Answer 28

cause of severe B12 deficiency

Question 29

how is B12 deficiency treated

Answer 29

b12 + folate until B12 deficiency exclude folic acid should not be given in isolation

Question 30

what is haemolysis

Answer 30

shortened red cell life

Question 31

what can cause haemolysis

Answer 31

something wrong with - inside of red cell (haemoglobinopathy sickle cell) - red cell membrane (Hereditary Spherocytosis / elliptocytosis) ``` - external to the red cell (Antibodies (warm / cold) Drugs, toxins Heart valves Vascular / vasculitis / ‘microangiopathy’) ```

Question 32

what can indicate the present of haemolysis

Answer 32

anaemic, high MCV, macrocytic, high reticulocytes, raised bilrubin, LDH (lactate dehydrogenase), Urinary Haemosiderin

Question 33

treatment of haemolytic anaemia

Answer 33

steriods/immunosuppression, transfusion

Question 34

what are some common causes for anaemia of chronic disease

Answer 34

malignant/inflammatory/infectious | multiple medial disease (DM, autoimmune)

Question 35

what is the fundemential cause to anaemia of chronic disease

Answer 35

abnormal iron metabolism, poor erythropoetin response and blunted marrow response release of inflammatory cytokines esp. Hepcidin (regulator of iron absorption and release from macrophages)

Question 36

what are the features of ACD

Answer 36

``` No other causes of anaemia A suitable medical history Usually mild anaemia, normal MCV Often raised inflammatory markers ESR, CRP, PV etc Normal/high ferritin + low serum iron Normal % Saturation transferrin ```

Question 37

what is the common causes of thrombocytopenia

Answer 37

Drugs, alcohol, toxins ITP (sometimes associated with lymphoma/CLL/HIV) Other autoimmune diseases Liver disease and / or hypersplenism Pregnancy (physiological and a range of complications) Haematological / marrow diseases Infections acute or otherwise e.g. Acute sepsis / HIV / other viral infections (EBV and many others) Disseminated Intravascular Coagulation (DIC)

Question 38

what does ITP stands for

Answer 38

immune thrombocytopenic purpura

Question 39

what is ITP?

Answer 39

``` immune disorder Occurs on its own or as part of: Other autoimmune disease Lymphomas / CLL HIV Can be acute /chronic / relapsing ```

Question 40

what is a common cause for ITP in children

Answer 40

post-viral infection - self-limiting problem

Question 41

what is the common presentation of ITP?

Answer 41

Bruising or petechiae or bleeding, varied degree of low platelet

Question 42

what is the treatment for ITP?

Answer 42

Steroid remains first line IV immunoglobulin Other immunosuppressives or splenectomy are common next options Newer thrombo-mimetics now have a place Eltrombopag Romiplostin

Question 43

what does TTP stands for?

Answer 43

Thrombotic thrombocytopenia purpura

Question 44

what is TTP

Answer 44

rare - largely immunological conditions

Question 45

what are some presentation for TTP

Answer 45

Fever Neurological symptoms Haemolysis (retics / LDH)

Question 46

treatment for TTP?

Answer 46

steroids, transfusion