CP45 - Common causes of anaemia and thrombocytopenia Flashcards
what are some causes of anaemia excluding blood loss
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
what are the different type of MCV
marcocytic, normocytic, microcytic
what are some conditions which might have macrocytic anaemia?
B12, folate, metabolic (thyroid/liver disease)
marrow damage (booze, drugs, marrow diseases)
haemolysis (due to reticulocytosis)
what are some conditions which might have normocytic anaemia?
anaemia of chronic disease/inflammatory
what are some conditions which might have microcytic anaemia?
iron deficiency, haemoglobin disorders
where is iron stored in the body?
absorbed in the duodenum, stored in ferritin/haemosiderin, transported by transferrin
what is some test for establishing low iron
ferritin, MCV, %hypochromic cells, serum iron, marrow
what does MCH
mean cell haemoglobin
what is the general stratergy for establishing the main causes of iron deficiency
blood loss
increased demand (pregnancy/growth)
reduced absorption
what are some treatment for iron deficiency
oral iron, IM iron, IV iron
what is megaloblastic anaemia
a characteristic cell morphology caused by imparied DNA synthesis - cause High MCV
what are the causes of megaloblastic anaemia
B12 and/or folic acid deficiency
alcohol
drugs - cytotoxic, folate antagonists
haematological malignancy,
congenital - Transcobalamin deficiency
orotic aciduria
purine
A & G - PAG
what is required for the synthesis of purine
folates
what is required for folate generation?
B12
B12 - folate - purine - DNA damage
how is B12 absorbed ?
gastric parietal cells produce acid contain intrinsic factors which binds to B12 and then internalises B12 in the terminal ileum
who is common to get b12 deficiency
vegan - b12 only present in animal products
what can cause B12 deficiency
gastric problem - pernicious anaemia (autoimmune), gastrectomy
small bowel problems - terminal ileal resection/Crohns, fish tapeworms
where in folic acid present
mainly in green veg, beans
where is folic acid absorbed
upper small bowel
what is the commonest cause of folic deficiency
dietary, malnutrition, malabsorption, increased usage - pregnancy, haemolysis, severely ill
common features for B12 or folate deficiency
Megaloblastic anaemia
Can have pancytopenia if more severe
Mild jaundice
Glossitis / angular stomatitis
anorexia / wt loss
sterility
what is pancytopenia
deficiency of all three cellular components of the blood (red cells, white cells, and platelets).
what are some lab features for B12 + folate deficiency
bilirubin and LDH - haemolysis
low B12 and folate levels
antibodies
GI problems
what is pernicious anaemia
autoimmune specific to parietal cells/intrinsic factors - increase stomach Ca
what does SACDC stands for
subacute combined degeneration of the cord
B12 deficiency - damages to the brain and CNS
How does SACDC usually present
peripheral nerve damages
what causes SACDC
cause of severe B12 deficiency
how is B12 deficiency treated
b12 + folate until B12 deficiency exclude
folic acid should not be given in isolation
what is haemolysis
shortened red cell life
what can cause haemolysis
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’)
what can indicate the present of haemolysis
anaemic, high MCV, macrocytic, high reticulocytes, raised bilrubin, LDH (lactate dehydrogenase), Urinary Haemosiderin
treatment of haemolytic anaemia
steriods/immunosuppression, transfusion
what are some common causes for anaemia of chronic disease
malignant/inflammatory/infectious
multiple medial disease (DM, autoimmune)
what is the fundemential cause to anaemia of chronic disease
abnormal iron metabolism, poor erythropoetin response and blunted marrow response
release of inflammatory cytokines esp. Hepcidin (regulator of iron absorption and release from macrophages)
what are the features of ACD
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
what is the common causes of thrombocytopenia
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)
what does ITP stands for
immune thrombocytopenic purpura
what is ITP?
immune disorder Occurs on its own or as part of: Other autoimmune disease Lymphomas / CLL HIV Can be acute /chronic / relapsing
what is a common cause for ITP in children
post-viral infection - self-limiting problem
what is the common presentation of ITP?
Bruising or petechiae or bleeding, varied degree of low platelet
what is the treatment for ITP?
Steroid remains first line
IV immunoglobulin
Other immunosuppressives or splenectomy are common next options
Newer thrombo-mimetics now have a place
Eltrombopag
Romiplostin
what does TTP stands for?
Thrombotic thrombocytopenia purpura
what is TTP
rare - largely immunological conditions
what are some presentation for TTP
Fever
Neurological symptoms
Haemolysis (retics / LDH)
treatment for TTP?
steroids, transfusion