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Haematology > Diagnostic Approach to Anaemia > Flashcards

Diagnostic Approach to Anaemia Flashcards

1
Q

What is anaemia?

A

Low haemoglobin which is:

Men <13.5g/dl

Women <11.5g/dl

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2
Q

Symptoms of anaemia

A 
Fatigue
Dyspnoea
Faint
Palpitations
Headache
Tinnitus

Normally symptoms are due to cause more than anaemia

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3
Q

Outline the diagnostic approach to anaemia

A

FBC to confirm anaemia

MCV to categorise anaemia

Microcytic: iron panel

Normocytic: reticulocyte count to assess bone marrow

Macrocytic:
Peripheral blood smear to decide if megaloblastic or non-megaloblastic

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4
Q

Classifications of anaemia based on MCV

A

MCV <80fL: microcytic

MCV 80-100fL: normocytic

MCV >96: macrocytic

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5
Q

Causes of microcytic anaemia

A

IRON LAST

Iron deficiency
Lead poisoning
Anaemia of chronic disease
Sideroblastic anaemia
Thalassaemia
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6
Q

What is the most common cause of microcytic anaemia?

A

Iron deficiency

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7
Q

Investigation results seen in iron deficiency anaemia

A

Low serum iron

Low ferritin

High transferrin

High TIBC

Low TIBC SATURATION

Blood films can show poikilocytosis, target and pencil cells

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8
Q

Clinical features of iron deficiency anaemia

A 
Fatigue
SOB
Palpitations
Pallor
Hair loss
Atrophic glossitis
Angular stomatis
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9
Q

What tests might you consider doing in someone with iron deficiency anaemia?

A

Occult blood tests, haemoglobin electrophoresis, anti-TTG
endoscopy/colonoscopy

Men of any age with a Hb under 110g/L should be referred under 2WW

Patients >60 should be referred for colonoscopy

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10
Q

Management of iron deficiency anaemia

A

Ferrous sulfate oral TDG 200mg.

Reticulocyte count will improve in 7 days and treatment should carry on for 5-6 months

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11
Q

What is sideroblastic anaemia?

A

Iron granules form a ring around the nucleus in developing erythroblasts due to a defect in haem synthesis

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12
Q

What type of anaemia does sideroblastic anaemia cause?

A

Hypochromic microcytic picture

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13
Q

Investigation findings in sideroblastic anaemia

A

Low TIBC

Raised serum iron

Hypochromic RBC’s

Ringed sideroblasts

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14
Q

Management of sideroblastic anaemia

A

Regular transfusions and iron chelation

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15
Q

What is the effect of haemolysis on reticulocyte count?

A

Increased as more RBC’s are produced by the bone marrow to try and compensate

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16
Q

Causes of normocytic anaemia

A

Anaemia of chronic disease

CKD/RA

Pregnancy (due to increased plasma volume)

Acute blood loss

Aplastic anaemia

Haemolytic anaemias

17
Q

What is aplastic anaemia?

A

Bone marrow failure causes a normocytic anaemia, leukopenia and thrombocytopenia

18
Q

Causes of aplastic anaemia

A

Phenytoin

Sulphonamides

Chloramphenicol

ALL

AML

Parvovirus

Hepatitis

Congenital is X linked recessive

19
Q

Investigation findings in aplastic anaemia

A

Low reticulocyte count (as bone marrow can’t produce new RBC’s)

Neutropenia

20
Q

Investigation for aplastic anaemia

A

Bone marrow biopsy

21
Q

What are types of haemolytic anaemia?

A 
Intrinsic defects:
Haemoglobinopathies (sickle cell, HbC)
Enzyme deficiencies (pyruvate kinase deficiency, G6PD deficiency)
Membrane defects (paroxysmal nocturnal haemoglobinuria, hereditary spherocytosis)
Extrinsic defects:
Autoimmune haemolytic anaemia
Microangiopathic haemolytic anaemia
Infections
Mechanical destruction
22
Q

What are the two categories of macrocytic anaemia?

A

Megaloblastic vs non megaloblastic

Megaloblastic:
Have large and immature nuclei due to delayed nuclear maturation with defective DNA synthesis

Non-megaloblastic:
Normal DNA synthesis and no hypersegmented neutrophils

23
Q

Causes of megaloblastic macrocytic anaemia

A

Vitamin B12 deficiency

Folate deficiency

Myelodysplasia

24
Q

What is the neurological consequence of vitamin B12 deficiency?

A

Subacute combined degeneration of the spinal cord

Affects the pyramidal and dorsal columns

Symmetrical polyneuropathy

25
Q

Causes of vitamin B12 deficiency

A

Inadequate intake:
Poor diet
Vit B12 comes from animal sources mainly milk, eggs etc

Malapsorption:
Perncious anaemia
Gastrectomy
Congenital intrinsic factor deficiency

Intestinal causes:
Bacterial colonisation
Ileal resection
Crohn’s disease

26
Q

What is pernicious anaemia?

A

Autoimmune gastritis and reduced secretion of intrinsic factor and acid

Often have antibodies to intrinsic factor and parietal cells

27
Q

What investigations can you consider for someone with vitamin B12 deficiency?

A

Intrinsic factor antibody

Parietal cell antibodies

Serum gastrin levels

Upper GI endoscopy

28
Q

Management of vitamin B12 deficiency

A

1mg IM hydroxocobalamin

*if folate AND B12 deficient, treat the B12 first to prevent neuropathy

29
Q

What is the most common cause of vitamin B12 deficiency?

A

Pernicious anaemia

30
Q

How much folate acid does the body store?

A

4 months worth

31
Q

Why does pernicious anaemia lead to vitamin B12 defiency?

A

You have intrinsic factor antibodies which bind to intrinsic factor preventing vitamin B12 binding

You have gastric parietal cell antibodies which mean reduced acid production and atrophic gastritis

This leads to less intrinsic factor being produced and therefore less vitamin B12 absorption

32
Q

What is vitamin B12 important for?

A

Production of blood cells

Myelination of nerves

33
Q

What antibody test is most specific for pernicious anaemia?

A

Anti-intrinsic factor antibodies is highly specific

Anti-gastric parietal cell antibodies are sensitive but have low specificity

34
Q

Causes of folate deficiency

A

Nutritional: old age, poverty and famine

Malabsorption: gluten induced enteropathy, dermatitis herpetiformis

Increased use: pregnancy, lactation, haemolytic anaemia, carcinoma, lymphoma, myeloma, Crohn’s, RA, malaria.

Excess urinary loss: congestive heart failure and chronic dialysis

Drugs: anticonvulsants and sulfasalazine

Mixed: liver disease and alcoholism

35
Q

Causes of non-megaloblastic macrocytic anaemia

A

Pregnancy

Alcohol excess

Liver disease

Hypothyroid

Myeloma

Reticulocytosis

36
Q

What are the associations of Plummer Vinson syndrome?

A

Iron deficient anaemia

Dysphagia (post cricoid)

Oesophageal webs

37
Q

Causes of macroytosis

A

Alcohol

Aplastic anaemia

Cytotoxic drugs

Myeloma

Liver disease

Myxoedema

Pregnancy

Newborn

Haematology (16 decks)

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