GP - Haem Flashcards
What are the main causes of iron deficiency anaemia?
- Excessive blood loss (menorrhagia)
- Inadequate dietary intake (meat/dark green leafy vegetables)
- Poor intestinal absorption (coeliac)
- Increased iron requirements (children/pregnancy)
What are more specific features of iron deficiency anaemia?
- Koilonychia
- Atrophic glossitis
- Post-cricoid webs
- Angular stomatitis
- Pica
- Hair loss
What are the investigations for iron deficiency anaemia?
- FBC (hypochromic microcytic anaemia)
- Serum ferritin (low)
- Total iron-binding capacity/transferrin (high)
- Blood film (anisopoikilocytosis)
What is the management for iron deficiency anaemia?
- Oral ferrous sulphate (should continue taking for 3 months after it has corrected in order to replenish iron stores)
- Iron-rich diet e.g. dark green leafy vegetables/meat/iron-fortified bread
What are the main causes of vitamin B12 deficiency anaemia?
- Pernicious anaemia
- Post gastrectomy
- Vegan/poor diet
- Disorders/surgery of terminal ileum
- Metform
What are more specific features of vitamin B12 deficiency anaemia?
- Sore tongue/mouth
- Neurological symptoms (dorsal column affected first)
- Mood disturbances
What are the investigations for vitamin B12/folate deficiency anaemia?
- FBC (macrocytic megaloblastic anaemia)
- B12/folate
- Intrinsic factor antibodies
What is the management for vitamin B12 deficiency anaemia?
- 1mg of IM hydroxocobalamin 3 times/week for 2 weeks –> 1 time/3 months
- Treat B12 deficiency before folate deficiency
What are the main causes of folic acid deficiency?
- Phenytoin
- Methotrexate
- Pregnancy
- Alcohol excess
What type of anaemia does anaemia of chronic disease cause?
Microcytic or normocytic (more common)
Describe the pathophysiology of anaemia of chronic disease?
Inflammation-mediated reduction in RBC production/survival
What are the differences in results between iron deficiency anaemia and anaemia of chronic disease?
- Serum iron = both low (IDA - lower)
- Total iron binding capacity = high (IDA)/low (AOCD)
- Transferrin saturation = both low
- Ferritin = low (IDA)/high (AOCD)
How does chronic kidney disease cause anaemia?
- Reduced erythropoietin (EPO) levels - normochromic normocytic anaemia
- Reduced absorption of iron
- Reduced red cell survival
- Blood loss due to poor platelet function/capillary fragility
What is the target haemoglobin levels for anaemia due to chronic kidney disease?
10-12g/dl
Describe the pathophysiology of chronic lymphocytic leukaemia
Monoclonal proliferation of well-differentiate lymphocytes - almost always B cells
