Haem Flashcards
what is mcv for microcytic anaemia and what does it suggest
MCV < 80
insufficient haemoglobin production
what is mcv for normocytic anaemia and what does it suggest
mcv 80-100
decreased blood volume or decreased erythropoiesis
what is mcv for macrocytic anaemia and what does it suggest
mcv > 100
defective DNA synthesis and repair
clinical features of anaemia
pallor
dyspnoea on exertion
fatigue
tachycardia (bcos need more blood)
koilonychia (iron deficiency)
pica
what would iron studies for iron deficiency anaemia show
low ferritin (confirms IDA)
raised transferrin
increased TIBA
what would iron studies show for anaemia of chronic disease
high ferritin
low transferrin
reduced TIBC
raised ESR
increased hepcidin
what investigation would you use to diagnose thalassaemia
haemoglobin electrophoresis
what investigation would you use to diagnose sickle cell disease
haemoglobin electrophoresis
what does increased HbA2 suggest
beta thalassemia trait
what does blood film show for iron deficiency anaemia
pencil poikilocytes
hypochromic and microcytic red cells
target cells
anisopoikilocytosis
investigations for macrocytic anaemia
vit b12 and folate levels
homocysteine and methylmalonic acid levels
what do hypersegmented neutrophils on blood film suggest
megaloblastic anaemia (b12/folate deficiency)
test for autoimmune haemolytic anaemia
DAT test (aka Coombs test)
lab results for haemolytic anaemia
(and first line treatment)
raised unconjugated bilirubin
raised LDH (raised when intracellular contents released)
raised reticulocytes
low haptoglobin
spherocytes on blood film
may be warm (IgG antibodies, SLE, CLL) or cold (IgM antibodies, mycoplasma, mononucleosis, lymphoma)
Tx with steroids (prednisolone)
management for anaemia
blood transfusion with RBCs if severe
nutrient replacement
IDA > ferrous sulfate
Ix for microcytic anaemia
FBC
blood film
blood chemistry
iron studies
mnemonic for types of microcytic anaemias
Find Those Small Cells Last
Fe deficiency
Thalassemia
Sideroblastic
Chronic disease
Lead poisoning
causes of iron deficiency anaemia
decreased intake:
-eating disorders
-dietary restrictions
-food insecurity
decreased absorption
-coeliac disease
-surgical resection of GI tract
-bariatric surgery
-excessive dietary calcium
-tannates
-oxalates
increased need and growth
-pregnancy, lactation
-growing children
increased loss of blood
complications of iron deficiency anaemia
high output heart failure
angina
cardioresp failure
impaired growth and development
signs and symptoms of iron deficiency anaemia
split into decreased oxygen to tissues and effects on epithelium
decreased oxygen to tissues
-pallor
-fatigue
-exertional dyspnoea
-angina
-compensation: palpitations, increased pulse, increased cardiac output, tachypnoea, shunting of blood to vital organs
effects on epthelium
-glossitis
-scaling, fissuring, dryness, lip scaling
-koilonychia
-oesophageal stricture
lab results for IDA
low RBC count
low/normal reticulocytes
low hb, haematocrit
hypochromic-microcytic erythrocytes
- low MCV, low MCH, low MCHC
blood film shows rbc with central pallor, anisocytosis, poikilocytosis, target cells
iron studies show:
decreased serum iron
decreased ferritin
high transferrin
increased total iron binding capacity
treatment for IDA
PO iron supplements (ferrous sulfate)
parenteral iron for severe persistent anaemia or intolerance or non adherence to PO iron
increase dietary iron
vit C increases absorption
calcium DECREASES absorption
blood transfusion
components of HbF
2 alpha globin + 2 gamma globin
components of HbA
2 alpha globin + 2 beta globin