Haem- anaemia Flashcards by Elise Giblin

what is anaemia

decrease in haemoglobin in the blood

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anaemia in adult males level

Hb <130 g/l

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anaemia in adult females level

Hb <120g/l

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normal response to anaemia

make more red cells- reticulocytosis

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what are reticulocytes

cells that have just left the bone marrow

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size of reticulocytes

larger than average red cells

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reticulocytes stain-

purple/deep red

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symptoms of anaemia

breathlessness
palpitations
headaches
faintness
fatigue

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what is microcytic anaemia

anaemia caused by deficient haemoglobin synthesis (cytoplasmic defect)

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most common cause of microcytic anaemia

iron deficiency

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which cytokine is released due to chronic disease and causes anaemia

IL6

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what is Sideroblastic anaemia

excess iron buildup in mitochondria due to failure to incorportae iron into haem

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iron deficiency more likely in who

women and children

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causes of iron deficiency

dietary factors
losing too much- bleeding
not absorbing enough- malabsorption

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clinical features of iron deficiency (longstanding)

Brittle nails
Spoon-shaped nails (koilonychia)
Atrophy of the papillae of the tongue
Angular stomatitis
Brittle hair
Dysphagia and glottitis
Generalised pruritis

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what is megaloblastic anaemia

anemia characterized by the presence of abnormally large red blood cells (megaloblasts) in the bone marrow and peripheral blood

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what is Pernicious anaemia

autoimmune condition with resulting destruction of gastric parietal cells- B12 deficiency

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sources of B12

animals

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sources of folate

Liver, leafy veg, fortified cereals

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where is B12 absorbed

ileum

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where is folate absorbed

Duodenum and jejunum

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daily requirement of B12

1.5ug/day

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daily requirement of folate

200ug/day

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clinical features of B12/folate deficiency

anaemia symptoms
weight loss, diarrhoea, infertility
sore tongue, jaundice
neurological problems

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what is thalassaemia

autosomal recessive inherited disorders of haemoglobin, causing reduced global chain synthesis, resulting in impaired haemoglobin production

common conditions causing anaemia of chronic disease

cancer rheumatoid arthritis

patients diagnosed with microcytic anaemia with red flags for colorectal cancer are given :

FIT test- then may be referred for urgent colonoscopy

low ferritin in which type of anaemia

iron deficiency

% saturation of transferrin is reduced in which types of anaemia

iron deficiency anaemia anaemia of chronic disease

common cause of B12 deficiency

veganism

most common causes of megaloblastic anaemia

B12 deficiency follate deficiency

which autoantibody confirms the diagnosis of megaloblastic anaemia

Anti intrinsic factor

blood film findings in megaloblastic anaemia

macrovalocytes hypersegmented nucleus

clinical features of alpha thalassaemia

fatigue jaundice facial bone deformities

oral iron replacement therapy drugs

ferrous sulfate ferrous gluconate ferrous fumarate

how long before meals and taking other medications should oral iron supplements be taken

at least 30 mins before a meal 2 hours before taking other meds

what should you avoid taking iron supplements with

milk caffeine calcium antacids high fibre foods

what is pernicious anaemia associated with

atrophic gastritis family history of other autoimmune disorders eg hypothyroidism, Addisons disease

which type of anaemia does frontal bossing occur in

Beta thalassaemia

Beta thalassaemia major age of onset

6-24 months of age

diagnostic test for Beta thalassaemia

Hb electrophoresis

management of beta thalassaemia major

regular (2-4 weeks) blood transfusions for rest of life

blood results in thalassaemia

low Hb low MCV

in beta thalassaemia major, how many damaged/missing genes for beta-globin are there

Severest form of α thalassaemia

Hb Barts Hydrops Foetalis Syndrome

Alpha thalassaemia HbH disease- how many alpha genes

only one alpha gene left

example of Problems with porphyrin synthesis

sideroblastic anaemia

microcytic cells are hypochromic which means -

lacking in colour

what is haemolytic anaemia

condition characterised by the destruction or 'lysis' of red blood cells

what are sickle syndromes

group of genetic disorders that affect the structure of haemoglobin, resulting in the production of HbS

sickle cell trait Hb..

HbAS

beta genes in sickle cell trait

one normal, one abnormal b gene

sickle cell anaemia Hb..

HbSS

sickle cell anaemia beta genes

2 abnormal beta genes

what is a vaso-occlusive crisis

acute pain in the hands and feet due to vaso-occlusion of the small vessels

best diagnostic test for sickle cell anaemia

HPLC or electophoresis

acute chest syndrome symptoms

Shortness of breath chest pain pyrexia hypoxia new chest x-ray changes due to consolidation

core triad of acute chest crisis management

high-flow oxygen antibiotics (with atypical cover) exchange transfusion

medication which reduces the frequency and severity of sickle cell crises

Hydroxycarbamide

moa of Hydroxycarbamide

increases the levels of foetal haemoglobin (Hb F) in the blood

sickle cell disease anaemia disease pattern

autosomal recessive

blood count and film in microcytic anaemia

low MCV low MCH

management of pernicious anaemia

Vitamin B12 injections for life

Inherited haemolytic anaemias

hereditary spherocytosis hereditary elliptocytosis thalassaemia sickle cell anaemia G6PD deficiency

Acquired haemolytic anaemias

Autoimmune haemolytic anaemia Alloimmune haemolytic anaemia (transfusions reactions and haemolytic disease of newborn) Paroxysmal nocturnal haemoglobinuria Microangiopathic haemolytic anaemia Prosthetic valve related haemolysis

clinical features of haemolytic anaemia

anaemia splenomegaly jaundice

blood film findings in haemolytic anaemia

spherocytes red cell fragments Heinz bodies

causes of warm autoimmune haemolytic anaemia

idiopathic Lymphoproliferative neoplasms drugs SLE

which Ig mediates warm autoimmune haemolytic anaemia

IgG

causes of cold autoimmune haemolytic anaemia

Idiopathic Postinfectious haemolytic anaemia Lymphoproliferative disorders

which Ig mediates cold autoimmune haemolytic anaemia

IgM

mode of inheritance of G6PD deficiency

X-linked recessive disorder

causes of microcytic anaemia (TAILS)

thalassaemia anaemia of chronic disease iron deficiency anaemia led poisoning sideroblasic anaemia

SLE is associated with warm/cold autoimmune haemolytic anaemia

warm autoimmune haemolytic anaemia

post-infectious haemolytic anaemia associated with warm/cold haemolytic anaemia?

cold autoimmune haemolytic anaemia

which mechanism explains sickle cell anaemia

genetic- point mutation in codon 6 of beta global gene that substitutes glutamine to valine producing Bs