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HAI Lectures > HAEM: Anaemia I - Microcytic Anaemia > Flashcards

HAEM: Anaemia I - Microcytic Anaemia Flashcards

1
Q

What is anaemia?

A
  • Haemoglobine level below the lower limit of normal for the age and sex of the patient
  • A symptom, NOT a diagnosis
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2
Q

What are the clinical features of anaemia?

A
  • Pallor
  • Impaired oxygen delivery:
    • weakness, fatigue, lethargy
    • dizziness
    • headaches
  • Cardiac compensation:
    • tachycardia
    • increased pulse pressure
    • cardiac flow murmurs
  • In older patients:
    • cardiac failure
    • angina
    • claudication (leg cramp during exercise)
    • confusion
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3
Q

What are the causes of anaemia, using a pathophysiological classification?

(comprehensive list yuck)

A
  • Decreased red cell production
    • stem cell abnormalities (aplastic anaemia)
    • decreased erythropoietin (renal failure)
    • defective DNA synthesis (megaloblastic anaemia)
    • defective haemoglobin synthesis (iron deficiency, thalassaemia)
    • displacement of normal haemopoietic progenitors (bone marrow fibrosis, haemotologic and metastatic malignancies)
    • multifactorial (anaemia of chronic disease)
  • Increased red cell loss
    • blood loss (trauma, GI bleeding e.g. polyps)
    • haemolysis
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4
Q

What are 3 causes of hypochromic microcytic anaemias (low MCV, low MCH)

A
  • Iron deficiency
  • Anaemia of chronic disease
  • Thalassaemia
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5
Q

What are the causes of macrocytic anaemia? (high MCV)

A
  • Megaloblastic anaemia
  • Liver disease
  • Alcohol
  • Pregnancy
  • Hypothyroidism
  • Myelodysplasia
  • Reticulocytosis
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6
Q

What are the causes of normochromic normocytic anaemia? (normal MCV and MCH)

A
  • Anaemia of chronic disease
  • Renal failure
  • Acute blood loss (diagnosis of exclusion)
  • Some haemolytic anaemias
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7
Q

What is the primary cause of microcytic anaemia and how do we mainly measure it?

A

Iron deficiency

Measure ferritin - the major storage protein for iron

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8
Q

What are 3 causes of iron deficiency?

A
  • Excess blood loss
    • Menorrhagia
    • haematuris
    • GI bleeding
      • ulcer or malignancy
  • Decreased absoption
    • coeliac disease
    • achlorhydia (autoimmune or Helicobacter pylori gastritis)
  • Increased utilisation
    • pregnancy and lactation
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9
Q

What are the clinical features?

A
  • general features of anaemia (see other card)
  • pica
  • painless smooth glossitis
  • angular stomatitis
  • brittle nails
  • koilonychia (spoon nails)
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10
Q

What are the features of a full blood picture typical of mycrocytic anaemia e.g. iron deficiency?

A
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11
Q

What would you expect to see in a blood film?

A
  • Hypochromic microcytic red cells
  • Pencil cells
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12
Q

What are the typical results for iron studies?

A
  • Low ferritin
  • Low or normal serum iron
  • High transferrin
  • Low transferrin saturation (ratio of iron to transferrin)
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13
Q

Is iron deficiency a fine diagnosis?

A

NO - not a diagnosis in its own right. Underlying cause should always be established.

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14
Q

Explain the management of iron deficiency and when would expect to see response

A
  • Oral iron therapy
    • safe, cheap, effective
    • Iron best absorbed as salt (Fe2+)
    • ascorbic acid (vitamin c) enhances absorption
    • typical dose - 150-200mg daily
    • adverse effects: GI disturbance

Response: reticulocytosis (new young red cells) seen by 5-7 days following. Hb should normalise within 6-8 weeks

  • Parenteral iron therapy
    • indicated by:
      • unable to tolerate oral iron
      • non-compliant with oral iron
      • malabsorption GI
    • iron carboxymaltose (Ferinject) or polymaltose (Ferrosig)
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15
Q

What are blood transfusions indicated for iron deficiency?

A

Only when patient are haemodynamically unstabl or who have ischaemic symptoms secondary to severe iron deficiency.

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16
Q

What is anaemia of inflammation/anaemia of chronic disease?

A
  • Diagnosis of exclusion
  • Common, found patients with inflammatory or malignant disease
  • Multifactorial pathogenesis, including:
    • reduced erythropoietin response to anaemia
    • decreased red cell survival
    • impaired iron absorption in liver due to hepcidin release during inflammation
17
Q

Describe the FBP, Iron studies and management of typical of Anaemia of Chronic Disease

A
  • FBP:
    • shows mild anaemia
    • MCV normal or reduced
  • Iron studies - typical results (pic)

Management:

  • correction of underlying condition
  • doesn’t respond to oral iron therapy
18
Q

What is thalassaemia?

A
  • Genetic disorder of globin gene (alpha or beta)
    • Deletions or point mutations which result in decreased production of one of the globin chains
19
Q

Explain the differences between Beta thalassaemia trait and Beta thalassaemia major

A

Beta thalassaemia trait (heterozygotes)

  • Asymptomatic clinically
  • Detected as result family studies or FBP done

Beta thalassaemia major (homozygotes)

  • cannot produce any beta globin
  • leads to severe transfusions dependent anaemia
20
Q

What are the typical results of FBC and blood smear for thalassaemia?

A
21
Q

What are the clinical features of beta thalassaemia major?

A
  • Severe transfusion dependent anaemia
  • Expansion of haemopoietic tissue
    • bony deformities
      • marrow mass expands
      • facial bones increase in size to increase marrow capacity
    • hepatosplenomegaly
  • Can get iron overload from excessive infusions
22
Q

Explain α thalassaemia

A

Alpha thalassaemia = most common monogenic disorder

Most commonly occurs as result of deletions of various size in the alpha globin locus.

Clinical features depend on degree of reduction in alpha globin synthesis.

  • Silent/Thalassaemia trait: α α / α -
  • Thalassaemia trait: α α / - -
  • HbH Disease: α - / - -
  • Hb Barts/Hydrops fetalis: - - / - - (fatal)
23
Q

What are the laboratory features of α thalassaemia trait?

A
  • “Thalassaemic Red Cell Indices”
    • Hb level is normal/midly reduced
    • Microcytosis is disproportionate to the Hb level
    • RCC is often elevated
  • Hb studies are normal
  • Require molecular studies to confirm the diagnosis
  • Iron studies usually normal in uncomplicated cases
    • But can developed iron deficiency also!!
24
Q

Why is it important to recognise α thalassaemia trait?

A

HAI Lectures (14 decks)

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