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Haematology > Haem - Anaemia, IDA, B12+pernicious anaemia, Thalassaemia > Flashcards

Haem - Anaemia, IDA, B12+pernicious anaemia, Thalassaemia Flashcards

1
Q

Anaemia - what is the definition of anaemia?

A

Defined as low level of Haemoglobin in the blood

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2
Q

Anaemia - what is mean cell volume?

A

This is the size of the RBCs

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3
Q

Anaemia - what are the three categories MCV can be divided into?

A

Microcytic anaemia - low MCV, small RBCs

Normocytic anaemia - normal MCV, normal sized RBCs

Macrocytic anaemia - high MCV, large RBCs

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4
Q

Anaemia - what are microcytic anaemia causes?

A

TAILS

Thalassaemia
Anaemia of chronic disease
Iron Deficiency Anaemia
Lead poisoning
Sideroblastic anaemia

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5
Q

Anaemia - what are normocytic anaemia causes?

A

AAAHH or AHAHA

Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Hypothyroidism
Haemolytic anaemia

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6
Q

Anaemia - what two categories can macrocytic anaemia causes be divided into and what are the causes?

A

Megaloblastic anaemia - impaired DNA synthesis, prevents cell from dividing normally, so cell grows into larger abnormal cell, caused by VITAMIN DEFICIENCY:

  1. B12 deficiency
  2. Folate deficiency

Normoblastic macrocytic anaemia:

  1. Alcohol
  2. Reticulocytosis
  3. Hypothyroidism
  4. Liver disease
  5. Drugs - azathioprine
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7
Q

Anaemia - what are the symptoms?

A

Fatigue
SoB
Palpitations
Headaches
Dizziness
Worsening of other conditions

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8
Q

Anaemia - what are some signs?

A

Pale skin
Conjunctival pallor
Tachycardia
Increased resp rate

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9
Q

Iron Deficiency Anaemia (IDA) - what are some reasons as to why a patient may become iron deficient?

A
  1. Insufficient dietary iron
  2. Iron requirements increase (pregnancy)
  3. Iron being lost (bleeding, menorrhagia)
  4. Malabsorption
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10
Q

IDA - where is iorn mainly absorbed?

A

Duodenum and Jejunum

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11
Q

IDA - what medications reduce stomach acid, and why is this a problem in IDA?

A

PPIs

Duo and Jej need soluble form of iron to absorb, which requires stomach acid to stay in that soluble form, but PPIs reduce stomach acid, so it changes to Fe3+ insoluble form, so interferes with Fe absorption

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12
Q

IDA - what is transferrin?

A

Carrier protein that binds iron

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13
Q

IDA - what is total iron binding capacity (TIBC)?

A

Total space on the transferrin molecule for the iron to bind

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14
Q

IDA - what is transferrin saturation, and what is the equation?

A

Proportion of transferrin molecules that are bound to iron

Transferrin Saturation = Serum iron / TIBC

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15
Q

IDA - what is ferritin?

A

Ferritin is the form iron takes when it is deposited and stored in cells

If serum ferritin low, highly suggestive of IDA

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16
Q

IDA - what would you see on blood results?

A

Increased TIBC

Increased transferrin

Decreased transferrin saturation

Decreased Ferritin

Decreased serum iron

17
Q

IDA - what would you see on a blood film?

A

Poikilocytes - abnormally shaped RBCs

18
Q

IDA - management?

A

PO ferrous sulphate/fumarate, 200mg TDS:
Give Vit C to aid absorption
Can take 3-6 months
SE - N+V, black stools
UNSUITABLE when MALABSORPTION is cause

IV iron:
Quickly corrects ID
Avoided during sepsis, as iron ‘feeds’ bacteria

19
Q

B12 deficiency and Pernicious anaemia - what is it?

A

Pernicious anaemia is a cause of B12 (cobalamin) deficiency

B12 deficiency can be caused by insufficient diet of B12 or pernicious anaemia

20
Q

B12 deficiency and Pernicious anaemia - function of B12?

A

B12 and folate aid DNA synthesis

B12 aids myselin formation

21
Q

B12 deficiency and Pernicious anaemia - pathophysiology of B12 absorption

A
  • Gastric parietal cells produce protein called intrinsic factor (IF)
  • B12 binds to IF, B12-IF complex can then be absorbed in terminal ileum
22
Q

B12 deficiency and Pernicious anaemia - what is pernicious anaemia?

A

Autoimmune condition where antibodies destroy gastric parietal cells or IF itself

Lack of IF prevents absorption of vitamin B12

23
Q

B12 deficiency and Pernicious anaemia - what are the investigations and results?

A

1st line: IF antibody test

Bloods

FBC:

  1. Decresased Hb
  2. Increased MCV (as megaloblastic anaemia)

Decreased serum cobalamin

24
Q

B12 deficiency and Pernicious anaemia - what is the management?

A

1st line if problem is absorption - Hydroxycobalamin IM, 3 times weekly for 2 weeks, then every 3 months

1st line if dietary deficiency - cyanocobalamin

25
Q

Thalassaemia - what is it?

A

Alpha and Beta Thalassaemia are autosomal recessive disorders, which are cuased by a mutation that leads to dysfunction of either the alpha-globin or beta-globin chains on the Hb molecule

26
Q

Thalassaemia - pathophysiology

A
  • In thalassaemia, blood cells more fragile
  • Break down more easily
  • Spleen acts as a sieve to filter RBCs and remove RBCs
  • In thalassaemia, spleen collects destroyed RBCs and swells - splenomegaly
  • Bone marrow expands to produce more RBCs to compensate for anaemia, causes pronounced forehead and malar eminences
27
Q

Thalassaemia - signs and symptoms

A
  1. Microcytic anaemia
  2. Pallor
  3. Jaundice
  4. Gallstones
  5. Splenomegaly
  6. Pronounced head and eminences
  7. Poor growth
28
Q

Thalassaemia - investigations

A

FBC - Microcytic anaemia

Haemoglobin electrophoresis

DNA testing

29
Q

Thalassaemia - what can occur in thalassaemia in response to anaemia?

A

Iron overload

30
Q

Thalassaemia - why does iron overload occur, and what is the management?

A

Faulty creation of RBCs

Recurrent transfusions

Increased absorption of iron in response to anaemia

Management - limit transfusions, iron chelation

31
Q

Thalassaemia - alpha thalassaemia causes what impairment?

A

Alpha thalassaemia leads to impaired oxygen transport extravascular haemolysis

32
Q

Thalassaemia - beta thalassameia causes what abnormality?

A

Leads to failed erythropoiesis

Build up of alpha chains causing cell destruction

Compensatory erythroid hyperplasia causes bone growth

33
Q

Thalassaemia - investigations

A

Bloods:

Decreased Hb

Decreased MCV

RBCs may be normal or high

Increased reticulocytes

Diagnosis: HB electrophoresis

Liver biopsy if iron overload

34
Q

B12 deficiency and Pernicious anaemia - what is the presentation?

A

Megaloblastic anaemia

  1. Neurological symptoms - peripheral neuropathy with numbness or paraesthesia, impaired cognition, psychosis, impaired proprioception
  2. Glossitis
  3. Angular cheilitis
35
Q

B12 deficiency and Pernicious anaemia - what are some causes?

A

Impaired absorption - crohn’s, ileal resection

Diet - vegan diet, malnutrition

Drugs - PPIs, metformin, alcohol

36
Q

IDA - what are the soluble and insoluble forms of iron?

A

Soluble: Ferrous Fe2+
Stomach acid required to keep iron in soluble form, if acid levels drop, it changes to insoluble form Ferric Fe3+

37
Q

Anaemia - what two categories can macrocytic anaemia causes be divided into and what are the causes?

A

Megaloblastic anaemia - impaired DNA synthesis, prevents cell from dividing normally, so cell grows into larger abnormal cell, caused by VITAMIN DEFICIENCY:

  1. B12 deficiency
  2. Folate deficiency

Normoblastic macrocytic anaemia:

  1. Alcohol
  2. Reticulocytosis
  3. Hypothyroidism
  4. Liver disease
  5. Drugs - azathioprine

Haematology (5 decks)

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