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CP3 Medicine > HAEM - Micro and Macrocytic Anaemia > Flashcards

HAEM - Micro and Macrocytic Anaemia Flashcards

1
Q

Def anaemia

A

Decreased haemaglobin in blood such that = inadequate O2 delivery to the tissues

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2
Q

Hb value anaemia men

A

<135g/L

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3
Q

Hb value anaemia women

A

<115g/L

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4
Q

Sx anaemia (non-specific)

A

Fatigue
Weakness
Headaches

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5
Q

Sx anaemia (CV)

A

Intermittent claudication
Dyspnoea on exertion
Angina

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6
Q

Signs anaemia (4)

A

Pallor
TachyC
Systolic flow murmur
Cardiac failure

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7
Q

Specific sign IDA

A

Koilonychia

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8
Q

Specific sign haemolytic anaemia

A

Jaundice

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9
Q

Specific sign sickle cell anaemia

A

Leg ulcers

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10
Q

What drug should be given alongside blood transfusions and WHY

A

Furosemide

HF risk

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11
Q

Ways iron is stored

A

As intracellular ferritin + hemosiderin - macrophages, of spleen, liver, BM
Intracellular ferritin - hepatocytes
Myoglobin in Fe-containing enzymes

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12
Q

What 4 things should a low Hb be considered in relation to?

A

WBC count
Platelet count
Reticulocyte count
Blood film

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13
Q

Microcytic anaemia value

A

<80fL

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14
Q

Causes microcytic anaemia

A

Sideoblastic anaemia
Lead poisoning
Thalassaemia
IDA

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15
Q

Causes normocytic anaemia (8)

A 
Acute blood loss 
Anaemia chronic disease 
Renal anaemia 
Haemolytic anaemia 
Marrow failure 
Pregnancy 
CT disease 
Diamorphic blood film
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16
Q

Macrocytic anaemia value

A

> 96fL

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17
Q

Causes macrocytic anaemia

A 
B12 defic
FOlate defic
Alcohol XS
Myelodysplastic syndrome 
Severe hypothyroidism
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18
Q

What is diamorphic blood film?

A

Combined macro/microcytic processes

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19
Q

Clinical examination findings IDA (5)

A 
Koilonychia 
angular stomatitis 
brittle hair/nails 
atrophy of papillae of tongue 
Syndromes dysphagia/glossitis
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20
Q

What are the 4 Fe studies

A

Serum Fe
Serum ferritin
Total Fe binding capacity
Serum soluble transferrin receptors

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21
Q

What does IDA look llike on blood film

A

Microcytic, hypochromic (pale on blood film)
Poikilocytosis
Anisocytosis

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22
Q

What is the latent Fe deficiency period?

A

Where normal Hb is maintained despite Fe deficiency

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23
Q

What is the most common cause of IDA in the world?

A

Hookworm

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24
Q

What are the most common causes of IDA in the UK?

A

Blood loss

Menstruation

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25
Q

Other causes of IDA

A

Decreased absorption - coeliac/antacids/post gastrectomy
Increased demand - growth/pregnancy
Inadequate intake

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26
Q

Poikilocytosis

A

Shape variation

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27
Q

Anisocytosis

A

Size variation

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28
Q

Fe marker values IDA

A

Serum Fe = decreased
TIBC = increased
Serum ferretin = decreased
Soluble transferrin receptor = increased

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29
Q

Which is the most specific test for IDA

A

Soluble transferrin receptor

30
Q

DDx IDA

A

Anaemia of chronic disease

31
Q

Fe marker values anaemia of chronic disease

A

Serum Fe = decreased
TIBC = decreased
Serum ferritin = increased
STR = normal

32
Q

What does serum ferretin represent in anaemia of chronic disease?

A

Increased stored iron (b.c is an acute phase reactant)

33
Q

Mx IDA

A 
Address underlying cause 
PO FeSO4 200mg t.d.s 
Increase dietary intake 
Monitor - blood parameters after 1 month
Continue for 3 months after blood parameters return to norm
34
Q

What can be done if pt is not tolerating Ferrous sulphate

A

Switch to ferrous gluconate

35
Q

SE ferrous sulphate

A 
Cramping 
Bloating
N+V
Constipation 
Black stools
36
Q

Rules of 10’s

A

Max [Hb] in 1 week = 10g/L
If >10g/L decline in 1 week - blood is being lost
When transfusing - 1 bag will raise Hb [ ] by 10g/L

37
Q

Who gets Plummer-Vinson syndrome

A

post-menopausal women

38
Q

Mx Plummer-Vinson syndrome

A

Fe

Mechanical widening of oesophagus

39
Q

Sx beta-thalassaemia minor

A

Usually asymp

40
Q

What state can make minor beta thalassaemia worse?

A

Pregnancy

41
Q

PS B-thalassaemia major

A

Severe anaemia
HSmegaly
FTT
+/- facial deformities

42
Q

Blood film b-thalassaemia major

A

Hypochromic microcytic cells + target cells + nucleated RBC

43
Q

Mx major b-thalassaemia

A

Lifelong blood transfusions

44
Q

What is Bart’s hydrops

A

Deletion of all 4 alpha genes –> HbBarts (y4)

45
Q

Outcome Bart’s hydrops

A

Death in utero

46
Q

Deletion of 3 genes in alpha thalassaemia –>

A

Moderate microcytic anaemia + features haemolysis

47
Q

Deletion of 2 genes in alpha thalassaemia –>

A

Asymp carrier with reduced MCV

48
Q

Deletion of 1 gene in alpha thalassaemia –>

A

Clinically normal

49
Q

Cause sideroblastic anaemia

A

Congenital
Or
Acquired in myelodysplastic syndrome

50
Q

Approach to macrocytic anaemia

A

Blood film
LFT/TFT
Serum B12/folate levels
BM biopsy

51
Q

Relevance of serum folate levels

A

reflects recent intake

52
Q

Next Ix to do if B12 is low

A

Anti-parietal cell Ab
Anti-IF Ab
Schilling test

53
Q

Schilling test

A

Distinguishes between pernicious anaemia and small bowel disease

54
Q

Deoxyuridine suppression test

A

Differentiate B12/folate deficiency in vitro after BM biopsy

55
Q

mechanism by which b12 and /or folate deficiecy lead to anaemia

A

B12 - coenzyme for conversion folate to activated folate
ac folate = req for DNA synthesis
DNA fails to stop erythrocyte development –> v large cells = trapped = destroyed in reticuloendothelial system

56
Q

causes vit B12 definciency (3)

A

Chronic low uptake (vegan)
Impaired binding in stomach
Small bowel disease/terminal ileium disease

57
Q

What 3 things can cause mild impairment Vit B12 absorption

A

Pancreatitis
Coeliac disease
Metformin use

58
Q

What is pernicious anaemia

A

Autoimmune disease leading to severe B12 deficiency

59
Q

What are the 2 types of antibodies that may contribute to pernicious anaemia?

A

Blocking autoantibodies

Binding autoantibodies

60
Q

Blocking autoantibodies pernicious anaemia

A

Prevent IF-B12 binding

61
Q

Binding autoatibodies pernicious anaemia

A

Prevent if binding to ileal receptors

62
Q

Features pernicious anaemia

A

Lemon skin
Intramedullary haemolysis
High unconjugated bilirubin

63
Q

What is subacute combined degeneration of the cord

A

Simultaneous posterior column (LMN) and CST (UMN) loss

64
Q

What is subacute combined degeneration of the cord due to?

A

B12 deficiency

65
Q

Triad subacute combined degeneration of the cord

A

Extensor plantars
Brisk knee jerk
Absent ankle jerks

66
Q

PS subacute combined degeneration of the cord (6)

A 
Peripheral neuropathy 
Extensor plantars 
Brisk knee jerk
Absent ankle jerks 
Tone and power normal 
Gait may be ataxic
67
Q

Where in the digestive system is folate absorped?

A

Jejunum

68
Q

How long do the body’s reserves of folate last?

A

3 months

69
Q

Causes folate deficiency

A

Poor nutritional intake
Malabsorption - Chrons
Anti-folate drugs
XS physiological - pregnancy, prematurity
XS pathological - XS eryhtrocyte prod, malig, Inflamm disease

70
Q

E.g.s of drugs that cause folate deficiecy (3)

A

Methotrexate
Trimethroprim
Anti-convulsants

71
Q

Tx folate deficiency

A

folic acid 5mg /day PO for 4 months

Always combine w/ B12 (unless Pt known to have norm B12 levels)

72
Q

what condition can XS folate precipitate?

A

Subacute combined degeneration of cord

CP3 Medicine (29 decks)

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