haematological Flashcards
what is the definition of iron deficiency anaemia?
Iron deficiency as inadequate iron intake, increased loss or excessive requirement. Defined by WHO as Hb <130g/L in men older than 15yrs, <120g/L in women older than 15yrs & <110g/L in pregnant women
what are the symptoms of iron deficiency anaemia?
- Fatigue
- Pallor
- Dyspnoea on exertion
- hair loss
what are the signs of iron deficiency anaemia on examination?
- Nail changes: this includes koilonychia (spoon-shaped nails)
- angular stomatitis
- atrophic glossitis
- post-cricoid webs
what is the epidemiology of iron deficiency anaemia?
- Globally, iron deficiency is the most common cause of anaemia
- Preschool-age children have the highest prevalence of iron deficiency anaemia
- Premenopausal women have higher incidence (due to menstruation & pregnancy), common in young children
- In up to 14% of menstruating women
who is most at risk of iron deficient anaemia?
- Black women,
- pregnancy,
- vegan diet,
- menorrhagia
what is the Causes of iron deficient anaemia?
- excessive blood loss (menorrhagia most common in women, GI bleed in men)
- inadequate dietary intake (vegetarians)
- poor intestinal absorption (coeliac disease)
- increased iron requirements (pregnancy, children during growth spurts etc)
- hookworm
what are the differential conditions for iron deficiency anaemia?
- Anaemia of chronic disease
- Disorders of globin synthesis e.g. thalassaemias, unstable haemoglobins
- Sideroblastic anaemias
how do we investigate for iron deficiency anaemia?
history most important step
bloods
FBC
Serum ferritin - likely be low
total iron-binding capacity TIBC/Transferrin - TIBC will be low
blood film
- pencil poikilocytes
- low MCV, Low MCH
endoscopy
- rule out malignancy
how do we manage iron deficiency anaemia
- treat underlying cause of anaemia
Pharmacological
- oral ferrous sulphate - 3 months
lifestyle
- iron rich diet (dark-green leafy veg etc)
Monitor
- recheck haemoglobin levels after 2-4 weeks
what is the definition of macrocytic anaemia?
Macrocytosis means RBCs larger than normal, macrocytic anaemia occurs when there’s also a fall in Hb levels in the blood
what are the symptoms of macrocytic anaemia?
- Asymptomatic (if mild)
- Pallor
- Dyspnoea on exertion
- Fatigue
- Palpitations
- Angina exacerbation
- Asymptomatic (if mild)
- Pallor
- Dyspnoea on exertion
- Fatigue
- Palpitations
- Angina exacerbation
bounding pulse
what are the causes of macrocytic anaemia?
Macrocytic anaemia can be divided into causes associated with a megaloblastic bone marrow and those with a normoblastic bone marrow
megaloblastic
b12 and folate deficiency
cytotoxic drugs
nonmegaloblastic/ normoblastic
- alcohol excess
- reticulocytosis
- liver disease
- hypothyroidism
- pregnancy
- myelodysplasia
- myeloma
- myeloprofilerative disorders
- aplastic anaemia
what are the causes of folate deficiency
- poor diet - alcoholics, elderly
- increased demand - pregnancy, malignancy, Inflammatory diseases, renal dialysis
- malabsorption - coeliac disease
- alcohol
- drugs - antiepiletics, phenytoin, methotrexate, trimethoprim
what is the causes of b12 deficiency
- pernicious anaemia
- tapeworm
- crohns disease
