Haematology Flashcards
Define anaemia
A low level of haemoglobin in the blood.
Examples of microcytic anaemia
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia
Examples of normocytic anaemia
3 As and 2 Hs
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
Examples of macrocytic anaemia
Megaloblastic - B12, folate deficiency
Normoblastic - alcohol, reticulocytosis, hypothyroidism, liver disease, azathioprine.
History of anaemia
Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions
Iron deficient
Pica - crave abnormal things like dirt
Hair loss
Clinical signs of anaemia
Pallor
Tachycardia
Raised respiratory rate
Koilonychia - iron
Angular cheilitis - iron
Atrophic glossitis - iron
Brittle hair - iron
Jaundice - haemolytic
Bone deformities - thalassaemia
Oedema HTN and excoriations - CKD
Investigations in anaemai
Bloods - MCV, B12, folate, ferritin, film
OGD + colonoscopy - cancer?
Bone marrow biopsy if cause unclear
Causes of iron deficiency anaemia
Insufficient dietary iron
Increased requirements - pregnancy
Iron being lost - slow bleed, colon cancer
Inadequate iron absorption
Most common cause - menorrhagia
Management of iron deficiency anaemia
Investigate cause - ?cancer
Blood transfusion
Iron infusion
Oral iron supplement
Define pernicious anaemia
An autoimmune condition attacking the parietal cells or intrinsic factor. This prevents the absorption of vitamin B12 and they become deficient.
History of B12 deficiency
Peripheral neuropathy
Loss of vibration sense or proprioception
Visual changes
Mood or cognitive change
Management of pernicious anaemia
If dietary deficient - cyanocobalamin
IM hydroxocobalamin - B12 replacement
Treat B12 before folate -spinal cord degeneration
Define haemolytic anaemia
Anaemia caused by the destruction of red blood cells. Caused often by inherited condition .
Inherited haemolytic anaemias
Hereditary spherocytosis
Hereditary elliptocytosis
Thalassaemia
Sickle cell anaemia
G6PD dificiencty
Acquired haemolytic anaemia
Auto immune
Alloimmune - transfusion reactions, haemolytic disease of newborn
Paroxysmal nocturnal haemoglobinuria
Microangiopathic haemolytic anaemia
Prosthetic valve related
Clinical signs of haemolytic anaemia
Splenomegaly
Jaundice
Normocytic anaemia
Investigations in haemolytic anaemia
FBC - normocytic anaemia
Film - schistocytes
Direct coombs test - positive in autoimmune haemolytic anaemia
Define hereditary spherocytosis
Most common inherited haemolytic anaemia - causing sphere shaped red blood cells that are fragile and easily broken down when passing through the spleen
History of hereditary spherocytosis
Jaundice
Gall stones
Splenomegaly
Aplastic crisis - parvovirus
Management of hereditary spherocytosis
Folate supplementation
Splenectomy
Cholecystectomy - stones
Define G6PD deficiency
Defect in the red blood cell enzyme G6PD
X linked recessive condition causing crises that are triggered by infection medications or fava beans.
Classic presentation of G6PD deficieny
Mediterranean or African patient turns jaundiced and anaemic after eating broad beans, an infection or treatment with antimalarials.
What is seen on blood fil in G6PD deficiency
Heinz bodies - individual blobs seen inside rbcs - denatured globin.
Define target cells
Central pigmented area surrounded by a pale arrea, surrounded by a ring of thicker cytoplasm on the outside - bull’ eye