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Phase 2a Medicine (JH) > Haematology > Flashcards

Haematology Flashcards

1
Q

Define anaemia.

A

A low haemoglobin concentration (below the reference level for the age and sex of the individual).

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2
Q

A low haemoglobin level may be due to which two factors?

A

Due to a low red cell mass (RCM) or increased plasma volume.

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3
Q

Explain why pregnant women appear anaemic.

A

In pregnancy there is a small increase in red cell mass but a large increase in plasma volume so concentration of red blood cells is decreased.

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4
Q

What is the lifespan of a red blood cell?

A

120 days.

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5
Q

Define haematocrit.

A

The volume percentage of red blood cells in the blood.

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6
Q

Under what conditions may a person be defined as anaemic?

A

Due to reduced RBC production from the bone marrow.

Or increased loss of RBCs by the spleen, liver, bone marrow and blood loss.

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7
Q

What test may be performed to determine whether the cause of anaemia is reduced production from bone marrow or loss of RBCs?

A

Reticulocyte count.

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8
Q

What are reticulocytes?

A

Immature red blood cells.

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9
Q

What do the results of a reticulocyte count mean?

A

If reticulocyte count is low - production of RBCs is the issue.
If reticulocyte count is high - - loss of RBCs is the issue.

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10
Q

How are various anaemia types classified?

A

By mean corpuscular volume (MCV).

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11
Q

What is mean corpuscular volume?

A

The average volume of red blood cells.

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12
Q

What are the three major types of anaemia?

A

Microcytic.
Normocytic.
Macrocytic.

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13
Q

What is microcytic anaemia?

A

Anaemia with a low MCV (<80 fL).

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14
Q

What is normocytic anaemia?

A

Anaemia with a normal MCV.

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15
Q

What is macrocytic anaemia?

A

Anaemia with a high MCV (>96 fL).

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16
Q

Give three main consequences of anaemia?

A

Reduced oxygen transport.
Tissue hypoxia.
Compensatory changes.

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17
Q

Give three compensatory changes in the response to anaemia.

A

Increased tissue perfusion.
Increased oxygen transfer to tissues.
Increased RBC production.

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18
Q

Give five pathological consequences of anaemia.

A 
Myocardial fatty change. 
Fatty change in the liver. 
Aggravation of angina and claudication. 
Skin and nail atrophic changes. 
CNS cell death.
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19
Q

Give six non-specific symptoms of anaemia.

A 
Fatigue, headaches and faintness. 
Dyspnoea and breathlessness. 
Angina. 
Anorexia. 
Intermittent claudication. 
Palpitations.
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20
Q

What is claudication?

A

Cramping pain in the leg, induced by exercise.

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21
Q

Give four signs of anaemia.

A

Pallor.
Tachycardia.
Systolic flow murmur.
Cardiac failure.

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22
Q

Give an example of where pallor can be observed in those with anaemia?

A

In the conjunctivae - conjunctival pallor.

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23
Q

Under what conditions are tachycardia, systolic flow murmur and cardiac failure most often observed?

A

In severe anaemia (Hb <80g/L)

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24
Q

What is the most common cause of anaemia worldwide?

A

Iron-deficiency anaemia.

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25
Iron-deficiency causes what type of anaemia?
Microcytic anaemia.
26
What percentage of menstruating women have iron-deficiency anaemia?
Up to 14%
27
Iron deficiency anaemia arises due to what?
Inadequate iron for haemoglobin synthesis.
28
Suggest four causes of iron deficiency
Blood loss. Poor diet. Malabsorption. Increased demands.
29
Blood loss due to which three things can cause iron-deficiency anaemia?
Menorrhagia. GI bleeding. Hookworm.
30
What is menorrhagia?
Heavy/prolonged menstrual bleeding.
31
Iron-deficiency anaemia as a result of poor diet most commonly affects which group of people?
Children/babies in poverty.
32
What is the average daily intake of iron?
15 - 20mg
33
What percentage of iron intake is absorbed in the duodenum?
10%
34
Gives example dietary sources of iron.
``` Liver. Meat. Beans. Nuts. Dark-green leafy vegetables. ```
35
Iron is required for the formation of what in haemoglobin?
Haem.
36
Describe how iron ions are absorbed in the duodenum.
Iron ions are actively transported into the duodenal intestinal epithelial cells.
37
Iron ions are transported into the duodenal epithelial cells via which transport protein?
Intestinal harm transporter (HCP1)
38
What is the fate of iron ions once they have been absorbed by the duodenum?
Some are incorporated into ferritin while others are released into the blood.
39
What is ferritin?
An intracellular store of iron.
40
Iron ions released into the blood circulate bound to which protein?
Transferrin.
41
Circulating iron can be used in which two ways?
Iron is transported to the bone marrow where it is incorporated into new erythrocytes. Iron is stored in reticuloendothelial cells, hepatocytes and skeletal muscle cells.
42
Iron is stored in reticuloendothelial cells, hepatocytes and skeletal muscle cells is what form?
As ferritin or haemosiderin.
43
Suggest four risk factors for iron-deficiency anaemia.
Undeveloped countries. High vegetable diet. Premature infants. Delayed introduction to mixed feeding.
44
Why is delayed introduction to mixed feeding a risk factor for iron-deficiency anaemia?
Breast milk is low in iron.
45
What is the clinical presentation of someone with iron-deficiency anaemia?
``` General anaemia presentation. Brittle nails and hair. Koilonychia. Atrophic glossitis. Angular cheilosis. ```
46
What is koilonychia?
Spoon shaped nails.
47
What is atrophic glossitis?
Atrophy of the tongue papillae.
48
What is angular cheilosis?
Ulceration of the corners of the mouth.
49
Give three possible differentials for iron-deficiency anaemia?
Thalassaemia. Sideroblastic anaemia. Anaemia of chronic disease.
50
What blood tests can be performed in the diagnosis of iron-deficiency anaemia?
``` Blood count and film. Serum ferritin. Serum iron. Serum soluble transferrin receptors. Reticulocyte count. ```
51
What may a blood count and blood film show in a patient with iron-deficiency anaemia?
RBCs microcytic and hypochromic. Poikilocytosis. Anisocytosis.
52
What is meant if RBCs are hypochromic?
Less colour therefore paler.
53
What is poikilocytosis?
A variation in RBC shape.
54
What is anisocytosis?
A variation in RBC size.
55
Serum ferritin reflects what?
The amount of stored iron.
56
What would the serum ferritin result be for someone with IDA?
Low. (May be normal in malignancy or infection).
57
What would the serum iron result be for someone with IDA?
Low.
58
Why does transferrin saturation fall in patients with IDA?
Compensatory mechanism increases total iron binding capacity (by increasing conc. of transferrin). Saturation falls < 10%
59
What would the serum soluble transferrin receptor result be for someone with IDA?
Increased.
60
What would the reticulocyte count result be for someone with IDA?
Low.
61
Iron-deficiency anaemia is treated by what?
Oral iron - ferrous sulphate.
62
Give four side effects of ferrous sulphate?
Nausea. Abdominal discomfort. Diarrhoea. Black stools.
63
If the side effects of ferrous sulphate are bad, how should IDA be treated?
Ferrous gluconate.
64
In extreme cases of iron-deficiency anaemia, what is the appropriate treatment?
Parenteral iron.
65
How can parenteral iron be administered?
IV iron. | Deep intramuscular iron.
66
What is anaemia of chronic disease?
Anaemia secondary to chronic disease.
67
What is the histology of anaemia of chronic disease?
RBCs are often normocytic but may be microcytic.
68
In which cases does anaemia of chronic disease result in microcytic RBCs?
Rheumatoid arthritis. | Crohn's disease.
69
Anaemia arises from which chronic diseases?
``` Tuberculosis. Crohn's. SLE. Rheumatoid arthritis. Malignant disease. ```
70
Give three reasons why chronic disease results in anaemia.
Decreased release of iron from bone marrow to developing erythroblasts. Inadequate erythropoietin response. Decreased RBC survival.
71
How does anaemia of chronic disease present?
``` Fatigue, headaches, faintness. Dyspnoea and breathlessness. Angina (if preexisting coronary disease). Anorexia. Intermittent claudication. Palpitations. ```
72
What blood tests should be done and what will the results be in patients with anaemia of chronic disease?
Serum iron low. Total iron binding capacity low. Serum ferritin normal or raised. Serum soluble transferrin receptor normal. Blood count and film (normocytic/microcytic).
73
How is anaemia of chronic disease treated?
By treating the underlying cause or prescribing erythropoietin.
74
What are side effects of erythropoietin?
Flu-like symptoms. Hypertension. Thromboembolism.

Phase 2a Medicine (JH) (7 decks)

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