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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
Q

Iron-deficiency causes what type of anaemia?

A

Microcytic anaemia.

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26
Q

What percentage of menstruating women have iron-deficiency anaemia?

A

Up to 14%

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27
Q

Iron deficiency anaemia arises due to what?

A

Inadequate iron for haemoglobin synthesis.

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28
Q

Suggest four causes of iron deficiency

A

Blood loss.
Poor diet.
Malabsorption.
Increased demands.

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29
Q

Blood loss due to which three things can cause iron-deficiency anaemia?

A

Menorrhagia.
GI bleeding.
Hookworm.

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30
Q

What is menorrhagia?

A

Heavy/prolonged menstrual bleeding.

31
Q

Iron-deficiency anaemia as a result of poor diet most commonly affects which group of people?

A

Children/babies in poverty.

32
Q

What is the average daily intake of iron?

A

15 - 20mg

33
Q

What percentage of iron intake is absorbed in the duodenum?

A

10%

34
Q

Gives example dietary sources of iron.

A 
Liver. 
Meat. 
Beans. 
Nuts. 
Dark-green leafy vegetables.
35
Q

Iron is required for the formation of what in haemoglobin?

A

Haem.

36
Q

Describe how iron ions are absorbed in the duodenum.

A

Iron ions are actively transported into the duodenal intestinal epithelial cells.

37
Q

Iron ions are transported into the duodenal epithelial cells via which transport protein?

A

Intestinal harm transporter (HCP1)

38
Q

What is the fate of iron ions once they have been absorbed by the duodenum?

A

Some are incorporated into ferritin while others are released into the blood.

39
Q

What is ferritin?

A

An intracellular store of iron.

40
Q

Iron ions released into the blood circulate bound to which protein?

A

Transferrin.

41
Q

Circulating iron can be used in which two ways?

A

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
Q

Iron is stored in reticuloendothelial cells, hepatocytes and skeletal muscle cells is what form?

A

As ferritin or haemosiderin.

43
Q

Suggest four risk factors for iron-deficiency anaemia.

A

Undeveloped countries.
High vegetable diet.
Premature infants.
Delayed introduction to mixed feeding.

44
Q

Why is delayed introduction to mixed feeding a risk factor for iron-deficiency anaemia?

A

Breast milk is low in iron.

45
Q

What is the clinical presentation of someone with iron-deficiency anaemia?

A 
General anaemia presentation. 
Brittle nails and hair. 
Koilonychia. 
Atrophic glossitis. 
Angular cheilosis.
46
Q

What is koilonychia?

A

Spoon shaped nails.

47
Q

What is atrophic glossitis?

A

Atrophy of the tongue papillae.

48
Q

What is angular cheilosis?

A

Ulceration of the corners of the mouth.

49
Q

Give three possible differentials for iron-deficiency anaemia?

A

Thalassaemia.
Sideroblastic anaemia.
Anaemia of chronic disease.

50
Q

What blood tests can be performed in the diagnosis of iron-deficiency anaemia?

A 
Blood count and film. 
Serum ferritin. 
Serum iron. 
Serum soluble transferrin receptors. 
Reticulocyte count.
51
Q

What may a blood count and blood film show in a patient with iron-deficiency anaemia?

A

RBCs microcytic and hypochromic.
Poikilocytosis.
Anisocytosis.

52
Q

What is meant if RBCs are hypochromic?

A

Less colour therefore paler.

53
Q

What is poikilocytosis?

A

A variation in RBC shape.

54
Q

What is anisocytosis?

A

A variation in RBC size.

55
Q

Serum ferritin reflects what?

A

The amount of stored iron.

56
Q

What would the serum ferritin result be for someone with IDA?

A

Low. (May be normal in malignancy or infection).

57
Q

What would the serum iron result be for someone with IDA?

A

Low.

58
Q

Why does transferrin saturation fall in patients with IDA?

A

Compensatory mechanism increases total iron binding capacity (by increasing conc. of transferrin). Saturation falls < 10%

59
Q

What would the serum soluble transferrin receptor result be for someone with IDA?

A

Increased.

60
Q

What would the reticulocyte count result be for someone with IDA?

A

Low.

61
Q

Iron-deficiency anaemia is treated by what?

A

Oral iron - ferrous sulphate.

62
Q

Give four side effects of ferrous sulphate?

A

Nausea.
Abdominal discomfort.
Diarrhoea.
Black stools.

63
Q

If the side effects of ferrous sulphate are bad, how should IDA be treated?

A

Ferrous gluconate.

64
Q

In extreme cases of iron-deficiency anaemia, what is the appropriate treatment?

A

Parenteral iron.

65
Q

How can parenteral iron be administered?

A

IV iron.

Deep intramuscular iron.

66
Q

What is anaemia of chronic disease?

A

Anaemia secondary to chronic disease.

67
Q

What is the histology of anaemia of chronic disease?

A

RBCs are often normocytic but may be microcytic.

68
Q

In which cases does anaemia of chronic disease result in microcytic RBCs?

A

Rheumatoid arthritis.

Crohn’s disease.

69
Q

Anaemia arises from which chronic diseases?

A 
Tuberculosis. 
Crohn's. 
SLE. 
Rheumatoid arthritis. 
Malignant disease.
70
Q

Give three reasons why chronic disease results in anaemia.

A

Decreased release of iron from bone marrow to developing erythroblasts.
Inadequate erythropoietin response.
Decreased RBC survival.

71
Q

How does anaemia of chronic disease present?

A 
Fatigue, headaches, faintness. 
Dyspnoea and breathlessness. 
Angina (if preexisting coronary disease). 
Anorexia. 
Intermittent claudication. 
Palpitations.
72
Q

What blood tests should be done and what will the results be in patients with anaemia of chronic disease?

A

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
Q

How is anaemia of chronic disease treated?

A

By treating the underlying cause or prescribing erythropoietin.

74
Q

What are side effects of erythropoietin?

A

Flu-like symptoms.
Hypertension.
Thromboembolism.

Phase 2a Medicine (JH) (7 decks)

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