Haematology Flashcards
Name some causes of microcytic anaemia
Thalassaemia Anaemia of chronic disease Iron-deficiency anaemia Lead poisoning Sideroblastic anaemia
Name some causes of normocytic anaemia
Blood loss Bone marrow failure Pregnancy Hypothyroidism Haemolysis (normocytic or macrocytic) Anaemia of chronic disease (normocytic or microcytic)
Name some symptoms of anaemia
Dyspnoea Palpitations Fatigue Headache Tinnitus Anorexia
Name some signs of anaemia
Pale conjunctiva
Tachycardia
Hypotension
Murmurs
Name some causes of macrocytic anaemia
B12 or folate deficiency Alcohol excess/liver disease Reticulocytosis Marrow infiltration Antifolate drugs e.g. Phenytoin Myelodysplastic syndromes
What is haemolytic anaemia?
When there is premature breakdown of RBCs but the bone marrow can’t produce enough RBC to compensate. Can be normocytic or macrocytic
What is iron-deficiency anaemia?
When there is insufficient iron to produce enough Hb
What is the definition of ‘anaemia’?
A low Hb concentration, may be due to either a low red cell mass or increased plasma volume.
Name some causes of iron deficiency anaemia
Blood loss e.g. Menorrhagia or GI bleeding
Poor diet
Malabsorption of iron e.g. Coeliac’s
What sign present in the nails may indicate iron deficiency?
Koilonychia, spooning of the nails
What is the normal treatment for iron deficiency anaemia?
Treat the cause
Give oral iron e.g. Ferrous sulphate
Name some conditions where patients can get anaemia of chronic disease
Chronic infection Vasculitis Rheumatoid arthritis Malignancy Renal failure
What is anaemia of chronic disease?
Anaemia that occurs in people with a chronic disease, can occur due to 3 possible methods:
- poor use of iron in erythropoiesis
- cytokine-induced shortening of RBC survival
- decreased production of EPO
What are Howell-Jolly Bodies and when are you likely to see them?
DNA nuclear remnants in RBC, which would normally be removed by the spleen, seen in post-splenectomy patients and in hyposplenism
What is megaloblastic anaemia?
A type of macrocytic anaemia where the cell has delayed nuclear maturation compared to the cytoplasm. This occurs with B12 and folate deficiency as both B12 and folate are required for DNA synthesis
What is the Coombs test? What is the difference between direct and indirect?
Direct - detects antibodies stuck to the surfaces of RBC.
Indirect - detects antibodies that are floating freely in the blood, used in prenatal testing and before blood transfusion.
Why is reticulocyte count important on a FBC?
Gives you an indication of how much erythropoiesis is occurring and whether the bone marrow is working.
How can you check a patient’s iron levels?
Either serum iron or ferritin (although always check CRP with ferritin as ferritin can also be elevated with inflammation/infection).
What is a dimorphic blood film?
When there are 2 different populations of RBC - this is often seen after blood transfusions or starting iron tablets as more normal RBC are suddenly produced with a normal width - leads to an increased red cell distribution width (RDW).
What are some side effects of iron tablets/ferrous sulphate?
GI side-effects including dark faeces, constipation or diarrhoea.
When would you see Howell-Jolly Bodies and what are they?
RBC with some nuclear remnants, seen in patients with hyposplenism.
When would you get a physiological macrocytic anaemia?
Pregnancy
Neonates
What is pernicious anaemia?
Type of megaloblastic anaemia where the body isn’t able to absorb enough vitamin B12 due to a lack of intrinsic factor in stomach secretions.
What bloods would be included in a confusion screen?
FBC (WCC for signs of infection)
U+Es (deranged electrolytes, especially sodium can cause confusion)
LFTs (liver failure can cause confusion)
INR
TFTs
Calcium (hypercalcaemia often causes confusion/delirium)
B12 + folate
Glucose (hypoglycaemia can cause confusion)
