Haematology Flashcards
Microcytic anaemia
TAILS
Thalassaemia AoCD Iron deficiency Lead poisoning Sideroblastic
Normocytic anaemia
AoCD Acute bleed Pregnancy CKD Aplastic anaemia Bone marrow infiltration
Haemolytic anaemia
- G6PD
- Hereditary spherocytosis
- Sickle cell
Macrocytic anaemia
Folate
B12
Hypothyroid
Alcohol
Iron deficiency anaemia aetiology
Uptake in the duodenum
Excessive blood loss
- Menorrhagia
- GI bleed - Colorectal cancer in men, peptic ulcers
Inadequate dietary intake
- Meat and leafy greens
- Veggie diet is RF
Poor intestinal absorption
- Coeliac / Crohn’s
- Gastrectomy
Increased iron requirements
- Children
- Pregnant ladies
NSAIDs
Haemodialysis
Iron deficiency anaemia clinical features
Fatigue
SOBOE
Weakness
PICA - Abnormal craving for non-food substances
Restless leg syndrome
Kolionychia - Spoon nails
Glossitis
Angular stomatitis
Gastric difficulties
Hair loss
IDA investigations
History
- Change in diet
- Medication history
- Menstrual history
- Weight loss
- Change in bowel habit
FBC - Microcytic hypochromic + Low reticulocytes
Blood film - Anisopoikilocytosis - Red cells of different shapes and sizes
Iron studies
- MCH - Low
- Serum ferritin - Low
- TIBC - High
- Transferrin saturation - Low
Coeliac seriology
OGD if > 55 or red flags
IDA management
Treat cause
Ferrous sulphate
- Nausea
- Abdo pain
- Constipation
- Diarrhoea
- Black stools
Iron-rich diet
- Leafy greens
- Meat
- Iron-fortified bread
Pernicious anaemia pathophysiology
B12 deficiency
Normal absorption
- Oily fish, meat, dairy
- Parietal cells produce IF
- IF binds to B12
- Absorption in terminal ileum
Pathology
- AI disorder affecting gastric mucosa
- Antibodies to IF and/or gastric parietal cells
- Antibodies bind to IF - Block B12 binding site
- Gastric parietal cell antibodies - Reduce IF production
B12 important for…
- Erythropoiesis - Megaloblastic anaemia
- Nerve myelination - Neuropathy
Pernicious anaemia RFs and clinical features
Females > Males
AI disorders - Thyroid, DM, Addison’s, RA, etc.
Symptomatic anaemia
Peripheral neuropathy - Paraesthesia
Subacute combined spinal cord degeneration
- Progressive weakness
- Ataxia
- Paraesthesia
- Spasticity
- Paraplegia
Neuropsychiatric features
- Memory loss
- Poor concentration
- Confusion
- Depression
- Irritability
Pernicious anaemia investigations
FBC - Macrocytic anaemia
- WCC - Low
- Platelets - Low
Blood film - Hypersegmented polymorphs
B12 < 200
Antibodies
- Anti-IF antibodies
- Anti-GP cell antibodies
Schilling test
- Radiolabelled B12 administered
- Once without IF + Once with oral IF
- Urine B12 measured
Pernicious anaemia management and complications
B12 replacement therapy - IM
- 3 injections per week for 2 weeks
- Then 3 monthly
- More frequently if neurological symptoms
Folic acid supplementation
Complications - Increased risk of gastric cancer
Folate deficiency aetiology
Leafy green vegetables
Converted to tetrahydrofolate
Involved with DNA/RNA synthesis
Dietary deficiency Malabsorption - Coeliac/IBD Pregnancy and breast-feeding Prematurity Alcohol excess
Iatrogenic
- Phenytoin / Phenobarbitol
- Trimethoprim
- Methotrexate
- Sulfasalazine
- Pyrimethamine
- Anticonvulsants
Folate deficiency clinical features and investigations
Symptomatic anaemia
Exfoliative dermatitis
Weight loss / LOA
Headaches
Serum folate - Low
Blood film - Hypersegmented neutrophils
Reticulocytes - Low
FBC - Macrocytic anaemia
- Hb - Low
- MCV ^
- MCH ^
Folate deficiency management
Folic acid - 5mg
Preventing NTD during pregnancy
- 400mcg folic acid until 12th week of pregnancy
- Higher risk of NTD - 5mg folic acid before conception to 12th week
Increased risk of NTD
- Either partner has NTD
- Previous pregnancy affected by NTD
- Family history of NTD
- Anti-epileptic drugs
- Coeliac disease
- DM
- Thalassaemia
- Obesity
Haemolytic anaemia clinical features
Jaundice - Unconjugated bilirubin ^
Pallor
Dark urine
G6PD deficiency
Haemolytic anaemia - X-linked
Clinical features - Haemolytic anaemia following a precipitant
- Abx - Nitro
- Anti-malarial - Chloroquine
- Infection
- Fava beans
Investigations - Normocytic anaemia with high reticulocytes
Blood film
- Heinz bodies
- Bite cells
- Hemi-ghosts
Management - Supportive
- Transfusion if severe
- Avoid precipitants
Hereditary spherocytosis
Haemolytic anaemia - AD
Defect in RBC membrane synthesis
Spherical RBCs removed by spleen
Reduced RBC lifespan
Patients from Northern Europe - Finland, etc.
Clinical features = Haemolytic anaemia + Splenomegaly
Investigations - Normocytic anaemia with high reticulocytes
- Blood film - Spherocytes
- EMA binding test
Management
- Acute crisis - Supportive + Transfusion
- Long-term - Folic acid + Splenectomy
Sickle cell pathophysiology
Haemolytic anaemia - Autosomal recessive
Glutamate to Valine
Abnormal HbS
HbS turns sickle shaped when deoxygenated
Results in haemolysis and capillary obstruction
Precipitants
- Hypoxia
- Cold
- Exercise
- Dehydration
- Infection
Sickle cell crises
Thrombotic - Painful / vaso-occlusive crises
- AVN femoral head
- Hand-foot syndrome in children
- Lungs
- Spleen
- Brain - CVA
- Mesenteric ischaemia
Sequestration - Sickling with organs
- Spleen or lungs
- Pooling of blood with worsening anaemia
Acute chest syndrome
- Dyspnoea
- Chest pain
- Pulmonary infiltrates
- Low pO2
Aplastic - Infection with parvovirus
- Sudden fall in Hb
Haemolytic - Fall in Hb due to increased haemolysis
Sickle cell investigations and crisis management
Guthrie heel-prick test
FBC - Normocytic anaemia with high reticulocytes
Protein electrophoresis
- HbAS/HbSS
- HbF ^
Blood film - Howell jolly bodies
Crisis management - Treat cause
- O2
- IV fluids
- Analgesia
- Transfusion
Sickle cell long-term management and complications
Avoid triggers! Hydroxyurea - Stimulates HbF production Vaccinations - Influenza and pneumococcal Prophylactic abx - Penicillin Repeated transfusions Bone marrow transplant
Complications
- CVA
- Stunted growth
- Developmental delay
- Crises
- Osteomyelitis - Salmonella
Aplastic anaemia aetiology
Peak incidence 30 years old
Idiopathic Congenital - Fanconi or dyskeratosis congenita Toxins - Benzene Infection - Parvovirus and Hepatitis Radiation
Iatrogenic
- Cytotoxics
- Chloramphenicol
- Sulphonamides
- Phenytoin
- Gold
Aplastic anaemia clinical features / investigations / management
Symptomatic anaemia
Neutropenia - Infections
Thrombocytopenia - Bleeding and bruising
Investigations
- Normocytic hypochromic anaemia
- Hypoplastic bone marrow
- Pancytopenia
- Reticulocytes - Low
Management - Monitoring
- Immunosuppressants
- Transfusions
- Prophylactic abx
Autoimmune haemolytic anaemia
Warm vs Cold - According to what temperature the antibodies cause haemolysis
Investigations
- Direct antiglobulin test - Coombs’ test - Positive
- FBC - Haemolytic anaemia
Management
- Corticosteroids
- Immunosuppression
- Splenectomy
Warm AIHA - IgG
Haemolysis best caused at body temperature
Haemolysis at extravascular sites - E.g. spleen
Aetiology
- AI disease - SLE
- Neoplasia - Lymphoma / CLL
- Iatrogenic - Methyldopa
Clinical features - Haemolytic anaemia
Cold AIHA
Haemolysis best caused at 4c
Haemolysis mediated by complement
More commonly intravascular
Aetiology
- Neoplasia - Lymphoma
- Infections - Mycoplasma / EBV
Clinical features
- Haemolytic anaemia
- Raynaud’s
AoCD
Inflammation mediated reduction in RBC production
Aetiology
- IBD
- RA
- JIA
- Malignancy
Clinical features - Symptomatic anaemia
Investigations - Normocytic anaemia with low reticulocytes
- Iron - Low
- TIBC - Low
- Transferrin saturation - Low
- Ferritin - High
Management - Treat cause
- Transfusion
- ESAs - Epoetin Alfa
- Iron supplementation - Sodium ferric gluconate complex
Sideroblastic anaemia aetiology
Microcytic - X-linked
Defect in synthesis of protoporphyrin ring
Iron can’t bind haem
Free iron circulating
Leads to iron overload picture
Aetiology - X-linked
- Alcohol
- Lead
- Myelodysplasia
- TB medication
Sideroblastic anaemia clinical features / investigations / management
Symptomatic anaemia + Iron overload
- Heart
- Liver
- Kidneys
Investigations
- FBC - Hypochromic microcytic anaemia
- Ferritin ^
- TIBC - Low
- Iron ^
- Bone marrow biopsy - Sideroblasts
Management - Treat cause
- Desferoxamine
- Pyridoxine
Alpha thalassaemia
Hypochromic microcytic
SE Asia
Deficiency of alpha chains in Hb
2 separate alpha-globulin genes located on each Ch16
1 or 2 alleles affected - Normal Hb
3 alleles affected
- HbH disease
- Splenomegaly
All 4 alleles affected
- Death in utero
- Hydrops fetalis
- Bart’s hydrops
Beta thalassaemia aetiology
Trait - Hypochromic microcytic - Mediterranean
Major - Hypochromic microcytic
- Absence of beta chains
- Ch11