haematology - anaemia Flashcards
Hb values if anaemic
M: <135 g/L
F: <115g/L
general causes of anaemia
↓ RBC production
↑ RBC loss
↑ plasma volume
general symptoms of anaemia
fatigue dyspnoea faintness palpitations headache tinnitus anorexia
general signs of anaemia
pallor
hyper dynamic circulation (tachycardia)
flow murmurs (HF)
high MCV suggests
↓ RBC production
low MCV suggests
normal RBC count but low content
eg. iron deficiency, thalassaemia
causes of microcytic anaemia (FAST)
Fe deficiency
anaemia of chronic disease
sideroblastic anaemia
thalassaemia
causes of normocytic anaemia
acute blood loss
haemolysis
anaemia of chronic disease
bone marrow failure
renal failure
hypothyroidism
pregnancy
causes of microcytic anaemia (FT MR. ABC)
fetus (pregnancy) thyroid (hypo) myelodysplastic syndromes reticulocytosis antifolates B12/folate deficiency cirrhosis
signs of IDA
koilonychia atrophic glossitis angular chelosis post-cricoid webs (PV syndrome) brittle hair and mails
IDA blood film
microcytic hypochromic anisocytosis poikilocytosis pencil cells
IDA classification
blood loss - GI bleed
intravascular haemolysis - chronic Hb loss
↑ use - pregnancy/lactation, child growth
↓ intake - diet, prematurity
↓ absorption - coeliac, post gastric surgery
treatment of IDA
treat cause
oral ferrous sulphate
IV Fe if severe symptomatic anaemia
treatment of IDA in sepsis/severe infection
transfusion
- Fe will not absorb well
- Fe can fuel sepsis
side effects of oral Fe
nausea
abdominal discomfort
diarrhoea/constipation
black stools
anaemia of chronic disease is
cytokine driven inhibition of RBC production
inflammatory markers involved in anaemia of chronic disease
IFNs
TNF
IL1
IL6
LPS
role of IFNs, TNF, and IL1 in anaemia of chronic disease
reduce EPO receptor production and EPO synthesis by kidneys
role of IL6 and LPS in anaemia of chronic disease
stimulates liver to make hepcidin
inhibition of transferrin
decreased iron absorption from gut
iron accumulation in macrophages
ferritin in anaemia of chronic disease
high
Fe held in macrophage to deprive invading bacteria
anaemia of chronic disease in renal failure is
not cytokine driven
due to EPO deficiency
sideroblastic anaemia
ineffective erythropoiesis
- iron loading haemosiderosis
- endocrine, liver, and cardiac damage
diagnosis of sideroblastic anaemia
ring sideroblasts seen in marrow
erythroid precursors with iron deposited in mitochondria in a ring around nucleus
causes of sideroblastic anaemia
myelodysplastic disorders myleoproliferative disease chemotherapy irradiation alcohol excess lead excess anti-TB drugs
treatment of sideroblastic anaemia
remove cause
pyridine (vit B6 - promotes RBC production)
iron, TIBC and ferritin in IDA
iron - low
TIBC - high
ferritin - low
iron, TIBC and ferritin in anaemia of chronic disease
iron - low
TIBC - low
ferritin - high
iron, TIBC and ferritin in chronic haemolysis
iron - high
TIBC - low
ferritin - high
iron, TIBC and ferritin in haemochromatosis
iron - high
TIBC - low/normal
ferritin - high
iron, TIBC and ferritin in pregnancy
iron - high
TIBC - high
ferritin - normal
iron, TIBC and ferritin in sideroblastic anaemia
iron - high
TIBC - normal
ferritin - high
transferrin saturation
serum Fe/TIBC
<20% indicated iron deficiency
when checking ferritin also check
CRP
ferritin is acute phase protein increased with inflammation
investigations for pancytopenia
B12/folate/iron abdominal examination reticulocyte count blood film myeloma screen parvovirus PCR in immunosuppressed medication review bone marrow biopsy
low reticulocyte suggests
bone marrow failure syndromes
pancytopenia blood smear
look for:
blasts
hairy cell leukaemia features
dysplastic changes - myelodysplasia
