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Pathology (Guide) > Haematology - Anaemia > Flashcards

Haematology - Anaemia Flashcards

1
Q

Which investigations would you do for microcytic anaemia?

A

Peripheral Blood Smear + Iron Studies

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2
Q

Which investigations would you do for macrocytic anaemia?

A

Peripheral Blood Smear + LFTs + TFTs

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3
Q

Which investigations would you do for normocytic anaemia?

A

Peripheral Blood Smear + Direct Antiglobulin Test + CRP + ESR

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4
Q

What are three causes of anaemia?

A
  • Reduced production of RBCs
  • Increased loss of RBCs (haemolytic anaemias)
  • Increased plasma volume/dilution (pregnancy)
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5
Q

What are some symptoms of anaemia?

A
  • Fatigue
  • Dyspnoea
  • Faintness
  • Palpitations
  • Headache
  • Tinnitus
  • Anorexia
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6
Q

What are some signs of anaemia?

A
  • Pallor

In severe anaemia (Hb <80g/L):
- Tachycardia
- Flow murmurs (ejection-systolic loudest over apex)
- Heart Failure

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7
Q

What is a high MCV?

A

> 100fL
Decreased production of RBCs

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8
Q

What is a low MCV?

A

<80fL
Normal number of RBCs (most of the time), but not much to go in them

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9
Q

Define anaemia

A

A condition in which the number of RBCs or the haemoglobin in them is lower than normal.

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10
Q

What are some causes of a microcytic anaemia?

A

FAST:
F - (Fe) Iron-deficiency anaemia
A - Anaemia of chronic disease
S - Sideroblastic anaemia
T - Thalassaemia (may not be anaemic if mild)

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11
Q

What are some causes of normocytic anaemia?

A

All Hoes Fuck Prostitutes:
All - Anaemia of chronic disease
Hoes - Haemorrhage, Hypothyroidism, Haemolysis
Fuck - Failure (renal + bone marrow)
Prostitutes: Pregnancy

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12
Q

What are some causes of macrocytic anaemia:

A

FAT RBC
F - Foetus (pregnancy)
A - Antifolates (e.g. phenytoin)
T - Thyroid (hypothyroidism)
R - Reticulocytosis (release of larger immature cells e.g. with haemolysis)
B - B12/folate deficiency
C - Cirrhosis (alcohol excess or liver disease)

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13
Q

What are some signs of IDA?

A

Koilonychia
Atrophic Glossitis
Angular Cheilosis
Post-cricoid webs (PLUMMER-VINSON SYNDROME)
Brittle hair + nails

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14
Q

What are signs of IDA on a blood film?

A

Microcytic
Hypochromic
Ansiocytes
Poikilocytosis
PENCIL CELLS

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15
Q

How does IDA present with on iron studies?

A

Decreased Iron
Decreased Ferritin
Increased Transferrin
Decreased Transferrin Saturation
Increased TIBC

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16
Q

What is the commonest cause of IDA?

A

Bleeding (commonest cause)
Menorrhagia in young women

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17
Q

Name four causes of IDA

A

Blood loss = Gi loss (e.g. peptic ulcers, Meckel’s diverticulum, menorrhagia etc.)
Increased utilisation = pregnancy/lactation or growth in children
Decreased uptake = prematurity/suboptimal diet
Decreased absorption = coeliac/post-gastric surgery (decreased acid which helps Fe absorption)
Intravascular haemolysis = MAHA/PNH (chronic loss of Fe in urine)

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18
Q

What investigations would youo do for IDA?

A

IF no obvious cause = OGD + colonoscopy, urine dip, ceolia investigations

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19
Q

What is the treatment of IDA?

A
  • Treat Cause
  • Oral Iron
  • IV Iron (e.g. Ferrinject/Monofer - anaphylaxis risk)
  • Blood transfusion in SEPSIS (iron will not absorb well)
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20
Q

What are some side effcts of oral iron supplements?

A

Nausea
Abdominal discomfort
Diarrhoea/constipation
Black stools

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21
Q

What are the indications for IV iron?

A

Poor oral absorption
Failure of oral iron trial
Need for rapid rise (e.g. imminent major surgery)

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22
Q

What is Anaemia of Chronic Disease?

A

Cytokine driven inhibition of red cell production

EXCEPT in renal failure: it’s due to erythropoeitin (EPO) deficiency which is made by the kidney

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23
Q

What are the causes of ACD?

A
  • Chronic infection (e.g. TB/osteomyelitis)
  • Vasculitis (inflammation)
  • Rheumatoid arthritis
  • Malignancy
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24
Q

What would iron studies show for ACD?

A

Normal Iron
Increased Ferritin
Decreased Transferrin
Decreased TIBC

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25
Q

Why is Ferritin high in ACD?

A

Iron is sequestered in macrophage to depreive invasding bacteria of iron

26
Q

What causes reduced EPO synthesis by the kidneys in renal failure-causing ACD?

A

Inflammatory markers (e.g. IFNs, TNF, IL1) reduce receptor production and therefore synthesis

27
Q

Why is iron metabolism dysregualted in ACD?

A

IL6 and LPS stimulate liver to make hepcidin, which decreases iron absorption from the gut (by inhibiting transferrin) and causes iron accumulation in macrophages

28
Q

How would you manage ACD?

A

Treat underlying cause

29
Q

What are the iron studies of sideroblastic anaemia?

A

Increased Iron
Increased Ferritin
Decreased Transferin
Decreased TIBC

30
Q

What would be seen on the blood film of sideroblastic anaemia?

A

Basophilic stippling

31
Q

How is sideroblastic anaemia diagnosed?

A

Ring sideroblasts seen in marrow

32
Q

What are ring sideroblasts?

A

Erythroid precursors with iron deposited in mitochrondria in a ring around the nucleus

33
Q

What are some causes of sideroblastic anaemia?

A

Congenital or acquired

Myelodysplastic disorders
Post-chemo
Irradiation
ALCOHOL EXCESS
lead excess
Anti-TB drugs
Myeloproliferative disease
?Lead poisoning

34
Q

What is the management of sideroblastic anaemia?

A
  • Remove cause
  • ?Pyridoxine (vitamin B6 promotes RBC production)
  • ?Giving EPO
  • Transfusions
35
Q

What is sideroblastic anaemia?

A

Congenital or acquired anaemias of INEFFECTIVE ERYTHROPOEISIS leading to iron loading, causing haemosiderosis.

36
Q

What is Transferrin saturation?

A

Serum Iron / TIBC

IF <20% = IDA

37
Q

What are the Iron studies for chronic haemolysis?

A

Increased Iron
Decreased TIBC
Increased Ferritin

38
Q

What are the iron studies for haemachromatosis?

A

Increased Iron
Low/Normal TIBC
Increased Ferritin

39
Q

What are the iron studies for pregnancy?

A

Increased Iron
Increased TIBC
Normal Ferritin

40
Q

What is ferritin?

A

An acute phase protein that increases with inflammation.

41
Q

What investigations would you do for pancytopenia?

A
  • B12/Folate/Iron
  • Abdo exam (Splenomegaly = ?myelofibrosis)
  • Reticulocyte count (if low = bone marrow problem)
  • Blood Film for abnormal cells (?acute leukaemia) + dysplasia (?myelodysplasia)
  • Myeloma screen
  • Blood PCR for Parvovirus
  • ?check medications
  • Bone marrow UNLESS clear cause found from other tests
42
Q

What are the megaloblastic causes of macrocytosis

A
  • B12 deficiency
  • Folate deficiency
  • Cytotoxic drugs
43
Q

What are the non-megaloblastic causes of macrocytosis

A
  • Alcohol
  • Reticulocytosis
  • Liver disease
  • Hypothyroidism
  • Pregnancy
44
Q

What is the most common cause of macrocytosis without anaemia?

A

Alcohol

45
Q

What are other haematological diseases causing macrocytosis?

A
  • Myelodysplasia
  • Myeloma
  • Myeloproliferative disorder
  • Aplastic anaemia
46
Q

What are features of a megaloblastic blood film?

A
  • Hypersegmented polymorphs
  • Leucopenia
  • Macrocytosis
  • Anaemia
  • Thrombocyopenia with megaloblasts
47
Q

What are megaloblasts?

A

Red cell precursors with an immature nucleus and mature cytoplasm

48
Q

What vitamin is required for nucelus maturation in megaloblasts?

A

B12 + Folate

49
Q

What investigations would you do to assess for macrocytic anaemia?

A
  • Peripheral blood smear
  • LFTs
  • TFTs
50
Q

Where does Vitamin B12 come from?

A

Meat + dairy products

51
Q

What are some causes of B12 deficiency?

A
  • Diet (e.g. vegans)
  • Malabsorption (e.g. pernicious anaemia, post-gastrectomy, ileal resection, crohn’s disease, bacterial overgrowth, tropical sprue + tapeworms)
52
Q

What glycoprotein is required for the absorption of B12, where is it produced and where is B12 absorbed?

A
  • Intrinsic Factor
  • Produced by gastric parietal cells
  • B12 absorbed in terminal ileum
53
Q

What are the clinical features of B12 deficiency?

A
  • Mouth: Glossitis, angular cheilosis
  • Neuropsychiatric: Irritability, depression, psychosis, dementia
  • Neurological: Paraesthesiae, peripheral neuropathy
54
Q

Which carboxylic acid is elevated in B12 deficiency?

A

Serum Methylmalonic Acid (MMA)

55
Q

What is the most common cause of macrocytic anaemia in Western countries?

A

Pernicious anaemia
(Usually >40yrs)

56
Q

What is pernicious anaemia?

A

A type of B12 anaemia
- Autoimmune atroophic gastritis leading to achlorhydria and lack of gastric intrinsic factor

Achlorhydria = condition where stomach does not produce hydrochloric acid

57
Q

What are specific tests for pernicious anaemia?

A
  • Parietal cell antibodies (90%)
  • Intrinsic factor antibodies (50%)
  • Schilling test (outdated - positive if B12 deficiency secondary to pernicious anaemia)
58
Q

What is the treatment of B12 deficiency?

A
  • Replenish stores with IM hydroxocobalamin (B12) - 6 injections over 2 weeks
  • Test for anti-parietla cell/ anti-intrinsic factor Abs as IF autoimmune cause then need 3-monthly injections
59
Q

What are some sources of folate?

A

DIET
- Green vegetables
- Nuts
- Yeast
- Liver

60
Q

What are some causes of folate deficiency?

A
  • Poor diet
  • Increased demand (e.g. pregnancy)
    OR increased cell turnover (e.g. haemolysis, malignancy, inflammatory disease and renal dialysis)
  • Malabsorption (e.g. coeliac disease, tropical sprue)
  • Drugs (e.g. alcohol, anti-epileptics, phenytoin, methotrexate, trimethoprim)
61
Q

How does phenytoin cause folate deficiency?

A

It inhibits folate absorption

62
Q

What is the management of folate deficiency?

A
  • Oral folic acid
  • Ensure B12 checked + replaced before folic acid as it may exacerbate neuropathy of B12 deficiency

Pathology (Guide) (84 decks)

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