Haematology - Anaemia Flashcards
what are the blood features of aplastic anaemia?
pancytopenia
no abnormal cells
(hypo cellular marrow)
causes of aplastic anaemia?
drugs (chloramphenicol/NSAIDs)
idiopathic
autoimmune disease
viral (post hep)
features of aplastic anaemia?
infections fatigue SOB tachycardia bruising bleeding pallor
Ix and results in aplastic anaemia?
FBC (pancytopenia)
reticulocyte count (low)
bone marrow biopsy (hypocellular)
hepatitis test
LFTs
B12 and folate
Tx for aplastic anaemia?
monitor
steroids
immunosuppression
what happens in haemolytic anaemia?
increased RBC destruction
exceeds bone marrows capacity for production
premature RBCs released into circulation
what features can be seen in haemolytic anaemia?
organomegaly
jaundice
no stool/urine changes
where can red cells be destroyed? what are the consequences of each?
extravascular -> taken up by liver/spleen causing organomegaly
intravascular -> destroyed in circulation causing
haemoglobinaemia (Hb in circulation)
haemoglobinuria (pink urine)
haemosiderinuria (coca cola urine)
what location of RBC destruction if more dangerous? why?
intravascular
abnormal waste products created
what hereditary conditions can cause haemolytic anaemia?
G6PDD
sickle cell
thalassaemias
hereditary spherocytosis
Ix for haemolytic anaemia? results?
Hb (low) FBC reticylocytes (high) blood film (Heinz bodies, red cell fragments) Coombs test (+ve suggest immune cause)
Tx for haemolytic anaemia?
Tx cause
steroids
plasmaphoresis
what happens in microcytic anaemia?
shortage of globins/haem to make up Hb
cells are microcytic and hypochromic
cell does not get bigger
features of microcytic anaemia?
angular stomatitis koilonychia pica fatigue hair loss glossitis restless legs SOB
causes of iron deficiency anaemia?
menorrhagia
veggie
GI blood loss
malabsorption
what happens in anaemia of chronic disease?
inflam causes hepcidic to be upregulated
iron doesnt leave macrophages due to this
not enough iron to supply marrow -> microcytic hypochromic anaemia
Ix for iron deficiency anaemia? results?
transferrin (circulating iron)
ferritin (stores)
Hb (low)
MCV (low)
Ix for anaemia of chronic disease? results?
transferring (reduced)
serum iron (low)
ferritin (stores - normal/high)
Tx for iron deficiency anaemia?
ferrous sulphate
ascorbic acid
RBC transfusion
Tx for anaemia of chronic disease?
treat condition
transfusion
EPO
ferrous sulphate
what happens in macrocytic anaemia?
megaloblast is a RBC precursor that hasn’t lost its nucleus and failed to get smaller before release into circulation
what are the causes of macrocytic anaemia?
megaloblastic = defect in DNA synthesis/nuclear maturation:
B12 deficiency
folate deficiency
non megaloblastic:
alcohol
liver disease
marrow failure
spurious = size of RBC normal but MCV high:
acute blood loss
where is folate absorbed?
jejunum
where is B12 absorbed?
terminal ileum while bound to IF (released by parietal cells)
what happens in pernicious anaemia?
autoantibodies against IF/gastric parietal cells
features of macrocytic anaemia?
wt loss diarrhoea sore tongue jaundice stomatitis chelitis pallor of conjunctiva
features of B12 deficiency?
dementia
peripheral neuropathy
dorsal column abnormalities
what dorsal column abnormalities result in B12 deficiency? why?
loss of fine touch, vibration and proprioception
subacute combined degeneration of the cord
Ix for macrocytic anaemia? result?
Hb (low) MCV (high) blood film (macrovalocytes and hyperseg neutrophils) B12 and folate anti gastric parietal cell Ab anti intrinsic factor Ab
Tx for macrocytic anaemia?
hydroxycobalamin injections
5mg folic acid
RBC transfusion
what is the inheritance of sickle cell?
autosomal recessive
what is the pathology of sickle cell mutation?
HbS is created due to defect in B chains of Hb
made of 2alpha and 2betaS
polymerises in low oxygen
what is normal HbA made of?
2 alpha
2 beta
features of sickle cell? what happens to those with trait?
painful
lungs, spleen, digits, bone marrow
hyposplenism
traits only in severe stress/illness
Ix for sickle cell?
FBC
blood film
HPLC
Tx for sickle cell crisis?
opiates oxygen hydrate rest transfusion
Tx for sickle cell?
penicillin vaccination
hydroxycarbamide/hydroxyurea
what are acquired IMMUNE causes of haemolytic anaemia?
warm/cold
transfusion reactions
what are acquired NON IMMUNE causes of haemolytic anaemia?
TTP
DIC
prosthetic heart valves
malaria
out of warm and cold haemolytic anaemia, where does haemolysis occur?
warm - extravascular
cold - intravascular
causes of a normocytic anaemia?
CKD haemolytic anaemias anaemia of chronic disease aplastic anaemia blood loss
in chronic alcoholism, what happens to bloods?
megaloblastic anaemia (high MCV)
thrombocytopenia
hypoalbuminaemia
hyponatraemia
