intro to haematology and anaemia Flashcards
the hb ranges :
in nonpreg woman:
in men :
in pregnant women :
in sever anemia its:
- less than 12
- less than 13
- 11
- less than 7
anemia refers to the reduction of —- due to disorder of globin or haem
hb
causes of reduction of the bone marrow function:
1- —- of the bone marrow by anything that — the bone marrow as —- for priamry , infection , granulsomes
2- —- process which includes myelofibrosis can be primary of —-
2- bone marrow —- syndrome and conditions as :
- repalacemnt
- invaded
- cancer
- fibrotic
- secondary
- failure
- aplastic anamia and myeolodyplasia
—– is a condition in which the number of rbc or their o2 carrying capacity is insufficient to meet their physiological needs which varies by —–
- anemia
- age sex smoking pregnant starts , altitude
hemoglobin structure is a —- consisiting of — pairs of similar polypeptide chains called —–
each 4 chains is attached to — which is a complex of iron in — state and —– .
the majority of hb (96%) present in adults is — which has :
- tetramer
- 2 pairs
- globin chain
- team
- ferrous
- protoporphyrin
- hbA
- 2 alpha globin and 2 beta globin
symptoms in anemia include:
- fainting and fatigue
- skin - yellow
- muscle -pain
- digestion- change in stool color
- respiratory - shortness of breath
true or false:
anemia is a major global public health concern which has prevalence in India is 42% in women 15-59% and men 30% 15-59 years , it affects disportionalling women and girls globally due to iron deficency and inadequate access to health care
true
the 2 classifications of anemia are;
1- morphological
2- phathological
the full blood count includes :
- Platete count
- white blood cell count as: neutrophils basophils estinophils monocytes lymphocytes
- hb
a morphological classification by which the mcv is less than 80fl and the major cause is menorrhagia
microcytic anemia
a morphological classification when mcv is more than 100fl
macrocytic anemia
a morphological classification where the mcv is between 80-100 fl
normocytic
iron diffencuey anaemia and maneorrge , thalasemia , sideroblastic anemia are all under —-
microcytic anemia
megaloblastic anemia as: b12 diffencuy m folate deficient ,
non megaloblastic as:
- liver Diases , myelodysplasia , hypothyroidism , haemolytic anemia , alcohol excess
all fall under:
microcytic anmeia
anemia of chronic disease and aplastic anmeia , chronic kidney disease as EPO diffency fall under:
normocytic anemia
mean corpuscular hb ( MCV ) or mean cell volume refers to the measure of the average — of the —-
volume of the rbc
1-mean corpuscular hb refers to the average amount of — in each —
2- mean corpsularar hb concentration refers to the average ——- of — in inside a group of rbc which is ——
3- reticylaocyte are —– rbc larger than the mature ones and they have the ability to —– the MCV , they usually reside in the — but in the state of erythroid stress they are pushed into the — so they are ready to be mature which is why we see —- reticulocyte count in name as the bone marrow trees to compensate
- hb in each red ce;;
- avg koncentration of hb
- 31-37 g/dl
- immature rbc
- increase
- bone marrow
- high
pathological causes of anaemia:
1- —- to make rbc which is a —- problem
2- lack of —– as:
3- increase — pf rbc due to :
4- increase — of rbc aka :
5- —- diseases
- failure , marrow
- heamaticnic as: b12 , folate m dietary deofocmey , malabsorption , loss
- loss , bleeding
- destruction , heamolysis
- chronic
read:
1- history taking anaemia:
- diet history, chronic blood loss , heredity as sickle cell and thalesmia
- alcohol and renal disease
- chronic disease as rheumatoid arthritic
- history of systemic symptoms as: b symptoms which include: nigh sweats weight loss and itch
- recent travel
2- menorrhagia history taking:
* Detailed history
– Menarche
– Length of cycle and bleeding days
– Pads/tampons
– Soaks clothes
– Days off work/school
– Previous iron deficiency
– Other bleeding issues
* Be sensitive and professional
* Encourage self assessment
* Keep a diary
* Cultural and social norms
* Family norms can mask heavy periods
3- more detailed blood tests :
* Reticulocyte count
* Blood film
* ESR – old fashioned test not clinically useful
* B12 and folic acid
* Liver function – bilirubin
* Renal function
* EPO level
* Iron profile
* LDH, uric acid
* Hb electrophoresis if you suspect hereditary anaemia
* Bone marrow test
* Direct antibody test (DAT) used to be called Coombes test
koilonchyia aka spoon nail and glossitis aka Plummer visons syndrom are seen in —-
severe iron defiency anemia
iron deficiency anaemia causes — of blood as menaces , GI blood loss can cause celiac disease , h pylori infection
history of pica includes :
- loss of blood
- eating ice clay or starch
causes of IDA includes:
- Dietary
- Malabsorption
– Coeliac disease
– Crohn’s disease
– Intestinal resection - Loss e.g.
– GIT e.g. Duodenal or gastric ulcer, Ca colon
– Menorrhagia - Increased requirements requirement Childhood,
Pregnancy
treatment of IDA includes:
- Find out the underlying cause and manage that
– Iron will continue to drop until this is addressed
– Ulcer management
– Menorrhagia management – OCP, coil, tranexamic acid - Oral iron replacement
- IV iron replacement in cases where iron deficiency is
severe (Hb <7) and oral iron is not tolerated or will not
work fast enough - Avoid blood transfusion if at all possible
- Only in cases where patient is severely symptomatic
(e.g. coronary disease) or Hb < 5 - REMEMBER TO FOLLOW THE PATIENT UP!!!
—–is a term used to describe disorders of impaired DNA synthesis in hematopoietic cells but affects all proliferating cells.
* Due to folic acid or vitamin B12 deficiency
megaloblastic anemia
diagnosis of megablastic anaemia include :
Diagnosis-
* In addition to sx of anemia peripheral neuropathy,
paresthesias,
Seizures and dementia may found due to vit b12
deficiency
* On examination- Jaundice or splenomegaly
* Decreased vibratory and positional sense, ataxia,
megaloblastic anemia include and increase in —– and —- while low ——-
other investigations include:
- MCV , MCH
- RBC , WBC , platelets only in severe cases
- other investigation includes : * Blood film – oval macrocytic red cells
– Hypersegmented neutrophils - LDH is raised
- Serum B12 and or folate reduced
- Normal B12 level 160-200ng/L folate 2-15ug/L)
- Serum methylmalonic acid (MMA) and homocysteine are
elevated in B12 def, only HC is elevated in folate def –
we don’t use these tests much in Ireland - Antibodies to intrinsic factor
the investigation of iron difiencey anemia include —-
- low hb mcv mch mchc
- reticloucyte count is normal or decreases
- iron ferritin decreased
b12 is gained from — such as :
it combines w intrinstic factors which are secreted by gastric parietal cells
the b12 intrinsic factor complex are absorbed in —–
- diet as milk eggs meat
- terminal ileum
lack of b12 which causes megaloblastic anaemia lead to :
pernicious anemia
causes of b12 deficiency :
- Lack of B12 in diet
– Main sources are liver, beef, sardines, nuts, wholegrain breads - Inability to absorb B12
– Pernicious anaemia which is due to antibodies to intrinsic factor
or to the gastric parietal cell
– Patient cannot absorb any oral B12
– Must receive lifelong parenteral B12 replacement usually as
intramuscular injections every 3 months - Some patients with Coeliac disease also do not absorb
B12 very well - Conditions of the stomach that interfere with gastric
parietal cells – e.g. surgery - Conditions of the bowel that cause the terminal ileum to
be damaged e.g. Crohn’s disease
folate is absorbed in —- and — and the causes of folate deficiency may include:
treatment :
- duodenum and upper jejunum
-diet , alcohol , drugs , malabsorption , increased requirements as preg lactation , haemolytic anaemia and chronic blood loss - oral folic acid
