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103 Theme 2 - Blood > Introduction to Anaemia > Flashcards

Introduction to Anaemia Flashcards

1
Q

What is the definition of anaemia?

A
  • Haemoglobin (Hb) concentration falls below defined level (outside normal range)
  • Units of Hb are g/L
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2
Q

What is the clinical consequence of anaemia?

A

•insufficient O2 delivery

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3
Q

What are the 3 causes of anaemia?

A
  • Decreased Hb content
  • Decreased red blood cells (RBCs)
  • Altered Hb does not carry sufficient O2
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4
Q

Name the 5 red cell indices

A
  • Haematocrit = % red cells after centrifugation ~ 40-45%
  • RBC = number of red cells per litre ~ 4x1012/L
  • MCV = mean cell volume (80-100fL)
  • MCH = mean cell Hb
  • MCHC = mean cell Hb concentration
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5
Q

Complete the table of the normal haemoglobin range

A
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6
Q

What are the symptoms of anaemia?

A
  • Lethargy, fatigue
  • Shortness of breath
  • Palpitations
  • Headache
  • Worse symtoms if acute onset
  • Acute bleed / haemolysis
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7
Q

What are the clinical signs of anaemia?

A
  • Skin pallor
  • Pale conjunctivae
  • Tachypnoea
  • Tachycardia
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8
Q

What clinical sign is this?

A

Koilonychia

  • spoon shaped nails
  • iron deficiency
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9
Q

What are the 2 types of inadequate synthesis and name some examples

A

•Deficiency in necessary components

Iron, B12, folic acid

•Bone Marrow Dysfunction / Infiltration

e.g., myelodysplasia or aplastic anaemia

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10
Q

What are the 2 problems of blood loss or consumption and name some examples

A
  • Bleeding
  • Haemolytic

Increased red cell destruction

Shortened RBC lifespan

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11
Q

What is the most common type of anaemia?

A

Iron deficiency anaemia

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12
Q

What are the 3 causes of iron deficiency anaemia and name some examples

A
  • Bleeding (esp. occult)
  • Nutritional deficiency
  • Increased requirements
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13
Q

What tests are included in iron studies and what do they test for?

A

Serum Ferritin

  • Storage form of iron
  • Low = iron deficient (high = iron overload or reactive)

Serum Iron

•Labile in blood, so reflects recent intake of iron

Serum Transferrin

  • Carrier molecule for iron from gut to stores
  • Homeostatically goes up if iron is deficient
  • Reflects total iron binding capacity (TIBC) of the blood•

% Transferrin Saturation

  • Sensitive measure of iron status
  • Reflects proportion of transferrin with iron bound
  • Low TF saturation indicates iron deficiency
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14
Q

How would you confirm iron deficiency anaemia?

A
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15
Q

Complete the table

A
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16
Q

Complete the table with low, normal or high

A
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17
Q

What are the 3 catagories of RBC size and name some anaemias that would present with that MCV

A

Microcytic (small)

  • Iron deficiency (iron contained within the haem molecule in Hb)
  • Inherited disorders of haemoglobin (beta-thalassaemia trait)

Macrocytic (large)

  • B12 and folate deficiency (needed for synthesis of nucleotides)
  • Myelodysplasia (causes defective erythropoiesis)

Normocytic (normal)

  • Anaemia of chronic disease
  • Acute haemorrhage
  • Renal failure (caused by low erythropoietin levels)
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18
Q

How is RBC size measured and what is the normal range?

A

Mean Corpuscular Volume

  • This is the size of red blood cells (mean cell volume)
  • Normally about 80-100fL
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19
Q

What 4 types of abnormalities can be seen on a blood film?

A

? haematinic deficiency

  • microcytic/macrocytic
  • hypochromic
  • anisopoikilocytosis

? haemoglobinopathy

•sickled cells

? haemolysis

•polychromasia

? other abnormalities

  • white cells
  • platelets
  • leukaemic cells
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20
Q

What is the lifespan of a red cell?

A

100 days

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21
Q

What are reticulocytes?

A

Reticulocytes represent newly produced RBCs ~1 day old

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22
Q

How can reticulocyte count be measured and what is the normal result?

A
  • Can be calculated on a blood film using a stain to detect RNA
  • Usually measured by flow cytometry based on size and colour
  • Typically ~1% but can be >10% in haemolysis e.g., sickle cell disease
  • Causes polychromasia on a blood film (large blue-ish red cells)
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23
Q

What do reticulocytes indicate?

A

Indicates the rate of production of RBCs by bone marrow

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24
Q

What do high / low reticulocytes indicate?

A
  • Low during precursor deficiencies (e.g. iron)
  • Low if bone marrow is infiltrated
  • High in chronic bleeding
  • High in haemolysis
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25
Q

What hormone drives RBC production and where is it produced?

A

Erythropoietin from kidney

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26
Q

What does this blood film show and what disease is it?

A
  • Hypochromia
  • Microcytosis
  • Pencil Cells
  • Target Cells

Iron deficiency anaemia

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27
Q

What history would you take from a patient with ?Iron deficiency anaemia?

A
  • GI Symptoms
  • Dyspepsia / Reflux
  • Change in bowel habit (?melaena)
  • Weight loss?
  • Menstrual History ?menorrhagia
  • Bowel history ?coeliac / Crohn’s disease
  • Dietary history
  • Travel History
  • Ethnic Origin
  • Family History
28
Q

What causes megaloblastic anaemia?

A

Caused by deficiency of

  • Vitamin B12
  • Folate
29
Q

What are the morphological features of megalobastic anaemia?

A
  • Macrocytic red cells (MCV > 100)
  • Hypersegmented neutrophils (more than 4 nuclear lobes)
30
Q

What does this blood film show and what disease is it?

A

• Hypersegmented neutrophils (more than 4 nuclear lobes)

Megalobastic anaemia

31
Q

How does pernicious anaemia work?

A
  • Autoimmune – parietal cell loss
  • Deficiency of intrinsic factor
  • Cannot absorb B12 in terminal ileum where IF receptors are located
32
Q

What would you check for in ?pernicious anaemia

A

Check for autoantibodies against intrinsic factor or gastric parietal cells

33
Q

What is the treatment for pernicious anaemia?

A

Treat with B12 injections

Load initially with 5 doses alternate days, then every 3 months

34
Q

What are the 3 causes of B12 deficiency and name some examples

A

Pernicious Anaemia

Dietary

•Strict vegans (B12 found in diary produce)

Malabsorption

  • Coeliac disease and Crohn’s disease
  • Post gastric / ileal surgery
35
Q

What are the 5 causes of folate deficiency and name some examples

A

Dietary – common

Malabsorption

  • Coeliac
  • Crohn’s disease

Excess Utilisation

  • Chronic haemolysis
  • Pregnancy

Alcohol

Drugs

•Phenytoin

Methotrexate

36
Q

What is the most common form of anaemia in hospital patients?

A

Anaemia of chronic disease

37
Q

What are the 5 causes of anaemia of chronic disease?

A
  • Chronic inflammation
  • Chronic infection e.g. TB
  • Auto-immune conditions e.g. rheumatoid arthritis
  • Cancer
  • Renal failure (also causes low EPO level)
38
Q

What is the 3 ways that chronic disease causes anaemia?

A
  • Poor utilisation of iron in the body
  • Dysregulation of iron homeostasis
  • Impaired proliferation of erythroid progenitors
39
Q

How does poor utilisation of iron in the body cause anaemia of chronic disease?

A
  • Iron is stuck in macrophages of the reticuloendothelial system
  • There is poor mobilisation of the iron from the stores into the erythroblasts
40
Q

How does dysregulation of iron homeostasis cause anaemia of chronic disease?

A
  • Decreased transferrin
  • Increased ferritin (acute phase reactant)
  • Increased hepcidin
41
Q

How does impaired proliferation of erythroid progenitors cause anaemia of chronic disease?

A
  • Blunted response to EPO (erythropoietin)
  • Iron is functionally unavailable
42
Q

What’s the diagnosis?

A

Diagnosis – iron deficiency (or beta-thalassaemia trait)

43
Q

What’s the diagnosis?

A

Diagnosis – megaloblastic anaemia due to B12 or folate deficiency

(or myelodysplasia)

44
Q

How does sickle cell disease cause anaemia?

A
  • Point mutation in the beta globin gene causing HbS (sickle Hb)
  • Increased turnover of red cells = survival approx 20 days due to haemolysis
45
Q

What is a sickle cell crisis?

A
  • Triggered by low blood O2 level
  • Vaso-occlusive due to sickling in the vessels
  • Causes ischaemia leading to pain, necrosis and potential organ damage
46
Q

What is the management of a sickle cell crisis?

A

Analgesics, hydration, transfusion

47
Q

What is the genetic inheritance pattern of sickle cell disease and which geographical region does it originate from?

A
  • Genetic, autosomal recessive
  • Sub-Saharan Africa
48
Q

Does sickle cell anaemia cause a shortened lifespan?

A

Yes

49
Q

What disease is this?

A

Sickle cell anaemia

50
Q

What disease is this?

A

Sickle cell anaemia

51
Q

What are the differences between normal haemoglobin and sickled haemoglobin?

A

mutated sickle haemoglobin (HbS)

  • forms long filamentous strands
  • insoluble at low O2 tension
  • RBCs become inflexible + spiky -> crisis
52
Q

What is the difference between sickle cell anaemia and sickle cell trait?

A

Sickle cell trait - heterozygous,

  • 50% HbS and 50% HbA
  • much lower risk of sickling and crisis
  • resistance to malaria infection
53
Q

What is thalassaemia?

A
  • Insufficient production of normal Hb
  • Imbalance of alpha and beta chains
54
Q

What is the genetic inheritance pattern for thallasaemia?

A
  • Inherited autosomal recessive
  • Either alpha or beta thalassaemia
55
Q

What are the clinical features of thalassaemia?

A
  • enlarged spleen, liver, and heart
  • bones may be misshapen (frontal bossing)
56
Q

What is the difference between beta-thal major and beta-thal minor?

A

Beta-thal major (homozygous) = disease - requires life-long transfusions

Beta-thal minor (heterozygous) = carrier (aka Beta-thal trait) - clinically healthy

57
Q

What features would you see in a blood film for thalassaemia?

A
  • Microcytic
  • Hypochromic
58
Q

What are the 3 types of bone marrow infiltration?

A

Leukaemia

Lymphoma

Myeloma

59
Q

What are the symptoms of leukaemia?

A
  • Non-specific symptoms
  • Bone marrow failure
60
Q

What are the symptoms of lymphoma?

A
  • Lymphadenopathy
  • Weight loss
61
Q

What are the symptoms of myeloma?

A
  • Anaemia
  • Hypercalcaemia
  • Renal Failure
  • Bone lesions
62
Q

What tests would you do for bone marrow infiltration?

A

Bone marrow sample obtained from iliac crest:

  • aspirate film for morphology of cells
  • trephine biopsy for histological section
63
Q

When would you transfuse a patient for anaemia?

A
  • Acute > chronic
  • Be guided by symptoms rather than Hb level
  • Can the patient make blood with haematinic therapy?
  • If not, then transfuse for symptoms (usually if Hb <80g/L)
64
Q

Name an example of an acute and a chronic haemorrhage

A

Actue - haematemesis (vomiting blood)

Chronic - melaena (darkened stools)

65
Q

What is the management for long-term anaemia?

A

Treat the underlying cause:

  • Iron supplementation (oral ferrous sulphate 3 months)
  • Folic acid (oral folate for 3 months)
  • B12 (load initially then injections every 3 months)

Erythropoietin (EPO) weekly sub-cut injections in patients receiving haemodialysis or with kidney failure

66
Q

What are the negative side effects of long-term transfusion?

A
  • Iron overload (iron deposition in organs)
  • Allo-antibodies (to foreign red cells)

103 Theme 2 - Blood (10 decks)

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