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Haemotology > introduction to anaemia > Flashcards

introduction to anaemia Flashcards

1
Q

what is anaemia?

A

reduced total red cell mass

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2
Q

what is a surrogate marker of anaemia?

A

hemoglobin concentration

haematocrit

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3
Q

what level of Hb is considered anaemia in adult males?

A

Hb<130g/L

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4
Q

what level of Hb is considered anaemia in Adult females?

A

Hb <120g/L

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5
Q

where does red cell production take place?

A

in the bone marrow

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6
Q

measuring hemoglobin concentration using a spectrophotometric method involves ———- the red cells to create Hb solution
Stabilise the Hb molecules ———
Measure the optical density (OD) at ———-

A
  1. lyse
  2. cyan-metHb
  3. 540nm
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7
Q

what is Beer’s law?

A

OD proportional to the concentration

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8
Q

wat is calculated against a known reference standard cyan-metHb concentration solution?

A

Hb concentration

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9
Q

Hb concentration is calculated against known reference of?

A

standard cyan-metHb concentration solution

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10
Q

how to measure hematocrit?

A

it is a ratio/percentage of the whole blood that is red cells if the sample was left to settle

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11
Q

how do modern machines measure hematocrit?

A

by adding the calculated volume of the red cells it counts

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12
Q

in what situations are Hb/Hct not good markers of anaemia?

A

Rapid bleeds

Haemadilution

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13
Q

wat are the two pathophysiological classifications of anaemia?

A

decreased production

increased loss or destruction of red cells

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14
Q

when there is decreased production what is the reticulocyte count?

A

low reticulocyte count because you are not producing enough cells

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15
Q

when there is increased loss or destruction of red cells the reticulocyte count is?

A

increased because you are producing more cells to compensate the loss

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16
Q

hypo proliferative problems?

A

reduced amount of erythropoiesis , amount of production is a problem

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17
Q

maturation abnormalities?

A

present but ineffective erythropoiesis

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18
Q

cytoplasmic defects?

A

impaired haemoglobinisation

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19
Q

nucleus defects?

A

impaired cell division

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20
Q

what two states cause in increased loss or destruction of red cells?

A

bleeding

haemolysis

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21
Q

what is the difference between bleeding and hemolysis?

A

in bleeding no bilirubin present

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22
Q

why is there bilirubin present in hemolysis?

A

increase of breakdown products

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23
Q

if MCV iss low (microcytic) consider problems with?

A

haemoglobinisation

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24
Q

if MCV is hight (macrocyclic) consider problems with?

A

maturation

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25
Q

if MCV is normal consider problems with?

A

hypo proliferation

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26
Q

where is HB synthesized?

A

cytoplasm

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27
Q

to make Hb you need?

A

globins

Haem : porphyrin ring, Iron (Fe2+)

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28
Q

causes of microcytic anaemia?

A

commonest iron deficiency (low body iron)

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29
Q

what is the second commonest cause of microcytic anaemia?

A

thalassemia which is when there is a globin deficiency

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30
Q

shortage of globins and ham result in?

A

small red cells with a los Hb content

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31
Q

in microcytic anaemia the cells are——–and ———

A

microcytic and hypo chromic )small and lack in color)

32
Q

some causes of microcytic anaemia of chronic disease occur because?

A

normal body iron but lack of available iron - most normocytic

33
Q

very rare reasons of microcytic anaemia?

A

problems with porphyrin synthesis - lead poisoning, pyroxidine responsive anemias

34
Q

another rare cause of microcytic anaemia?

A

congenital sideroblastic anaemia

35
Q

what amount of iron is absorbed everyday?

A

1mg/day

36
Q

what is the actual circulating iron in plasma?

A

4mg of iron in the pool

37
Q

most of the iron in the body is as?

A

Hb

38
Q

iron is stored in the body as?

A

ferritin

39
Q

different in post-menopausal women and men is that?

A

don’t lose much blood, so can’t cope with loss of blood that well

40
Q

when hemoglobin is fully saturated?

A

1gHb will bind 1.34mlO2

41
Q

transferrin

A

picks up from storage area and takes it to tissues where it is required

42
Q

transferrin saturation

A

is the amount of available iron

43
Q

ferritin?

A

is a large intracellular protein

44
Q

spherical protein stores up to?

A

4000 ferric ions

45
Q

ferritin is also an ———– ——— reactive protein?

A

acute phase,

46
Q

what is serum ferritin a measure of?

A

indirect measure of storage iron

47
Q

low ferritin means?

A

iron deficiency

48
Q

high ferritin?

A

could be falsely high

49
Q

iron deficiency can be confirmed by a combination of?

A

anaemia (decreased functional iron) and reduced storage iron (low serum ferritin)

50
Q

iron is absorbed from?

A

the proximal small bowel

51
Q

what two conditions cause insufficient absorption of of iron?

A

coeliac disease

achlorhydria

52
Q

red meat iron is absorbed much?

A

faster

53
Q

examples of relative deficiency of iron?

A

women of childbearing age and children

54
Q

what are examples of absolute deficiency of iron?

A

vegetarian diets

55
Q

causes of chronic blood loss? (5)

A 
Menorrhagia
Gastrointestinal
-Tumours
-Ulcers
-Non-steroidal anti-inflammatory agents
Haematuria
56
Q

what is average menstrual blood loss per month?

A

30-40ml/month = 15-20mg/month of iron

57
Q

what is the average daily intake of iron?

A

1mg/day

58
Q

heavy menstrual blood loss is?

A

> 60ml ie. >30mg iron/month

59
Q

what are the sequential consequences of negative iron balance?

A
  1. Exhaustion of iron stores
  2. Iron deficient erythropoiesis
    - Falling red cell MCV
  3. Microcytic Anaemia
  4. Epithelial changes
    - skin
    - koilonychia
60
Q

what is occult blood loss?

A

A small volume gastrointestinal blood loss can occur without any symptoms or signs of bleeding

61
Q

what can occult blood loss cause?

A

This can outstrip the maximum dietary iron absorption of iron and result in anaemia
iron absorption can be increased by iron supplements

62
Q

iron deficiency anaemia is a ——– not a ——–

A

symptom not diagnosis

63
Q

what may relieve iron deficiency without treating the underlying problem?

A

iron replacement therapy

64
Q

what may be curative of iron deficiency anaemia?

A

early GI surgery of tumors

65
Q

what is the body’s natural response to anaemia?

A

increased red cell production- reticulocytes

66
Q

what are reticulocytes?

A

red cells that have just left the bone marrow

67
Q

what is the size of reticulocytes?

A

larger than average red cells

68
Q

what is different amount reticule cites?

A

still have remnants of protein making machinery (RNA)

69
Q

what color do reticulocytes stain?

A

purple/deeper red as a consequence

70
Q

how does the blood film appear for reticulocytes?

A

polychromatic

71
Q

how long does up regulation of reticulocyte production by the bone marrow take in response to anaemia?

A

a few days

72
Q

what can automated analyses tell us about red cells?

A

Physical principles – e.g. cell size and light-scattering properties

73
Q

what is the advantage of using automated analysers?

A

rapid and reproducible

74
Q

what are measured red cell indices?

A

The haemoglobin concentration
The number of red cells (concentration)‏
The size of the red cells. (Mean Cell Volume or MCV)‏

75
Q

what are the calculated indices of red cell indices?

A

Haematocrit
Mean cell haemoglobin
Mean cell haemoglobin concentration

76
Q

what can blood films show?

A

look at acellular morphology

77
Q

what can reticulocyte count show?

A

asses marrow response

Haemotology (7 decks)

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