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Haematology > Iron Deficient Anaemia > Flashcards

Iron Deficient Anaemia Flashcards

1
Q

what is the physiological response to anaemia?

A

reticulocytosis

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2
Q

what is Hb criteria for anaemia in males?

A

HB<130G/L

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3
Q

what is Hb criteria for anaemia in females?

A

HB<120G/L

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4
Q

what is HCT criteria for anaemia in males?

A

HCT 0.38 – 0.52

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5
Q

what is HCT criteria for anaemia in females?

A

HCT 0.37-0.47

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6
Q

what are the pathophysiological classifications of anaemia?

A

Decreased production

Increased loss or destruction

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7
Q

What are the morphological classifications of anaemia?

A

microcytic anaemia

Macrocytic anaemia

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8
Q

what are the two types of anaemia related to decreased production?

A

Hypoproliferative

Maturation abnormality - cytoplasmic defects, nuclear defects

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9
Q

what is the mechanism hypoproliferative anaemia?

A

reduced amount of erythropoiesis

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10
Q

what is the mechanism of anaemia caused by cytoplasmic defects?

A

impaired haemoglobinisation

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11
Q

what is the mechanism of anaemia caused by nuclear defects?

A

impaired cell division

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12
Q

what is the mechanism of microcytic anaemia?

A

problems with haemoglobinisation

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13
Q

what is the mechanism of macrocytic anaemia?

A

consider problems with maturation (cell division)

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14
Q

what are the main symptoms of anaemia?

A

fatigue, dyspnoea, faintness, palpitations, headaches, tinnitus, anorexia, angina

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15
Q

what are the main signs of anaemia?

A

pallor, hyperdynamic circulation (tachycardia, flow murmurs, cardiac enlargement, retinal haemorrhage, HF)

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16
Q

what investigations are used in anaemia diagnosis?

A 
History/Examination
FBC
Reticulocyte count
Blood film features
Haematinics
Bone marrow biopsy
specialised tests (HB, A2, HLPC)
Measure Haemoglobin, Haematocrit
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17
Q

what types of anaemia does reduced reticulocyte count indicate?

A

Micro/Macrocytic

Normocytic

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18
Q

What types of anaemia does increased reticulocyte count indicate?

A

Haemolysis

Bleeding

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19
Q

how can haemolysis be differentiated to bleeding?

A

look for red cell breakdown products

Haemolysis - raised unconjugated serum bilirubin, increased urinary urobilinogen

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20
Q

what are the causes of microcytic anaemia?

A

haem deficiency
Problems with porphyrin synthesis
Globin deficiency

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21
Q

what are the causes of haem deficiency in microcytic anaemia?

A

Lack of iron for erythropoiesis - iron deficiency, anaemia of Chronic Disease

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22
Q

what are the causes of porphyrin synthesis problems in microcytic anaemia?

A

o Lead poisoning

o Pyridoxine responsive anaemias

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23
Q

what are the causes of globin deficiency in microcytic anemia?

A

Thalassaemia (trait, intermedia, major)

24
Q

where is Hb synthesised?

A

cytoplasm

25
Q

what is needed to make Hb?

A

o Globins

o Haem - Porphyrin ring + Iron (Fe 2+)‏

26
Q

what do cells look like in microcytic anaemia?

A

Small

Hypochromic

27
Q

what are the causes of iron deficiency anaemia?

A

Blood loss: GI bleeding (peptic ulcer, diverticulitis), Menorrhagia, hookworm (developing countries)
Poor Diet
Malabsorption

28
Q

what are the causes of anaemia of chronic disease?

A

infection, colloagen vascular disease, rheumatoid arthritis, malignancy, renal failure, chronic inflammatory disease (crohns), TB, endocarditis.
survival.

29
Q

what are the causes of sideroblastic anaemia?

A

Inherited or – Acquired

2* to myelodysplasia, alcohol, lead or isoniazid poisoning, idiopathic, malignancy, anti- TB drugs, malabsorption

30
Q

what are the investigations for iron deficiency anaemia?

A 
– Hb ↓, ↓MCV
– RBC microcytic, hypocgromic, anisocytosis, poikilocytosis.
-Serum ferritin ↓
-Serum Iron ↓
– TIBC ↑
31
Q

what are the investigations for Anaemia of chronic disease?

A

– ↓serum iron levels
– ↓ serum iron binding capacity
– ↑or normal serum ferritin.

32
Q

what are the histological features for sideroblastic anaemia?

A

refractory anaemia
hypochromic cells in the peripheral blood
ring sideroblasts in bone marrow.(erythrocytes with granules of iron in their cytoplasm)

33
Q

what is the management of iron deficiency anaemia?

A

Treat underlying cause.

– Oral iron – ferrous sulphate

34
Q

what is the management of anaemia of chronic disease?

A

– Treat underlying cause

– If due to renal failure recombinant erythropoietin

35
Q

what is the management of sideroblastic anaemia?

A

Withdraw causative agents
– some response to pyridoxine (Vit B6)
– Maybe transfusion dependent and iron overload is a problem

36
Q

what is the disease progression of iron dependent

A
  1. Exhaustion of iron stores
  2. Iron deficient erythropoiesis
  3. Microcytic Anaemia –
  4. Epithelial changes- systemic effects
37
Q

what are the types of causes of iron deficiency anaemia?

A

diet
malabsorption
blood loss

38
Q

what diets can lead to iron deficiency anaema?

A

o RELATIVE deficiency - especially women of child bearing age and children
o ABSOLUTE deficiency - vegetarian diets

39
Q

what are the causes of malabsorption leading to iron deficiency anaemia?

A

o Coeliac disease

o achlorhydria

40
Q

what are common causes of blood loss that can lead to iron deficient anaemia?

A

o Menorrhagia
o Gastrointestinal, Tumours, Ulcers, NSAIDs, Occult blood loss
o Haematuria

41
Q

what are the clinical features characteristic of iron deficient anaemia?

A
  • Koilonychia
  • Atrophic glossitis
  • Angular cheilosis
  • Post-crocid webs
42
Q

what are the cell volume features of iron deficient anaemia?

A

↓MCV, ↓MCH, ↓MCHC

43
Q

what is functional iron?

A

haemoglobin

44
Q

what is transported iron?

A

o Serum iron
o Transferrin
o Transferrin saturation

45
Q

what is storage iron?

A

Serum ferritin

46
Q

what is the functional iron in iron deficient anaemia?

A

o Haemoglobin (reduced)

47
Q

what is transported iron levels in iron deficient anaemia?

A

o Serum iron (↓)
o Transferrin (receptors ↑)
o Transferrin saturation (reduced)

48
Q

what is storage iron levels in iron deficient anaemia?

A

o Serum ferritin (↓)

49
Q

how is iron deficient anaemia diagnosed?

A

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

50
Q

how is iron deficient anaemia managed?

A
  • treat the cause
  • oral iron – e.g. ferrous sulphate 200mg/8h PO
  • Continue until Hb is normal or for 3 months
51
Q

what are the side effects of ferrous sulphate?

A

nausea, abdominal discomfort, diarrhoea or constipation, black stools

52
Q

what are the causes of Anaemia of Chronic Disease?

A
  • Chronic infection (TB)
  • Vasculitis
  • Rheumatoid
  • Malignancy
  • Renal failure
53
Q

what is the pathophysiology of anaemia of chronic disease?

A
  • Poor use of iron in erythropoiesis
  • Cytokine-induced shortening of RBC survival
  • ↓ production of and response to erythropoietin
  • Inflammatory Macrophage iron block
54
Q

what is the process of inflammatory macrophage iron block?

A

o Increased transcription of ferritin mRNA stimulated by inflammatory cytokines so ferritin synthesis increased
o Increased plasma hepcidin blocks ferroportin-mediated release of iron
o Results in impaired iron supply to marrow erythroblasts and eventually hypochromic red cells

55
Q

what is the ferritin level in anaemia of chronic disease?

A

normal or raised

56
Q

what anaemia is present in anaemia of chronic disease?

A

Mild normocytic anaemia

57
Q

what is the management of anaemia of chronic disease?

A
  • Treat underlying cause
  • EPO
  • Iron
  • Hepcidin and inflammatory markers inhibitors

Haematology (13 decks)

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