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IIH > L03: Anaemia > Flashcards

L03: Anaemia Flashcards

1
Q

What is the definition of anaemia

A

A reduction in haemoglobin

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2
Q

What does the range for low haemoglobin depend on

A 
Age
Gender
Pregnancy 
Altitude 
Different labs
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3
Q

What is in the blood

A 
Plasma proteins 
Electrolytes
Hormones
Nutrients 
Platelets
White cells 
Red cells
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4
Q

What are the cell features of red cells

A

Biconcave

No nucleus

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5
Q

What is the key role of red cells

A

Oxygen and carbon dioxide transport

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6
Q

Where does erthropoiesis take place

A

In the bone marrow

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7
Q

What happens during bleed

A

Erythropoiesis increases and sometimes reticulocytes can become releases (reticulocytosis)

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8
Q

What is haemoglobin made of

A

4 polpypeptide chain

1 haem for each polypeptide chain

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9
Q

How many oxygen molecules bind to haemoglobin

A

4

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10
Q

What are the types of haemoglobin

A

HbA
HbA2
HbF
HbS

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11
Q

What is affinity

A

The ability to hold onto oxygen

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12
Q

What does haemoglobin affinity depend on

A 
Body area
Ph 
Temperature 
Co2
2.3DPG
Haemoglobin type
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13
Q

What are the symptoms of anaemia

A

Nausea
Breathlessness
Palpitations due to heart working harder to get oxygen round the body
Angina (heart pain)

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14
Q

What are the signs of anaemia

A 
Pallor 
Tachycardia 
Bounding pulse 
Flow murmur 
Signs of heart failure 
Conjunctiva- pale inside of eye 
Koilonychia - spooning of nails
Angular stomatitis - sores at the angle of the mouth
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15
Q

What are the 3 main causes of anaemia

A

1) reduced production
2) increased destruction
3) poor function of haemoglobin

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16
Q

Why is it not enough to to diagnose anaemia

A

Anaemia indicates an underlying disease

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17
Q

How can reduced production occur to give anaemia

A

Deficiency in:
iron : due to dilatory, malabsorption, chronic blood loss
B12 & folate: due to pernicious anaemia, increased alcohol, using too much B12& folate

Reduced production due to bone marrow:
Aplastic anaemia
Myeloma
Myelodysplasia

Displacement in bone marrow:
Leukaemia

Chronic disease:
Renal failure : due to lack of erythropoietin
Myeloma
Chronic inflammatory disease

18
Q

How can destruction occurs to give anaemia

A 
Haemolysis (break down of red blood cells)
Large spleen (macrophages can take out red cells)
Bleeding (lose red cells quickly)
19
Q

How can you get poor function to give anaemia

A

Red blood cell membrane defect:
Hereditary spherocytosis

Haemoglobin defect:
Sickle cell anaemia
Thalassemia

Red blood cell enzyme defect:
G6DP defiency

20
Q

Why is iron important in RBC

A

Essential for haemoglobin production

21
Q

Why is folate and b12 important in RBC

A

Turns uracil into thymidine for dna building

22
Q

What is hereditatory spherocytosis

A

A defect in the red blood cell cytoskeleton means the RBC cannot pass through narrow vessels. RBC becomes damages and therefore quickly removed by macrophages.

23
Q

What is the shape of RBC in hereditary spherocytosis

A

Sphere instead of biconcave

24
Q

What is thalassaemia

A

Defect in alpha or beta globin gene resulting in abnormal form of haemoglobin

25
Q

What is sickle cell anaemia

A

Defect of hb beta globin gene which changes the shape of haemoglobin

26
Q

What can sickle cell anaemia lead to

A

Obstructed capillaries leading to spleen damage

27
Q

How do we investigate anaemia

A 
Take full history 
Full blood count 
Blood film 
Ferritin, b12 and folate levels 
Liver and kidney functions 
Haemolysis screen
28
Q

How do we use hb and mean cell volume (MCV) to diagnose anaemia

A

Low hb and low MCV= iron deficiency anaemia, thalassemia, sickle cell anaemia

Low hb and normal MCV- chronic disease, acute blood loss, bone marrow failure

Low hb and high MCV- B12& folate deficiency anaemia, alcohol, haemolytic anaemia

29
Q

What is mcv

A

Mean cells volume i.e size of cell

30
Q

Where does Vitamin b12 get absorbed in the body

A

Terminal ileum

31
Q

What factor does vitamin b12 need to become absorbed in the terminal ileum

A

Intrinsic factor

32
Q

Where are intrinsic factors made

A

In the stomach from the parietal cells

33
Q

What can stop the production of intrinsic factor form the stomach

A

Pernicious anaemia

34
Q

If we have enough pernicious anaemia and B12 from the diet what can stop the absorption

A

Crohn’s disease which affects the small intestine and stops absorption of vitamin B12

35
Q

If the stomach and small intestine are working well what can another cause be to haver b12 deficiency

A

Vegan diet because B12 is in animal products

36
Q

What are the sources of folate in the diet

A

Vegetables

37
Q

Where is folate absorbed

A

Small intestine

38
Q

Therefore what can stop the absorption of folate in the body

A

Small intestine disease such as coeliac disease

39
Q

What are the causes of iron deficiency

A

Blood loss
A lack of iron in diet
Inability to absorb
Pregnancy

40
Q

What does the blood loss in iron deficiency anaemia involve

A

Menstrual loss
Slow chronic loss such as peptic ulcer, cancer
Gastrointestinal bleeding

41
Q

Where does iron get absorbed in the body if consumed in the diet

A

Small intestine so intestinal disorder can give iron deficiency
Or if small intestine as been bypassed or removed

42
Q

What levels do we look at to confirm low iron

A

Ferritin levels

IIH (26 decks)

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