Lecture 6 - Clinical Approach to a Patient with Anaemia Flashcards
Causes of impaired production?
deficieny of iron, B12 or folate, thalassaemia, failure of bone marrow
Causes of reduced red cell survival?
bleeding, haemolysis
Morphology approach?
using mean cell volume: microcytic hypochromic (low), normocytic normochromic (normal), macrocytic (high)
Causes of microcytic hypochromic anameia?
iron deficiency, chronic illness (iron block), thalassaemia
Diagnosis criteria of iron deficiency?
low iron, high binding capacity and low ferritin
Diagnosis for anaemia or chronic disease?
low iron, low/normal binding capacity, high/normal ferritin
Causes of iron deficiency?
diet, malabsorption (proximal small bowel), increased demands (pregnancy), chronic blood loss (GI or GU)
Suspicions for cause of iron deficiency?
diet (kids), imbalance between intake and menstrual loss (pre-menopausal females), occult blood loss (males and menopausal females)
Treating iron deficiency?
iron replacement therapy: oral (ferogradumet) and IV infusion (ferric carboxymaltose)
Anaemia of chronic inflammation - iron block?
normochromic to mild hypochromic, mild anaemia - upregulation of hepcidin in inflammation blocking iron absorption in gut, kidneys and for RBC production
Laboratory diagnosis of thalassaemia?
haemoglobinopathy screen (iron studies and basic haemotology) and genetic testing
Macrocytic anaemia?
B12 or floate deficiency (megaloblastic anaemia), liver disease, alcohol, hypothyroidism - haemoglobin production normal, DNA synthesis abnormal
Pernicious anaemia?
immune response leading to decreased B12 absorption
Haemolytic anaemia?
shortened survival of red cells, intrinsic auto-immune defect of RBC membrane (environmental or inherited)
Haemolytic anameia - clinical signs?
raised red blood cell destruction (anaemia, jaundice, spleen growth) and increased RBC production raised reticulocyte)
