Looking affy peely wally Flashcards
What does patient 1 have?
Patient 1 has a functional iron deficiency (low saturated transferrin and low serum iron)
Anaemia of chronic disease: microcytic, hypo chromic anaemia + high ferritin (inflammatory state means iron cannot be readily utilised)
What does patient 2 have?
Patient 2 has an absolute iron deficiency (low ferritin)
Microcytic, hypo chromic anaemia; low ferritin -> iron deficiency anaemia
What does hepcidin do and how does it work?
Hepcidin regulates release of iron
Hepcidin inhibits ferroportin which reduces release of iron to blood plasma
Hepcidin synthesis is increased in inflammatory states -> reduced release of iron to blood plasma -> high serum ferritin (stores of iron not readily used)
What diagnoses should you exclude in iron deficiency anaemia?
Coeliac disease
Post menopausal and menopausal women should have upper and lower GI endoscopy
What does this patient have?
This patient has thalassaemia trait (microcytosis, hypo chromic RBCs)
Reduction in red cell size and colour but no anaemia
What does this patient have?
Macrocytic hyper chromic anaemia
What are causes of megaloblastic anaemias?
B12 / folate deficeincy
Drugs
Inherited disorders
What are causes of non megaloblastic anaemias?
Liver disease
Alcoholism
Bone marrow disorder
If there is an increase in reticulocytes, what should we suspect?
Haemolysis
Acute blood loss
How can spherocytes be used to distinguish between blood loss or haemolysis?
No spherocytes in acute blood loss
What tests can we do for haemolytic anaemia?
Urinary haemosiderin
Serum LDH
Serum haptoglobin
What is haptoglobin?
A protein that can bind to free Hb from lysed RBCs
Anaemia + reticulocytosis = ?
Haemolytic anaemia or acute blood loss
Does chronic blood loss cause increased reticulocytes?
No
Blood in urine suggests what kind of haemolysis?
Intravascular haemolysis
What tests can we do for autoimmune haemolysis?
Direct (Coombs) antibody test
- Presence of autoantibodies on RBC surface can be incubated with antihuman antibodies -> agglutination
If patient has IgG autoantibody then they have autoimmune haemolytic anaemia
If autoimmune haemolysis is not present, what are other causes?
Hereditary membrane or Hb problems
- Quantitative defects suggest thalassaemia
- Qualitative defect suggest sickle cell anaemia
- Enzyme defects
Acquired - traumatic (cardiac valves, microangiopathy)
- Platelet and red cell fragmentation becomes important
What is management of autoimmune haemolysis?
Steroids as 1st line (not always effective)
Rituximab against B cells
Splenectomy
Chemotherapy
What is this?
Myelodysplastic syndrome
Serum B12/folate levels are not always reliable so what other tests should we do?
Blood films
Folate / B12 levels
Antibody testing (intrinsic factor, parietal cells)
