MEH - Anaemias Flashcards
What are the micro/normo/macrocytic anaemias?
TAILS - micro - thalassemia, anaemia of chronic disease, iron deficiency, lead poisoning, sideroblastic
ABCD - acute blood loss, bone marrow failure (aplastic or infiltrated), chronic disease, destruction (haemolysis)
FATRBCC - fetus (pregnancy), alcohol (folate deficiency), Thyroid (hypo), reticulocytosis (things causing increased reticulocyte), b12/folate deficiency, cirrhosis (liver disease), Chronic disease
Can anaemia of chronic disease be micro normo and macro?
Yes
What is a differential for Iron deficient anaemia as they present quite similarly? What are the similarities
Thalassemia
Both microcytic
Both show target cells
Both show hypochromasia
How do you test for iron deficient anaemia? What are the problems with the tests?
Serum ferritin - but also is an Acute phase protein so increased in inflammation etc so normal or increased ferritin levels don’t necessarily exclude iron deficiency
CHR - Reticulocyte haemoglobin content - but this is also reduced in thalassemia so can’t be used to differentiate
What are symptoms/signs of anaemia?
Tiredness
Shortness of breath
Palpitations
Angina
Tachycardia Pallor Angula stomatitis Spooning of nails Shiny tongue
What would you see on a blood smear in iron deficient anaemia?
Hypochromasia
Target cells
Anisopoikilocytosis (change in size and shape)
Pencil cells
What would you expect the blood results to be for iron deficient anaemia (6)?
Low Hb
Low serum ferritin
Low CHR (reticulocyte haemoglobin content)
Increased TIBC (Total iron binding capacity)
Low serum iron
Low % transferrin saturation
What does TIBC measure?
Bloods capacity to bind iron with transferrin
What does % transferrin saturation measure?
Measures the amount of iron reversibly bound to transferrin (a protein that binds to iron and transports it into cells e.g. into duodenal cells in absorption and into RBCs to transport iron into them).
Less iron less attaches so less % saturation
What is a normal MCV?
80-100
What kinds of things cause haemolytic anaemia (11)?
Sickle cell - due to misshapen and aggregates - break in capillaries
Damaged/prosthetic heart valves - shearing
Myelodysplastic disorders/ leukaemia/lymphoma ?due to autoimmune response?
Pyruvate kinase deficiency
G6PDH deficiency
DIC - due to infection/sepsis
Thalassemia
Hereditary spherocytosis
Autoimmune haemolytic anaemia
Non immune - burns
Osmotic haemolysis - drowning
What is hereditary spherocytosis?
Only produce spherocytes - get haemolytic anaemia
What happens in bone marrow failure? How do you diagnose this kind of normocytic anaemia?
Can be aplastic - not producing any RBCs due to multiple myoloma/leukaemia/lymphoma/ drugs/ post viral aplastic
Diagnose with bone marrow biopsy
What would see on a blood film with Folate/Vit B12 deficiency? Are the distinguishable? When might you see this kind of anaemia?
Megaloblastic - macrocytic
Large cells with arrest of nuclear maturation - large nucleus
Hyper segmented neutrophils
What is extra medullary haemopoiesis and when might you see it?
Not bone marrow
So liver or spleen taking over role of blood cell production e.g. in Thalassemia
Why does folate/B12 deficiency cause megaloblastic cells with large nuclei?
As it inhibits DNA synthesis so cells don’t produce enough DNA to divide at the right time and therefore grow too large with large nuclei
What is the mechanism of anaemia of chronic disease?
Functional lack of iron
Iron not released from macrophages
Reduced RBC made
How can kidney disease cause anaemia?
Decreased Epo less synthesis
How does pyruvate kinase deficiency cause anaemia?
RBC can’t complete glycolysis so no ATP is being made –> haemolytic anaemia - normocytic
What can cause folate deficiency?
Lots of things Alcohol Pregnancy Reduced in diet Some drugs - e.g. Crohns drugs methotrexate Coeliac Urinary loss in liver disease
What effect does haemolysis of RBC have on Hb in blood?
excess- haemoglobinaemia due to the breakdown of RBC releasing Hb
also increased Bilirubin
What can increased bilirubin in haemolytic anaemia lead to (2)?
Jaundice
Gallstones
What is pernicious anaemia? How does it occur?
Type of Vit B12 deficiency that is due to lack of intrinsic factor that is needed for Vit B12 absorption
Why can’t you treat pernicious anaemia with oral Vit B12? How do you treat it?
Because can’t absorb it
Need to give IM Vit B12
What are the most common causes of anaemia in pregnancy?
Iron
Folate
What is sideroblastic anaemia?
Bone marrow produces sideroblasts instead of healthy RBCs can’t incorporate boy iron into Hb
Can be apart of myelodysplastic syndrome