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12- Haematolgy > Microcytic and Macrocytic Anaemias > Flashcards

Microcytic and Macrocytic Anaemias Flashcards

1
Q

define anaemia

A

reduced total red cell mass

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2
Q

what Hb is considered anaemia in males and females?

A

Hb <130g/l in males

Hb <120g/l in females

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3
Q

which law is used when measuring optical density of red blood cells?

A

beers law

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4
Q

why is measuring haematocrit not reliable straight away in someone who’s just suffered a massive bleed?

A

there will be no change- need to wait as plasma to blood volume will be more accurate

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5
Q

what is haemodilution?

A

lower red blood cell count due to plasma expansion but not actually lost any red cells i.e. giving somone fluids overnight

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6
Q

how can anaemia be classified? (2)

A

decreased production

increased loss/destruction

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7
Q

what will reticulocyte count be in somone with an anaemia due to

1) decreased production
2) increased loss/destruction

A

1) low reticulocyte count
2) high reticulocyte count

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8
Q

what is microcytic anaemia?

A

presence of small red blod cells

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9
Q

what are some causes of microcytic anaemia?

A

iron deficiency

globin deficiency

problems with prophyrin synthesis (v,v rare)

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10
Q

what are siderocites?

A

iron accumulating wrong in place in blood cell

(seen in problems w porphyrin ring synthesis)

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11
Q

a problem with Hb production will produce what kind of coloured cells?

A

hypochromic

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12
Q

how is iron deficiency anaemia confirmed?

A

anaemia (dec functional iron)

low serum ferritn

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13
Q

what are some causes of iron deficiency anaemia?

A

relative deficiency- women of child bearing age/ children

absolute deficiency- vegetarian diet

blood loss

Malabsoprtion- coeliac

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14
Q

if menorrhagia is cause of iron deficiency anaemia what is treatment?

A

ferrosulphate

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15
Q

define macroytic anaemia

A

red cells have larger than normal volume

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16
Q

how is red blood cell size expressed?

A

Mean Corpuscular Volume (MCV)

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17
Q

what will HB, RBC and MCV look like in a macrocytic anaemia?

A

low Hb

low RBC

high MCV

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18
Q

what is the range for red blood cell size?

A

80-100, >100= macrocytic

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19
Q

what are the two kinds of true macrocytic anaemia?

A

megaloblastic

non-megalobastic

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20
Q

define megaloblastic anaemia

A

abnormally large cells with immature nucleus- megaloblasts

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21
Q

where is the defect in megaloblastic anaemia?

A

defect in DNA synthesis

22
Q

RNA and Hb sythesis is preserved in megaloblastic anaemia. how does this cause production of macroytes (lrger cells)?

A

when Hb level in cell is optimal nucleus is extruded leaving behind bigger than normal red cell (macrocyte)

(cytoplasm etc develops normally but nucleus refuses to divide so left with one massive cell that was meant to be two)

23
Q

why does anaemia occur in megaloblastic anaemia?

A

even thogh cells are larger there are less as apoptosis occurs to remove defective cells

24
Q

what are some causes of megaloblastic anaemia?

A

B12 or Folate deficiency

25
Q

what is seen in non-megaloblastic anaemia?

A

red cell membrane changes

26
Q

what are some causes of non-megaloblastic anaemia?

A

alcohol

liver disease

hypothyroidism

marrow failure

27
Q

why is spurious macrocytosis also known as ‘false’?

A

the volume of mature red cell is normal but the MCV is measured as high

28
Q

what are some causes of spurious macrocytosis?

A

inc in reticulocytes in response to acute blood loss/hameolysis

cold-agglutinations, clumps registered as one giant cell

29
Q

why does an increase in reticulocyte numbers give an increase in MCV?

A

reticuloytes are slightly larger than fully matured red cells

30
Q

what are some sources of B12?

A

meat/eggs

31
Q

where does B12 absoprtion occur?

A

distal small bowel

32
Q

how is B12 modified in order to be absorbed?

A

binds to R protein in stomach

intrinsic factor released from parietal cells

all travel to duodenum- lower pH

R protien cleaved and B12 binds to intrinsic factor

33
Q

what are some causes of B12 deficiency?

A

vegan diet

lack of gastric acid

pH doesn’t change with pancreatic secretion

bacterial overgrowth in small bowel

34
Q

where is intrinsic factor released?

A

gastric parietal cells

35
Q

how does pernicous anaemia cause B12 deficiency?

A

autoimmune destruction of gastric parietal cell so no longer able to produce intrinsic factor

36
Q

what should you watch out for in hisotry when dianosing pernicious anaemia?

A

other autoimmune disorders i.e. hypothyroidism, vitiligo, addisons

37
Q

how is pernicous anaemia treated?

A

IM B12 for life

38
Q

where is folate absorbed?

A

jejunum

39
Q

what are some causes of foalte deficiency?

A

inadequate intake

malabsortion i.e. coeliac, crohns

excess utilisation- haemolysis, pregnancy, malignancy

drugs- anticonvulsant

40
Q

what are some sources of folate?

A

liver, leafy veg, fortified cereals

41
Q

what is the daily requirement of B12 and Folate?

A

B12- 1.5ug/day

Folate- 200ug/day

42
Q

what are the clinical features of B12/folate deficiency?

A

symtptoms of anaemia

wgt loss, diarrhoea

sore tongue, jaundice

developmental problems in children

43
Q

hypersegmented nuetrophils and macrovalocytes are seen in which kind of anameia?

A

macrocytic - maegaloblastic anaemia

44
Q

what auto-antibodies can be checked when investigatign macrocytic anaemia?

A

anti-intrinsic factor

anti-gastric paretal cell

45
Q

why can patients with pernicous anaemia present mildly jaundiced?

A

intramedullary haemolysis causes Hb to be converted to bilirubin causing change in skin colour

46
Q

neurological problems and psychiatric manifestations are more regularly seen in deficiency of B12 or folate?

A

B12

47
Q

if proximal bowel is removed what anaemia will occur?

A

iron deficiency anaemia

48
Q

iron deficiency causes which macrocytic/microcytic anaemia?

A

microcytic

49
Q

B12 or folate deficiency causes macrocytic/microcytic anaemia?

A

macrocytic

50
Q

removal of the distal bowel will cause which anaemia?

A

macrocytic due to deficiency in B12

12- Haematolgy (9 decks)

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