New GP Derm Flashcards
Define anaemia
Low concentration of haemoglobin in the blood
What is the Mean Cell Volume (MCV) in both females and males?
80-100 femtolitres
What are the categories of anaemia?
Categories based on mean cell volume:
* Microcytic anaemia (low MCV)
* Normocytic anaemia (normal MCV)
* Macrocytic anaemia (large MCV)
Mneumonic for microcytic anaemia
TAILS
T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia
What condition does anaemia of chronic disease often occur with? Why?
Chronic kidney disease (CDK) - due to reduced production of erythropoietin by the kidneys
Erythropoietin = hormone responsible for stimulating RBC production
Treatment = erythropoietin
Nmeumonic for normocytic anaemia
3 As + 2 Hs
A – Acute blood loss
A – Anaemia of chronic disease
A – Aplastic anaemia
H – Haemolytic anaemia
H – Hypothyroidism
What are the types macrocytic anaemia?
Normoblastic anaemia (H LARD):
* H- Hypothyroidism
* L - Liver disease
* A - Alcohol
* R - Reticulocytosis (usually from haemolytic anaemia or blood loss)
* D - Drugs (e.g. azathioprine)
Megaloblastic anaemia:
* B12 deficiency
* Folate deficiency
Megalobastic anaemia → deficiencies so don’t divide → big abnormal cells
Megalobastic anaemia → deficiencies → impaired DNA synthesis → don’t divide → big abnormal cells
What are the two main categories of macrocytic anaemia?
Normoblastic + megaloblastic
What causes megaloblastic anaemia?
Megaloblastic macrocytic anaemia = results from impaired DNA synthesis → preventing the cells from dividing normally
Rather than dividing → they grow into large abnormal cells
What is reticulocytsosis?
Reticulocytosis **= increased concentration of reticulocytes (immature RBCs) **
Happens where there is a rapid turnover of RBCs → such as haemolytic anaemia or blood loss
What are the generic symptoms of anaemia?
- Tiredness
- Shortness of breath
- Headaches
- Dizziness
- Palpitations
- Worsening of other conditions, such as angina, heart failure or peripheral arterial disease
What are two symptoms/signs specific to iron deficiency anaemia?
- Pica (dietary cravings for abnormal things, such as dirt or soil)
- Hair loss
What are the generic signs of anaemia?
- Pale skin
- Conjunctival pallor
- Tachycardia
- Raised respiratory rate
What are some specific signs for iron deficiency anaemia?
- Koilonychia (spoon-shaped nails)
- Angular cheilitis
- Atrophic glossitis (smooth tongue due to atrophy of the papillae)
- Brittle hair + nails
What type of anaemia can jaundice indicate?
Think about it
Haemolytic anaemia
Bone deformities can be a sign for what blood disorder (form of microcytic anaemia)?
Thalassaemia
What can the signs below indicate:
* Oedema
* Hypertension
* Excoriations on the skin
Chronic kidney disease
What are the investigations (imaging) for unexplained iron deficiency anaemia to exclude gastrointestinal cancer as a source of bleeding?
- Oesophagogastroduodenoscopy (OGD)
- Colonoscopy
What investigation is indicated for unexplained anaemia or possible malignancy (e.g. leukaemia or myeloma)?
Bone marrow biopsy
Blood tests for anaemia
- Full blood count (Hb + MCV)
- Reticulocyte count (indicates red blood cell production)
- Blood film (abnormal cells and inclusions)
- Renal profile (chronic kidney disease)
- Liver function tests (liver disease and bilirubin (raised in haemolysis))
- Ferritin (iron)
- B12 and folate
- Intrinsic factor antibodies (pernicious anaemia)
- Thyroid function tests (hypothyroidism)
- Coeliac disease serology (e.g., anti-tissue transglutaminase antibodies)
- Myeloma screening (e.g., serum protein electrophoresis)
- Haemoglobin electrophoresis (thalassaemia and sickle cell disease)
- Direct Coombs test (autoimmune haemolytic anaemia)
