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Haematology > Normocytic Anaemia > Flashcards

Normocytic Anaemia Flashcards

1
Q

What does normocytic mean?

A

The RBCs are a normal size

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2
Q

What are some causes of normocytic anaemia?

A

Acute haemorrhage
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia

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3
Q

What would blood from a patient with acute haemorrhage look like on a blood film?

A

Normocytic, normochromic

RBCs are normal there just aren’t enough of them

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4
Q

Treatment of acute haemorrhage?

A

Transfusion - packed red cells

Fluids

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5
Q

What type of chronic diseases can cause anaemia?

A

Chronic inflammation
Chronic infection
Malignancy

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6
Q

How would you treat chronic disease anaemia?

A

Treat the underlying cause

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7
Q

What is aplastic anaemia?

A

Failure of bone marrow to produce RBCs due to bone marrow hypocellularity

It is referred to as pancytopenia

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8
Q

Aplastic anaemia is referred to as pancytopenia. What does this mean?

A

Deficiency of all blood cells, red and white

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9
Q

Causes of aplastic anaemia?

A

Idiopathic
Fanconi’s anaemia
Drugs
Radiation

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10
Q

Besides the usual symptoms of anaemia, what do people with aplastic anaemia get?

A

Infections: due to lack of wbcs
Bleeding: due to lack of platelets

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11
Q

Investigation of aplastic anaemia?

A

Blood count:
- low white and red cells

Blood film:

  • low WBCs and RBCs
  • low reticulocytes
  • normocytic
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12
Q

Treatment of aplastic anaemia/

A

Treat the underlying cause
Supportive
Bone marrow transplant

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13
Q

What is haemolytic anaemia?

A

Increased destruction of red blood cells

A reduction in their lifespan

The bone marrow is unable to compensate the loss

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14
Q

Two types of haemolytic anaemia?

A

Red cell destruction can either be:

Extravascular: destruction occurs in the reticuloendothelial system

Intravascular: destruction occurs within the blood vessels

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15
Q

Is haemolytic anaemia most commonly intra or extravascular?

A

Extravascular

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16
Q

What is the reticuloendothelial system?

A

The spleen and bone marrow?

System involving macrophages that are involved with red cell destruction

17
Q

What are some causes of haemolytic anaemia?

A

RBC membrane defect

Enzyme defect: glucose-6-phosphate

Haemoglobin abnormalities

  • thalassaemia
  • sickle cell disease

Immune + non-immune

  • autoimmune
  • drugs

Infections:
- malaria

18
Q

What does haemolytic anaemia result in?

A

Increased serum unconjugated bilirubin

Increased urinary urobilinogen

Increased faecal stercobilinogen

19
Q

What is:

  • bilirubin
  • urobilinogen
  • stercobilinogen?
A

Bilirubin = breakdown product of haem

Urobilinogen = bilirubin present in a slightly different form in urine

Stercobilinogen = bilirubin present in a slightly different form in faeces

20
Q

Why does malaria cause jaundice?

A

Malaria causes haemolytic anaemia

Breakdown of RBCs

Excess bilirubin

High bilirubin levels = jaundice

21
Q

What causes glucose-6-phosphate deficiency?

A

Genetic mutation

22
Q

In what way does glucose-6-phosphate deficiency cause haemolytic anaemia?

A

It makes the person susceptible to acute haemolytic episodes

Brought on by:
Fava beans (BROAD BEANS
Drugs
Infection
Surgery
23
Q

Investigations of haemolytic anaemia?

A

Bilirubin, uro and stercobilinogen

Blood film:

  • normocytic
  • look for other features that might indicate cause: infection, sickle cells etc.
24
Q

Management of haemolytic anaemia?

A

Treat the underlying cause

Avoid any precipitating factors, like broad beans + glucose-6-phosphate deficieny

25
Q

What is sickle cell anaemia?

A

An inherited condition where a mutation in the gene for beta haemoglobin causes it to become haemoglobin S

Causing sickle shaped RBCs to arise

26
Q

What is the inherited pattern of sickle cell anaemia?

A

Autosomal recessive

27
Q

What do you call carriers (but not sufferers) of the sickle cell gene?

A

Sickle cell trait

28
Q

Being sickle cell trait is bad news. True or false?

A

False

You get no symptoms

And you get protection against falciparum malaria, a huge survival advantage

29
Q

What is the problem with sickle shaped RBCs?

A

They can cause blockages in small blood vessels, occluding them causing loss of blood supply to regions of the body

They also are not as efficient at carrying oxygen

30
Q

Clinical features of sickle cell disease?

A

Vaso-occlusive crises causing pain and symptoms in many regions of the body: abdo, joint, bone, angina, stroke, retinal

Aplastic crisis: temporary cessation of erythropoeisis = severe anaemia = CCF

Sequestration crisis: sudden enlargement of spleen, causing drop in Hb conc, circulatory collapse and hypovolaemic shock

Susceptible to infections (esp encapsulated bacteria like pneumococcus)

Growth impairment

31
Q

Investigation of sickle cell disease?

A

Blood film:

- visible sickle cells

32
Q

Management of sickle cell disease?

A 
Avoid triggers
Psychological support and education
Folic acid, zinc supplementation
Abx prophylaxis: penicillin
Vaccinations
Blood transfusions
Hydroxycarbamide (increase HbF)
Bone marrow transplant
33
Q

Symptoms of haemolytic anaemia?

A

Anaemia symptoms

Jaundice
Pulmonary hypertension

34
Q

What is fanconi anaemia? What type of anaemia does it cause?

A

A genetic condition that causes a defect in proteins that repair DNA

They get cancers and bone marrow failure - aplastic anaemia

35
Q

Management of a sickle cell crisis?

A

Analgesia using WHO pain ladder
Rehydrate
Oxygen
Consider antibiotics if evidence of infection
Blood transfusion
Exchange transfusion: e.g. if neurological complications
Hydroxycarbamide

36
Q

What often triggers vaso-oclusive crises?

A

Cold
Fever
Dehydration
Stress

37
Q

Features of sickle cell vaso-oclusive crisis?

A

Ischaemia

Arthralgia
Lung involvement: SOB
Neuro signs: focal neuro, seizure, stroke
Acute abdominal distension and pain (mesenteric sickling and bowel ischaemia)
Loin pain (renal papillary necrosis may cause renal colic or severe haematuria)
Priapism
Retinal occlusion

38
Q

What is…

Aplastic crisis
Sequestration crisis?

A

Aplastic: temporary cessation of erythropoeisis, resulting in severe anaemia which can cause CCF

Sequestration: enlargement of spleen, causing drop in Hb, circulatory collapse, hypovolaemic shock

Haematology (9 decks)

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