Normocytic Anaemia Flashcards

1
Q

Anaemia of Chronic Disease

-Mechanism

A

AOCD is most common cause of normocytic anaemia.
Inflammation leads to rise in cytokines, e.g. IL-6, which upregulate hepicidin expression.
This causes: decreased iron release from splenic macrophages, decreased intestinal iron absorption, decreased repsonse to EPO (reduced synthesis) and reduced RBC lifespan

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2
Q

Diseases that cause AOCD

A

Inflammatory conditions, e.g. RA, SLE
Malignancy, e.g. lymphoma, lung cancer
Chronic infections, e.g. TB

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3
Q

Labs in AOCD

A

L Fe, L TIBC and transferrin saturation
H ferritin
N MCV but longstanding can progress to L

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4
Q

Treatment of AOCD

A

Address underlying cause
Blood transfusion if req.
ESA if no response

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5
Q

CKD and Anaemia

  • mechanism
  • labs
  • treatment
A

In CKD, low EPO leading to reduced RBC production
Labs: L reticulocyte count, L serum EPO, N/L Fe
Rx. ESA (ensure iron stores sufficient) and Iron supplements
Avoid blood transfusion if transplantation possibility to avoid allosensitisation

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6
Q

Aplastic Anaemia

-Mechanism

A

Aplastic anaemia= non-haemolytic, normocytic anaemia

Rare stem cell disorder: reduced or absent haematopoietic stem cells causing pancytopenia and bone marrow aplasia

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7
Q

Causes of Aplastic Anaemia

A

Drugs: benzene, chloramphenicol, anti-epileptics, alcohol
Irradiation
Insecticides
Viruses: parvovirus B19, EBV, HIV, CMV, HCV
Inherited: Fanconi anaemia
Idiopathic
Paroxysmal nocturnal haemoglobinuria (PNH)
SLE

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8
Q

Fanconi Anaemia

  • Mode of inheritance
  • Anatomical defects
  • Risk of other diseases
A

Autosomal recessive HLA-DRB1*04 –> defective stem cell repair and chromosomal fragility causing aplastic anaemia
Anatomical defects: short stature, microcephaly, syndactyly
Assoc: increased risk AML, breast cancer and skin pigmentation

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9
Q

Presentation of Aplastic Anaemia

A

Fatigue, malaise and pallor
Thrombocytopenia: mucosal bleeding, petechiae
Leukopenia: infections

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10
Q

Diagnosis and Treatment of Aplastic Anaemia

A

Diagnosis by bone marrow biopsy
Rx. supportive therapy (e.g. transfusions), bone marrow transplant from HLA-matched sibling, immunosuppression (anti-thymocyte globulin + ciclosporin)

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