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Yr 3 Haem > normocytic anaemia > Flashcards

normocytic anaemia Flashcards

1
Q

causes of normocytic anaemia

A
  • acute blood loss
  • IDA/anaemia of chronic disease (can be microcytic)
  • bone marrow failure eg myeloproliferative malignancy, myelodysplastic syndrome
  • renal failure
  • hypothyroidism (can be macrocytic)
  • haemolysis (can be macrocytic)
  • pregnancy
  • aplastic anaemia
  • anaemia of chronic kidney disease
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2
Q

how does hypothyroidism cause anaemia

A

Causes a mild hypoproliferative normocytic anaemia due to the loss of the stimulatory effect of thyroid hormones on erythropoiesis.

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3
Q

definition of normocytic anaemia

A

decrease in circulating RBC represented by low Hb. Hct, RBC

MCV 80-100 fL

Hb <140g/L in men and <120 in women

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4
Q

mechanism of normocytic anaemia

A

decreased blood volume and/or decreased erythropoiesis

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5
Q

sx of normocytic anaemia

A

asymptomatic

pallor - mucous membrane, conjunctival

exertional dyspnoea, fatigue

faintness

pica - craving for ice/dirt

jaundice if haemolytic

worsing of angina

headache

tinnitis

anorexia

features of hyperdynamic state - bounding pulse, tachycardia/palpations, flow murmur (ejection systolic, loudest over apex), pulsatile sound in the ear, cardiac enlargement, retinal haemorrhages

features of extramedullary haematopoiesis in certain severe forms - hepatosplenomegaly, paravertebral mass, widening of diploic spaces of the skull

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6
Q

Ix for normocytic anaemia

A

FBC to confirm anaemia and assess severity

reticulocyte count to assess bone marrow response

  • if reticulocyte >2% - assess for blood loss, LDH, haptoglobin. unconjugated BR (for haemolytic anaemia)
  • if <2% - iron studies, serum B12 and folate, basic metabolic panel - LFT, TFT. serum erythropoietin levels if BUN/creatinine high

abnormal leukocytes may suggest bone marrow failure or bone marrow malignancy eg aplastic anaemia, leukaemia, myelodysplastic

pancytopenia - peripheral cell destruction, sequestration in hypersplenism, aplastic anaemia, infection

peripheral smear

bone marrow biopsy

imaging

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7
Q

bone marrow biopsy for normocytic anaemia

A

bone marrow aspirate and biopsy - in hypoproliferative anaemia with normal nutritional asses and metabolic panels

indications - pancytopenia and/or abnormal cells on FBC of smear

prussian blue staining if sideroblastic anaemia is suspected

used to dx:

  • aplastic anaemia
  • myelodysplastic syndromes
  • myeloproliferative neoplasm
  • malignant invasion of the bone marrow
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8
Q

peripheral blood smear for normocytic anaemia

A

reveal classic pathologic RVC forms

identify causes eg schistocytes in haemolytic anaemia

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9
Q

imaging for normocytic anaemia

A

endoscopy/colonoscopy to check for bleeding

US - hypersplenism, liver or renal disease

consider CT and or PET if malignancy is suspected

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10
Q

Mx of normocytic anaemia

A

identify and treat cause

blood transfusion with RBC if Hb <70 or <80 and CVD or orthopeadic surgery

consider hospital admission or observation of acutely symptomatic, actively bleeding, need transfusion

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11
Q

acute mx of anaemia

A

IV access

IV fluid resus if hypotensive or tachycardic

type and screen with crossmatching

consent for transfusion

identify cause

serial BP monitoring and continuous sats

ox

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12
Q

what is pure red cell aplasia

A

normocytic, normochromic anaemia

severe reduction in circulating reticulocytes and marked reduction or absence of erythroid precursers in marrow

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13
Q

pathophysiology of pure red cell aplasia

A

abnormal T cell function and IgG Ab that target erythroblasts and erythropoietin

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14
Q

aetiology of red cell aplasia

A

acquired:

  • idiopathic
  • associated with - thymoma, myelodysplastic syndrome, adverse drug effects eg phenytoin, chloremphenicol, parvovirus B19, autoimmune disorders T1dm, thyroiditis, RA
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15
Q

Ix for pure red cell aplasia

A

low reticulocyte

bone marrow biopsy - reduction or absence of erythroid precursors

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16
Q

Mx of pure red cell aplasia

A

treatment of cause

transfusion

immunosuppressive and/or cytotoxic agents

17
Q

definition and aetiology of acute blood loss anaemia

A

acute anaemia due to blood loss

bleeding - trauma, acute GI bleeding, rupture of aneurysm, surgery

RF - anticoagulant, consumptive or dilutional coagulopathy following repeated blood transfusions

18
Q

Ix for acute blood loss anaemia

A

low or normal Hb

check plts for thrombocytopenia

Xmatch

coagulation panel

CT of soft tissue if concern for IM bleeding

abdo/pelvic CT if intra-abdominal

chest XR/CT - pulmonary cause

19
Q

mx of acute blood loss anaemia

A

identify and treat underlying cause

blood transfusion

20
Q

complication of anorexia

A

can get HF later - if so then rapid transfusion can be fatal

21
Q

red cell distribution width

A

in unifactoral anaemia - all red cells are the same size - graph of volume forms a narrow peak

in mixed anaemia - peak broadens

eg in coeliac - poor absorption of iron = low MCV and folate = high MCV

this is anisocytosis

22
Q

RF for anaemia

A

extremes of age

female

lactation

pregnancy

23
Q

hyperproliferative normocytic anaemia

A

reticulocyte count >2%

proportion of circ reticulocytes increases as compensatory response to increased destruction or loss of RBCs

usually acute blood loss or haemolysis

24
Q

hypoproliferative normocytic anaemia

A

reticulocyte <2%

disorders of decreased red cell production, and proportion of circ reticulocytes remains unchanged

25
Q

how does chronic kidney disease cause normocytic anaemia

A

decreased erythropoietin production

accumulation of erythropoiesis inhibitors

secondary hyperparathyroidism

26
Q

prognosis of anaemia

A

life threatening if >40% loss of total body volume

27
Q

primary myelofibrosis

A

fibroblasts in BM become overactive and proliferate

Philidelphia negative myeloproliferative disorder - it is a cancer

causes crowding out effect - decreased BM production

tear drop cells (dacrocytes) can arise in myelofibrosis

dry tap on BM aspirate

normocytic anaemia

28
Q

complications of transfusions for normocytic anaemia

A

Dilutional, or consumptive, coagulopathy from tissue injury may result from the decrease of platelets and coagulation factors (factor V, factor VIII, and fibrinogen) in massive transfusions and must be corrected by the addition of these factors.

Yr 3 Haem (16 decks)

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