Overview of anaemias Flashcards by Jesse Dorset

What is anaemia?

Reduced haemoglobin level in relation to age, sex, and physiological state.

NZ adult reference ranges: Female 115 – 155 g/L, Male 130 – 175 g/L.

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What are the severity classifications of anaemia based on haemoglobin levels?

Mild: > ~100 g/L
Moderate: 70 - 100 g/L
Severe: <70 g/L

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What are common symptoms of mild anaemia?

Often none
Weakness
Fatigue
Shortness of breath
Heart racing
Feeling cold

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What clinical signs may indicate severe anaemia?

Increased pulse rate
Heart failure
Myocardial ischaemia in ECG/exercise test
Confusion

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How is anaemia classified from the blood count?

Based on haemoglobin levels and cell characteristics: normal/reduced/raised, microcytic/normocytic/macrocytic.

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What are the aetiological causes of anaemia?

Increased loss or destruction
Impaired red cell production

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What is the effect of blood loss on anaemia?

It leads to haemodilution.

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What is haemolysis?

Increased rate of RBC breakdown.

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What are inherited causes of haemolysis?

Red cell membrane defects
Red cell enzyme defects
Some haemoglobin abnormalities

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What are acquired causes of haemolysis?

Antibodies
Drugs
Heart valves

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What is the role of reticulocytes in anaemia?

Young red cells released from marrow that increase in number with bleeding or abnormal destruction of red cells.

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What is microcytic anaemia characterized by?

Small red cells with reduced haemoglobin.

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What are common causes of microcytic anaemia?

Iron deficiency
Thalassaemias
Anaemia of inflammation

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What is the most common cause of anaemia?

Iron deficiency.

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What test is best for assessing iron stores?

Ferritin.

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What defines thalassaemias?

Genetic diseases resulting in reduced production of either the alpha or beta globin chain.

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What causes anaemia of inflammation?

Lack of iron availability due to hepcidin release from the liver.

True or False: Anaemia of inflammation responds to iron therapy.

False.

What are common conditions associated with anaemia of inflammation?

Rheumatoid arthritis
Inflammatory bowel disease
Chronic infections
Some cancers

What is C-reactive protein (CRP)?

A protein produced in the liver that increases during acute and chronic inflammation.

What characterizes macrocytic anaemias?

Deficiency of folic acid or vitamin B12 leading to delayed maturation in marrow.

What are some non-megaloblastic causes of macrocytic anaemia?

Liver disease
Increased red cell production due to haemolytic anaemias

What is normocytic anaemia associated with?

Anaemia of renal failure
Acute blood loss
Bone marrow disease
Anaemia of inflammation
Haemolytic anaemias

What happens to blood volume during acute bleeding?

Blood volume is reduced, leading to hypotension and fluid movement into vessels.

What causes anaemia of renal disease?

Reduced erythropoietin production due to small diseased kidneys.

What is the effect of EPO abuse in athletes?

Increased Hb and blood viscosity, leading to risks for clots.

What indicates reticulocytosis?

Increased reticulocyte count in response to reduced red cell survival.

What can cause haemolytic anaemias?

* Malaria * Autoimmune conditions

What is haemolysis?

Destruction of red blood cells leading to their premature removal from circulation ## Footnote Haemolysis can occur due to various reasons, including infections and autoimmune responses.

What are Reticulocytes?

Immature red blood cells that indicate bone marrow activity ## Footnote Normal reticulocyte count is 20-100 x 10^9/L, representing 1-2% of total red blood cells.

What does a manual reticulocyte stain show?

Larger reticulocytes that appear polychromatic due to RNA content ## Footnote This staining helps in assessing the bone marrow response to anaemia.

What are some examples of haemolytic anaemias?

* Malaria * Autoimmune hemolytic anaemia * Hereditary spherocytosis ## Footnote Each type has distinct mechanisms leading to red cell destruction.

How does malaria cause haemolysis?

Red cells are parasitized, leading to haemolysis after the parasite matures ## Footnote The lifecycle of the malaria parasite involves several stages within the red blood cells.

What happens in autoimmune hemolytic anaemia?

Red cells are coated with autoantibodies and ingested by macrophages in the spleen ## Footnote This condition can lead to increased destruction of red blood cells.

What is hereditary spherocytosis?

A genetic membrane defect in red cells leading to spherocyte formation ## Footnote Spherocytes are more prone to destruction in the spleen due to their shape.

What are the main tests for haemolysis?

* Blood count and blood film examination * Reticulocyte count * Bilirubin levels * Haptoglobin levels ## Footnote Each test provides insight into the extent and cause of haemolysis.

What does bilirubin indicate in the context of haemolysis?

A breakdown product from recycled haemoglobin ## Footnote Elevated bilirubin levels can indicate increased red blood cell destruction.

What role does haptoglobin play in haemolysis?

A protein that binds free hemoglobin, used up in haemolysis resulting in low levels ## Footnote Low haptoglobin levels can be a marker of active haemolysis.

What is pancytopenia?

A condition where all major marrow cell types are low: haemoglobin, platelets, neutrophils ## Footnote This often occurs in cases of bone marrow failure, such as after chemotherapy.

What can cause pancytopenia?

* Chemotherapy * Advanced cancer involving the bone marrow ## Footnote Certain cancers, like breast or prostate cancer, can lead to metastasis in the marrow.

What is the normal marrow function in relation to blood cell production?

The marrow produces red blood cells, platelets, and white blood cells ## Footnote Dysfunction in marrow can lead to decreased production of all these cells.