Ph2: Haemotology Flashcards
What is Anaemia?
Anaemia is clinically low haemoglobin or red blood cell count in the blood.
What are the main symptoms of general anaemia and why?
Fatigue and weakness due to reduced oxygen supply to tissues.
What investigation should be performed for uninvestigated anaemia?
Full Blood Count (FBC) including Hb, Hct/PCV, MCV and RDW
What is the normal range of haemoglobin concentration in males and females?
135-180g/L in males
115-160g/L in females
What is MCV and what is the typical reference range?
Mean Corpuscular Volume and it is typically between 80-99fL
What is PCV and what is the typical reference range?
Packed Cell Volume and it is typically between 40-50%
What additional tests can be ordered for uninvestigated anaemia?
Reticulocyte Count, Reticulocyte Index, Lactate Dehydrogenase (LDH), Haptoglobin, Indirect Billirubin, Blood Smear.
What results would you see in haemolytic anaemia?
↑ Reticulocyte Count, ↑ Reticulocyte Index,
↑ LDH, ↑ Indirect Billirubin, ↓ Haptoglobin
What results would you see in underproductive anaemia?
↓/- Reticulocyte Count, ↓/- Reticulocyte Index, ↓ LDH, ↓ Indirect Billirubin, ↑/- Haptoglobin
What tests would you order for confirmed microcytic anaemia?
Iron Studies (Serum Fe, Ferritin, Transferrin/TIBC), Vitamin B12, Vitamin B9, Creatinine Concentration
How would you interpret the following?
↓ Serum Fe, ↓ Ferritin, ↑ TIBC,
- Vitamin B12, - Vitamin B9,
- Creatinine
BS shows: Hypochromic, Microcytic
Iron deficient anaemia
How would you interpret the following?
↓ Serum Fe, ↑ Ferritin, ↓ TIBC
- Vitamin B12, - Vitamin B9
- Creatinine
BS shows: Normochromic, Normocytic
Chronic inflammatory anaemia
How would you interpret the following?
- Serum Fe, - Ferritin, - TIBC
- Vitamin B12, - Vitamin B9
↑↑ Creatinine
BS shows: Normochromic, Normocytic
Anaemia of Chronic kidney disease
How would you interpret the following
↑ Serum Fe, ↑ Ferritin, ↓ TIBC
- Vitamin B12, - Vitamin B9
- Creatinine
BS shows: Microcytic, Hypochromic
Sideroblastic anaemia
What findings would you see in iron deficient anaemia on a blood smear?
Microcytic cells, Hypochromia, Pencil cells, Target cells
What findings would you see in a sideroblastic anaemia on a blood smear?
Microcytic cells, Hypochromia, Sideroblastic rings of iron on prussian blue staining
Describe the pathology of sideroblastic anaemia and possible causes?
There is a dysfunction in the production of the porphyrin ring leading to decreased haemoglobin. Causes include lead poisoning, alcoholism and lead poisoning.
Describe the pathology of anaemia of chronic inflammatory disease?
Body reduces available iron in bloodstream in case of bacterial infection. It increases ferritin storage and liver releases hepcidin which reduces iron absorption in GI
What tool can be used to differentiate between iron deficient anaemia and thalassemia?
Mentzer’s Index
= MCV / RBCC
> 13 is iron deficient, < 13 is thalassemia
When do the symptoms of alpha-thalassemia appear and why?
In uterine as alpha chains are involved in production of HbF (foetal).
What clinical sign is seen in 4 deletion alpha-thalassemia and what does it suggest?
Hb-Barts (Tetrameres of gamma chains), it is a sign of Hydrops Fetalus and the baby will not make it to term.
When do the symptoms of beta-thalassemia appear and why?
6-12 months after birth as the HbF (foetal) is replaced by HbA (adult) which contains beta chains.
What is the standard investigation for diagnosis of thalassemia? What would you see in beta-thalassemia?
Haemoglobin electrophoresis
You would see ↓ HbA, ↑ HbF and ↑ HbA2 in beta-thalassemia
What is the role of haptoglobin in the body?
Haptoglobin binds and removes free haemoglobin so a decrease in haptoglobin shows there is an increase in free haemoglobin
