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Systems: Haematology + Immunology > RBC: Acquired Anaemias > Flashcards

RBC: Acquired Anaemias Flashcards

1
Q

What is the normal haemoglobin level for a male 12-70?

A

140-180

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2
Q

What is the normal haemoglobin level for a male>70?

A

116-156

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3
Q

What is the normal haemoglobin level for a female 12-70?

A

120-160

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4
Q

What is the normal haemoglobin for a female >70?

A

108-143

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5
Q

What are the clinical features of anaemia?

A

General features due to reduced oxygen delivery to tissues:

  • Tiredness/pallor
  • Breathlessness
  • Swelling of ankles
  • Dizziness
  • Chest pain

Depend on age and Hb level

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6
Q

What features of anaemia may relate to the underlying cause?

A 
Evidence of bleeding
-Menorrhagia
-Dyspepsia, PR bleeding				
Symptoms of malabsorption
-Diarrhoea
-Weight loss

Jaundice

Splenomegaly/Lymphadenopathy

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7
Q

What is the approach to diagnosing cause of anaemia?

A

Bone marrow

  • Cellularity
  • Stroma
  • Nutrients

Red cell

  • Membrane
  • Haemoglobin
  • Enzymes

Destruction loss

  • Blood loss
  • Haemolysis
  • Hypersplenism
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8
Q

What are red cell indices?

A

Automated measurement of red cell size and haemoglobin content

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9
Q

MCV

A

Mean cell volume (cell size)

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10
Q

MCH

A

Mean cell haemoglobin

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11
Q

What can red indices tell us?

A

A morphological description of anaemia

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12
Q

Give 3 morphological descriptions of anaemia.

A
  • Hypochromic microcytic
  • Normochromic normocytic
  • Macrocytic
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13
Q

What does investigation of anaemia involve?

A
  • Investigation involves use of a discriminating test to guide further investigations
  • If laboratory is given adequate clinical information it will advise on further appropriate investigations
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14
Q

What investigation should be carried out to establish cause of hypochromic microcytic anaemia?

A

Serum ferritin

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15
Q

What investigation should be carried out to establish cause of normochromic normocytic anaemia?

A

Reticulocyte count

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16
Q

What investigation should be carried out to establish cause of macrocytic anaemia?

A
  • B12 and folate levels

- Bone marrow

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17
Q

What does low serum ferritin suggest in hypochromic microcytic anaemia?

A

Iron deficiency

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18
Q

What does normal/increased serum ferritin suggest in hypochromic microcytic anaemia?

A
  • Thalassaemia
  • Secondary anaemia
  • Sideroblastic anaemia
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19
Q

What are the features of iron metabolism?

A
  • Total body iron approx. 4g
  • Dietary intake balanced by loss
  • Most of the body’s iron is in Hb and is recycled
  • no pathway for excretion of excess iron
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20
Q

What happens to absorbed iron?

A
  • Bound to mucosal ferritin and sloughed off OR
  • Transported across the basement membrane by ferroportin
  • Then bound to transferrin in the plasma
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21
Q

Whhat happens to the iron absorbed in the duodenum?

A
  • Fe2>Fe3
  • Transported from eneterocytes and macrophages by ferroportin
  • Transported in plasma bound to transferrin
  • Stored in cells as ferritin
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22
Q

What reduced intestinal iron absorption?

A

Hepcidin synthesised in hepatocytes in response to inflammation (also renal failure and increased iron levels) so reduced intestinal iron absorption and mobilisation from reticuloendothelial cells

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23
Q

What is the commonest cause of anaemia worldwide?

A

Iron deficiency anaemia

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24
Q

What is normally in the history of iron deficiency anaemia?

A
  • Dyspepsia GI bleeding
  • Other bleeding, eg menorrhagia
  • Diet (NB children and elderly)
  • Increased requirement - pregnancy
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25
Q

What can be found on examination of iron deficiency anaemia?

A

Signs of iron deficiency

  • Koilonychia
  • Atrophic tongue
  • Angular cheilitis

Abdominal and rectal examination (bleeding)

26
Q

Give some examples of causes of iron deficiency.

A
  • GI blood loss
  • Menorrhagia
  • Malabsorption (can be due to gastrectomy of coeliac disease)
  • Diet
27
Q

How is iron deficiency anaemia managed?

A

Correct the deficiency -Oral iron usually sufficient

  • IV iron if intolerant of oral
  • Blood transfusion rarely indicated

Correct the cause -

  • Diet
  • Ulcer therapy
  • Gynae interventions
  • Surgery
28
Q

What does increased reticulocyte count suggest in normochromic normocytic?

A
  • Acute blood loss

- Haemolysis

29
Q

What does a normal or low reticulocyte count suggest in normochromic normocytic anaemia?

A
  • Secondary anaemia
  • Hypoplasia
  • Marrow infiltrate
30
Q

What happens in haemolytic anaemia?

A
  • Accelerated res cell destruction (decreases Hb)
  • Compensation by bone marrow (Increase in retics
  • Level of Hb= balance between red cell production and destruction
31
Q

What are the 2 forms of haemolysis?

A
  • Extravascular

- Intravascular

32
Q

What are some congenital causes of haemolytic anaemia?

A
  • Hereditary spherocytosis (HS)
  • Enzyme deficiency (G6PD deficiency)
  • Haemoglobinopathy (HbSS)
33
Q

What are some acquired causes of haemolytic anaemia?

A

Extravascular
-Auto-immune haemolytic anaemia

Intravascular

  • Mechanical e.g. artificial valve
  • Severe infection/DIC
  • PET/HUS/TTP
34
Q

How can acquired haemolytic anaemia be subdivided?

A
  • Immune (mostly extravascular)

- Non-immune (mostly intravascular)

35
Q

What is a direct antiglobulin test?

A

-A test which detects antibody or complement on red cell membrane

36
Q

How does the DAGT work?

A
  • Reagents contain either anti-human IGG or anti-complement
  • Reagent binds to Ab (or complement) on red cell surface and causes agglutination in vitro
  • Implies immune basis for haemolysis
37
Q

What does a positive DAGT suggest in in haemolytic anaemia/

A

Immune mediated

38
Q

What does a negative DAGT suggest in haemolytic anaemia?

A

Non-immune mediated

39
Q

In human haemolysis of haemolytic anaemia, what does a warm-auto-antibody suggest?

A
  • Auto-immune
  • Drugs
  • CLL
40
Q

In human haemolysis of haemolytic anaemia, what does a cold auto-antibody suggest?

A
  • CHAD
  • Infections
  • Lymphoma
41
Q

In human haemolysis of haemolytic anaemia, what does an alloantiody suggest?

A

Transfusion reaction

42
Q

What can be seen on blood film of immune haemolysis?

A
  • Spherocytes on film

- Agglutination in cold AIHA

43
Q

What can be seen on blood film of intravascular haemolysis?

A

Red cell fragments called schistocytes

44
Q

How is the mechanism of haemolytic anaemia established?

A
  • History and examination
  • Blood film
  • Direct Antiglobulin Test (Coombs’ test)
  • Urine for haemosiderin/urobilinogen
45
Q

What is the management for haemolytic anaemia?

A

Support marrow function
-Folic acid

Correct the cause

  • Immunosuppression if autoimmune (steroids, treat the trigger))
  • Remove site of red cell destruction (splenectomy)
  • Treat sepsis, leaky preosthetic valve, malignancy etc. if intravascular

Consider transfusion

46
Q

What is secondary anaemia?

A

Anaemia of chronic disease

47
Q

How does secondary anaemia present morphologically?

A
  • 70% normochromic normocytic

- 30% hypochromic microcytic

48
Q

What is the cause of secondary anaemia?

A

Identifiable underlying disease including infection, inflammation and malignancy

49
Q

Why does secondary anaemia occur?

A

Defective iron utilisation

  • Increased hepticidin in inflammation
  • Ferritin is often elevated
50
Q

In macrocytic anaemia, what can results of B12 and folate assays, blood films and bone marrow tell us?

A
  • Megaloblastic

- Non-megaloblastic

51
Q

What can cause megaloblastic macrocytic anaemia?

A
  • B12 deficiency

- Folate deficiency

52
Q

What can cause non-megaloblastic macrocytic anaemia?

A
  • Myelodysplasia
  • Marrow infiltration
  • Drugs
53
Q

How can B12/folate deficiency present?

A
  • Anaemia

- Neurological symptoms (subacute combined degeneration of the cord in B12 deficiency)

54
Q

What can cause B12 deficiency?

A
  • Pernicious anaemia

- Gastric/ilieal disease

55
Q

What can cause folate deficiency?

A

-Dietary
Increased requirements (haemolysis)
-GI pathology (e.g. coeliac disease)

56
Q

Why do people have a lemon yellow tinge in megaloblastic anaemia?

A
  • Due the bilirubin and LDH

- Red cells are friable

57
Q

How is vitamin B12 absorbed?

A 
-Dietary B12 binds to intrinsic factor,
secreted by gastric parietal cells
-B12-IF complex attaches to specific
IF receptors in distal ileum
-Vitamin B12 bound by 
transcobalamin II in portal circulation
for transport to marrow and other
tissues
58
Q

What is the commonest cause of B12 deficiency?

A

Pernicious anaemia

59
Q

What is pernicious anaemia?

A
  • An autoimmune condition where the bodies make antibodies against intrinsic factor (sometimes gastric parietal cells)
  • It results in malabsorption of dietary B12
60
Q

How long does it take for signs and symptoms of pernicious anaemia to develop?

A

1-2 years due to B121 stores

61
Q

What is the treatment for megaloblastic anaemia?

A

Replace vitamin B12
-B12 intramuscular injection
Loading dose 3 then 3 monthly maintenance

Replace folate

  • Oral folate replacement
  • Ensure B12 normal if neuropathic symptoms
62
Q

What are ‘other’ causes of macrocytosis?

A
  • Alcohol
  • Drugs (Methotrexate, Antiretrovirals, hydroxycarbamide)
  • Disordered liver function
  • Hypothyroidism
  • Myelodysplasia

Systems: Haematology + Immunology (19 decks)

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