Released from hepatocytes in response to - increased iron levels - inflammation Regulates Fe transport by blocking ferroportin and thus further Fe absorption

Red Blood Cells 2 Flashcards by C M

define anaemia

Haemoglobin below normal for age and sex

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factors influence haemoglobin normal range

Age 
Sex
Ethnic origin 
Time of day sample taken
Time to analysis

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Haemoglobin Normal ranges

Male 12-70 (140-180g/l)

Female 12-70 (120-160)

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Anaemia clinical features

Tiredness/ pallor
Breathlessness
Swelling of ankles 
Dizziness
Chest pain

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Anaemia clinical features

Evidence of bleeding:

menorrhagia
dyspepsia, PR bleeding

Symptoms of malabsorption:

diarrhoea,
weight loss

Jaundice

Splenomegaly/ lymphadenopathy

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What are the main branch causes of anaemia

Bone marrow- cellularity, stoma, nutrients

Red cell- membrane, haemoglobin, enzymes

Destruction loss- blood loss, haemolysis, hypersplenism

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What does MCH and MCV stand for?

MCH= Mean Cell Haemoglobin 
MCV= Mean Cell Volume

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Anaemia morphological classes?

Hypochromic microcytic (pale and small)

Normochromic normocytic (normal looking)

Microcytic

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Best investigation for hypochromic microcytic anaemia

Serum ferritin

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Best investigation for normochromic normocytic

Reticulocyte count

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Best investigation for macrocytic anaemia

B12/ folate

Bone marrow

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In hypochromic microcytic anaemia what will the results of the serum ferritin show as the cause

Low= iron deficiency 
Normal= thalassaemia OR secondary anaemia OR sideroblastic anaemia

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Role of ferroportin

Transporter for iron across basement membrane

Can also be transported bound to mucosal ferritin

THEN
Bound to transferrin in plasma

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Role of hepcidin

Released from hepatocytes in response to

increased iron levels
inflammation

Regulates Fe transport by blocking ferroportin and thus further Fe absorption

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History and examination to take from iron deficiency anaemia

Dyspepsia (?Gi bleed)
Other bleeding ? Eg menorrhagia
Diet
Increased requirement ? Eg pregnancy

Examination:

signs of iron deficiency
abdominal and rectal

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Cells appearance in iron deficiency anaemia

Pencil/ rod cell

Hypochromic microcytic red cells

Clinical features of iron deficiency

Atrophic tongue
Angular stomatitis
Koilonychia

Causes of iron deficiency

GI blood loss
Menorrhagia
Malabsorption- gastrectomy, coeliac disease

For normochromic normocytic anaemia you do a reticulocyte count, what would the causes be depending on the results

Increased reticulocyte count - acute blood loss or haemolysis

Normal/ low reticulocyte count- secondary anaemia, hypoplasia, marrow infiltration

Secondary anaemia causes

Defective iron utilisation (increased hepcidin in inflammation)

Identifiable underlying disease (infection, inflammation and malignancy)

Describe haemolytic anaemia

Accelerated red cell destruction (decreased Hb)
Compensation by bone marrow (increased reticulocyte)

So balance between red cell production and destruction

What are the 2 types of haemolysis

Extravascular:
-Auto-immune haemolytic anaemia 
Intravascular:
-Mechanical eg artificial valve 
-Severe infection/ DIC 
-PET/HUS (haemolytic uraemia syndrome) /TTP )THrombotic Thrombocytopenic purpura)

What is a DAT test

Direct Antiglobulin Test

Detects antibody or complement on red cells

Reagents contains either:

antihuman IgG
anticomplement

Reagent then binds to Ab on red cell surface and causes agglutination in vitro

Implies immune basis for haemolysis

Results from DAT test meaning

Positive- immune mediated haemolysis

Negative- non-immune mediated haemolysis

Immune haemolysis causes

If: Warm auto-antibody: auto-immune, drugs CLL Cold auto-antibody: CHAD, infections, lymphoma Alloantibody: transfusion reaction

How would immune haemolysis cells appear

Spherocytes on film Agglutination (clumping) in cold AIHA

What do intravascular haemolysis cells appear like

Red cell fragments- “schistocytes”

Tests to do for haemolytic anaemia?

``` FBC Reticulocyte count Blood film Serum bilirubin LDH Serum haptoglobin ``` History and examination Blood film Direct Antiglobulin Test Urine for haemosiderin/urobillinogen

Haemolytic anaemia management?

``` Folic acid If autoimmune- steroids Splenectomy Treat underlying cause Consider transfusion ```

What test would you do in macrocytic anaemia

B12/ folate assay | Blood film/ bone marrow

Causes of megaloblastic macrocytic anaemia

B12 deficiency | Folate deficiency

Causes of macrocytic non-megaloblastic anaemia

Myelodysplasia Marrow infiltration Drugs

Megaloblastic anaemia presentation

Due to B12/ folate deficiency So presents: -anaemia -Neurological symptoms (B12) -“lemon yellow” tinge

B12 and folate deficiency causes?

B12 deficiency: Pernicious anaemia Gastric/ileal disease ``` Folate deficiency: Dietary Increased requirements (eg haemolysis) GI pathology (eg Coeliac disease) ```

What is Pernicious anaemia

``` Autoimmune disease Autoantibodies against: -intrinsic factor -gastric parietal cells Malabsorption of dietary B12 (s/s take 1-2 years to develop) ```

Megaloblastic anaemia treatment

Replace vitamin: B12 deficiency- im 3 monthly injections Folate- oral folate replacement

Other causes of Macrocytosis

``` Alcohol Drugs (methotrexate, antiretrovirals, hydroxycarbamide) Disordered liver function Hypothyroidism Myelodysplasia ```