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Immunology and Haematology Brian > Red Cells 2 > Flashcards

Red Cells 2 Flashcards

1
Q

How is the normal range of something derived?

A
  • Subjects who don’t have disease
  • Normal distribution
  • Mean +/-2 standard deviations
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2
Q

What are some factors that influence the normal range?

A
  • Age
  • Sex
  • Ethnic origin
  • Time of day sample taken
  • Time to analyse
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3
Q

What are the reference ranges for Hb?

A
  • Male 12-70
    • 140-180
  • Male >12
    • 116-156
  • Female 12-70
    • 120-160
  • Female >70
    • 108-143
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4
Q

Describe the clinical features of anaemia?

A
  • Tiredness
  • Breathlessness
  • Swelling of ankles
  • Dizziness
  • Chest pain
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5
Q

What does the presentation of anaemia depend on?

A
  • Age, speed of onset, and Hb level
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6
Q

What are some potential clinical features of anaemia that could be related 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

Describe the approach to determining the cause of anaemia?

A

Can be due to:

  • bone marrow
  • red cell
  • destruction/loss
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8
Q

Describe the aetiology of anaemia due to bone marrow problems?

A

Cellularity

Stroma

Nutrients

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9
Q

Describe the aetiology of anaemia due to red cell problems?

A

Membrane

Haemoglobin

Enzymes

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10
Q

Describe the aetiology of anaemia due to destruction/loss?

A

Blood loss

Haemolysis

Hypersplenism

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11
Q

What does MCH stand for?

A

Mean cell haemoglobin

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12
Q

What does MCV stand for?

A

Mean cell volume (cell size)

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13
Q

What are red cell indices?

A

Calculations that provide information on the physical characteristics of RBCs

  • Automated measurement of red cell size and haemoglobin content
    • MCH = mean cell haemoglobin
    • MCV = mean cell volume (cell size)
  • Gives morphological description of anaemia and clue to cause
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14
Q

What are the 3 morphological describers for anaemic cells?

A
  • Hypochromic microcytic anaemia
    • Small, pale cells
  • Normochromic normocytic anaemia
    • Normal size and normal haemoglobin content in average cell
  • Macrocytic anaemia
    • Big, red cells
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15
Q

What do the cells look like in hypochromic microcytic anaemia?

A

Small, pale cells

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16
Q

What do the cells look like in normochromic normocytic anaemia?

A
  • Normal size and normal haemoglobin content in average cell
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17
Q

What do the cells look like in macrocytic anaemia?

A
  • Big, red cells
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18
Q

For each morphological describer of the cells in anaemia, what follow up investigations should be done?

A
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19
Q

Describe the investigations for anaemia?

A

Red cell indices and blood film

Then depending on the morphology of cells (look at picture)

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20
Q

Describe the aetiology of hypochromic microcytic anaemia?

A

Low serum ferritin - iron deficiency

Normal/increased serum ferritin - thalassaemia, secondary anaemia

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21
Q

Where is iron absorbed?

A

Absorbed in duodenam (Fe2 better than Fe3)

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22
Q

Describe the process of iron being absorbed?

A
  1. Bound to mucosal ferritin and sloughed off
  2. Or transported across the basement membrane by ferroportin
  3. Then bound to transferrin in plasma
  4. Stored as ferritin – mainly in liver
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23
Q

What protein transports iron across the basement membrane?

A

Ferroportin

24
Q

What is iron bound to in the plasma?

A

Transferrin

25
What is iron stored as?
Ferritin (mainly in liver)
26
What is hepciden?
* Synthesised in hepatocytes in response to increased iron levels and inflammation * Blocks ferroportin so reduces intestinal iron absorption and mobilisation
27
Is iron deficiency anaemia a diagnosis?
Is not a diagnosis, establish the cause: * History * Dyspepsia (Gi bleeding) * Other bleeding (such as menorrhagia) * Diet (particularly children and elderly) * Increased requirement (pregnancy) * Examination * Koilonychia * Atrophic tongue * Angular cheilitis
28
Describe the aetiology of iron deficiency?
* GI blood loss * Menorrhagia * Malabsorption
29
What is the commonest cause of anaemia?
Iron deficiency
30
Describe the management of iron deficiency?
* Correct deficiency * Oral iron usually sufficient, if not use IV iron * Correct the cause * Diet * Ulcer therapy * Gunae interventions * Surgery
31
Describe the aetiology of normochromic normocytic anaemia?
* If reticulocyte count increased * Acute blood loss * Haemolysis * If reticulocyte count normal or low * Secondary anaemia * Hypoplasia * Marrow infiltration
32
Describe the typical morphology of red cells in secondary anaemia?
* 70% normochromic normocytic * 30% hypochromic microcytic
33
Describe the pathophysiology of secondary anaemia?
* Defected iron utilisation * Increased hepcidin in inflammation * Ferritin normal or elevated (an acute phase reactant)
34
Describe the aetiology of secondary anaemia?
* Identifiable underlying disease * Infection * Inflammation * Malignancy
35
Describe the pathophysiology of haemolytic anaemia?
* Accelerated red cell destruction (decreased Hb) * Compensation by bone marrow (increased reticulocyte count) * How anaemic you are depends on this balance
36
What are the 2 kinds of haemolysis?
* Extravascular is physiological, but could be pathological * Intravascular is pathological
37
Is intra or extra-vascular haemolysis always pathological?
Intra-vascular
38
Describe the aetiology of haemolytic anaemia?
* Congenital * Hereditary spherocytosis (HS) * Enzyme deficiency (G6PD deficiency) * Haemoglobinopathy (HbSS) * Acquired * Extravascular * Auto-immune haemolytic anaemia * Intravascular * Mechanical (artificial valve) * Severe infection * PET
39
For haemolytic anaemia, are immune and non-immune causes usually extra or intra-vascular?
* Immune causes are mostly extravascular * Non-immune causes are mostly intravascular
40
What investigation can be done to determine if haemolysis is from an immune cause?
* Direct antiglobulin test * Detects antibody or complement on red cell membrane * Reagent contains either anti-human IgG or anti-compliment * Binds to Ab (or compliment) on red cell surface and causes agglutination in vitro * If positive – immune mediated * If negative – non-immune mediated
41
Some antibodies can only bind at certain temperatures, what is an implication of this for haemolytic anaemia?
Allows the cause to be guessed
42
Describe the different between intra and extravascular haemolysis on blood film?
* Extravascular * Spheres * Intravascular * Red cell fragments, “schistocytes”
43
What investigations can be done to determine if the patient is haemolysing?
* FBC, reticulocyte count, blood film * Serum bilirubin (direct/indirect), LHL * High * Serum haptoglobin * Low
44
Describe the management of haemolytic anaemia?
* Support marrow function * Folic acid * Correct cause * Immunosuppression if autoimmune * Steroids * Treat trigger * Remove site of red cell destruction * Splenectomy * Treat sepsis, leaky prosthetic valve, malignancy ect if intravascular * Consider transfusion
45
Describe the aetiology of macrocytic anaemia?
* B12/folate deficiency (most common cause) * Alcohol * Drugs * Disordered liver function * Hypothyroidism * Myelodysplasia
46
What investigation should be done after discovering macrocytic anaemia?
B12/folate assay
47
Describe the pathophysiology of megablastic anaemia?
* B12/folate deficiency
48
Describe the aetiology of megaloblastic anaemia?
* Of B12 deficiency * Pernicious anaemia * Gastic/ileal disease * Folate deficiency * Dietary * Increased requirements (haemolysis) * GI pathology
49
Describe the presentation of megaloblastic anaemia?
* Anaemia * Neurological symptoms * Subacute combined degeneration of the cord in B12 deficiency
50
Describe the treatment of megaloblastic anaemia?
* Replace vitamin * B12 deficiency * B12 intramuscular injection * Loading dose then 3 monthly maintenance * Folate deficiency * Oral folate replacement
51
Describe the mechanism of vitamin B12 absorption?
* Dietary B12 binds to intrinsic factor secreted by gastric parietal cells * If do not have this intrinsic factor cannot absorb * 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
52
What is intrinsic factor secreted by?
Gastric parietal cells
53
What is vitamin B12 bound to when in portal circulation for transport to marrow and other tissues?
Transcobalamin II
54
Describe the aetiology of pernicious anaemia?
* Autoimmune disease
55
Describe the pathophysiology of pernicious anaemia?
* Antibodies against intrinsic factor (diagnostic)
56
What is the commonest cause of B12 deficiency?
Pernicious anaemia
57
Describe the presentation of pernicious anaemia?
* Takes 1-2 years to develop * Anaemia * “Lemon yellow” tinge * Bilirubin, LDH * Red cells friable * Hypersegmentation of neutrophils

Immunology and Haematology Brian (23 decks)

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