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*Haematology + Immunology > Red Cells 2 > Flashcards

Red Cells 2 Flashcards

1
Q

What factors cause variability in Hb normal range?

A

Age
Sex
Ethnicity
Time of day/analysis

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2
Q

Clinical features of anaemia?

A 
Tiredness
Pallor
Breathlessness
Swollen ankles
Dizziness
Chest pain
May also see: Bleeding, malabsorption, jaundice, splenomegaly
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3
Q

What are the general symptoms of malabsorption?

A

Diarrhoea

Weight loss

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4
Q

What are the causes of anaemia?

A

Bone marrow abnormality
Red cell abnormality
Destruction/loss

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5
Q

What are the main indices of anaemia diagnosis?

A

MCH - meal cell haemoglobin

MCV - mean cell volume

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6
Q

What are the 3 descriptions of RBC?

A

Hypochromic microcytic
Normochromic normocytic
Macrocytic

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7
Q

What is the commonest cause of hypochromic microcytic anaemia? What should you check?

A

Iron deficiency

Check: serum ferritin

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8
Q

What should be checked in normocytic/normochromic anaemia?

A

Reticulocyte count (immature RBC)

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9
Q

When is reticulocyte count low in anaemia?

A

Suppressed bone marrow activity

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10
Q

When is reticulocyte high?

A

Haemolytic anaemia - bone marrow activity increased

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11
Q

What should be checked in macrocytic anaemia?

A

B12
Folate
Bone marrow

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12
Q

Hypochromic microcytic anaemia with low serum ferritin means what?

A

Iron deficiency

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13
Q

Hypochromic microcytic anaemia with normal/increased serum ferritin?

A

Thalassaemia
Secondary anaemia
(sideroblastic anaemia)

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14
Q

How can ferritin vary in inflammation?

A

Ferritin is an acute reactant, it will increase in normal inflammation

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15
Q

Outline the pathway of iron metabolism?

A

Bound by mucosal ferritin
-or-
Transported across basement membrane by ferroportin

Bound to transferrin in plasma
Stored as ferritin

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16
Q

What is the role of Hepcidin?

A

Made in liver
Regulate Iron storage
Made in response to ↑iron levels, inflammation
Blocks ferroportin

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17
Q

What is the role of ferroportin?

A

Regulates the passage of iron across membranes (uptake)

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18
Q

What stimulates the synthesis of hepsidin?

A

Inflammation

↑ Iron levels

19
Q

What are the causes of iron deficiency anaemia?

A 
GI bleed
Other bleed
Diet
Increased requirement (pregnancy) 
Malabosorption (gastrectomy, coeliac, carcinoma)
20
Q

What are the physical signs on examination of Fe deficiency?

A

Tongue atrophy
Angular cheilitis
Koilonychia

21
Q

How is iron deficiency managed?

A

Correct deficiency

Correct the cause

22
Q

What is the cause of Normochromic normocytic anaemia with increased reticulocyte count?

A

Acute blood loss

Haemolysis

23
Q

What is the cause of Normochromic normocytic anaemia with Normal/low reticulocyte count?

A

Secondary anaemia++

Hypoplasia

24
Q

How does Secondary anaemia present?

A

70% Normochromic normocytic

30% hypo/micro

25
Q

What are the causes of secondary anaemia?

A

(chronic disease)
Defective iron utilisation
Infection, inflammation, malignancy

26
Q

What the classes of haemolytic anaemia?

A

Congenital
Acquired
Immune- Extravascular
Non-immune- Intravascular

27
Q

How does the Direct antiglobulin test work?

A

Detect antibody or complement on red cell membrane

Implies immune basis for haemolysis

28
Q

DAGT positive Haemolytic anaemia suggests what?

A

Immune mediated Haemolytic anaemia

29
Q

DAGT negative Haemolytic anaemia suggests what?

A

Non-immune mediated haemolytic anaemia

30
Q

What are the main types of immune Haemolytic anaemia?

A 
Warm autoantibody
Cold autoantibody (only in cold)
Alloantibody
31
Q

What are the causes of alloantibody immune haemolytic anaemia?

A

Transfusion reaction

32
Q

What investigations should be used in suspected haemolytic anaemia?

A 
FBC
Reticulocyte count (will be increased)
Blood film (sphero/schistocytes, fragments?)
Serum bilirubin
Haptoglobin
Coomb's/DAGT
33
Q

How is haemolytic anaemia managed?

A

Folic acid
Correct cause
Consider transfusion

34
Q

How is Macrocytic anaemia diagnosed?

A

B12/folate assay

Blood film/bone marrow

35
Q

What is megaloblastic anaemia?

A

Macrocyctic anaemia caused by B12 or Folate deficiency

36
Q

What is non-megaloblastic anaemia?

A

Macrocytic anaemia NOT caused by B12/Folate deficiency

37
Q

What is the cause of non-megaloblastic anaemia?

A

Myelodysplasia
Marrow infiltration
Drugs

38
Q

How does B12/Folate deficiency present?

A

Anaemia

Peripheral neuropathy

39
Q

What causes B12 deficiency?

A 
Pernicious anaemia (AntiB vs IF)
Gastric/ileal disease
40
Q

What causes folate deficiency?

A

Diet
Haemolysis
GI pathology

41
Q

How does Megaloblastic anaemia present?

A

“lemon yellow” tinge
Elevated bilirubin, LDH
Red cells friable
?Neurological symptoms (Peripheral neuropathy)

42
Q

What is the cause of Pernicious anaemia?

A

Autoantibodies vs Intrinsic factor -or- gastric parietal cells

43
Q

How is megaloblastic anaemia treated?

A

Replace vitamins (both until assay returns)

*Haematology + Immunology (22 decks)

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