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YEAR 3 HAEMATOLOGY > Red cells 2 > Flashcards

Red cells 2 Flashcards

1
Q

general features due to reduced O2 delivery to tissues…

A

tiredness/ pallor, dyspnoea, ankle swelling, dizziness, chest pain

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2
Q

clinical Sy/Sx of anaemia relating to an underlying cause - examples are…

A

Menorrhagia, Dyspepsia, PR bleeding, Symptoms of malabsorption, Diarrhoea, Weight loss, Jaundice, Splenomegaly/Lymphadenopathy

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3
Q

which indicies from FBC can be useful in diagnosis of anemia?

A

MCH = Mean cell haemoglobin AND MCV = Mean cell volume (cell size), Can give a morphological description of anaemia – and a clue as to cause!!

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4
Q

3 different morphological descriptions of RBC’s in relation to Anaemia are…

A

pale and small = Hypochromic Microcytic , Normal = Normochromic normocytic , Big = Macrolytic

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5
Q

how is the difference between macrocytic, hypochromic microcytic anameia and Normochromic Normocytic Anamia Investigated?

A

Serum Ferritin = Hypochromic microcytic Anameia (low serum ferritin - body Fe low) distinguishes between thalassaemia and anaemia
Reticulocyte count = NN Anaemia (indicates bone marrow not working properly - low reticulocyte count)
B12/Folate levels = M Anaemia (low B12/folate)
these Ix guide the next Ix to be done in establishing the cause of anaemia.

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6
Q

Hypochromic Microcytic anaemia Ix

A

Serum ferritin low = Fe deficiency, Normal or increased = thalassaemia or secondary anaemia. Small, pale cells.

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7
Q

causes of Microcytic anaemia

A

iron deficiency anaemia, anaemia of chronic disease, thalassaemia trait, sideroblastic anaemia

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8
Q

what is approx total body Fe?

A

4g

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9
Q

Iron metabolism

A

Absorbed iron in the duodenum -transported from enterocytes and macrophages by ferroportin then bound to mucosal ferritin and sloughed off Or it is transported across the basement membrane by ferroportin. Then - bound to transferrin in plasma and Stored as Ferritin - mainly in liver.

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10
Q

Role of Hepcidin

A

Hepcidin synthesised in hepatocytes in response to ↑iron levels and inflammation – blocks ferroportin so reduces intestinal iron absorption and mobilisation from reticuloendothelial cells

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11
Q

common causes of iron deficiency anaemia?

A

bv

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12
Q

Sx of iron deficiency

A

Pallor of hands and mucous membranes, angular stomatitis, koilonychia, atrophic tounge, gi blood loss - ulcers, gastritis, tachypnoea, tachycardia, systolic flow murmur, brittle nails and hair

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13
Q

Sy of iron deficiency anaemia

A

tiredness/ pallor, dyspnoea, headaches, faintness, claudication, ankle swelling, dizziness, chest pain, palpitations, angina.

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14
Q

Microcytic Ix (other)

A

(blood film) FBC with MCV, MHC, Fe studies, serum ferritin, bone marrow aspirate, gi ix.

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15
Q

questions to ask a lady with microcytic anaemia?

A

menorrhagia, pregnant? Weight loss? Bowel habit changes? Urinary blood loss? Dietary restrictions/changes? Vegitarian? Epistaxis? Fhx blood conditions? Lead exposure?

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16
Q

Mx

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

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17
Q

se’s of ferrous sulphate TDS treatment?

A

nausea, constipation, black stool, epigastric pain.

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18
Q

Normochromic normocytic anaemia Ix

A

low reticulocyte count = secondary anaemia, hypoplasia, Increased = haemolysis, acute blood loss

19
Q

2ndry anaemia…

A

“Anaemia of chronic disease” = 70% normochromic normocytic, 30% hypochromic microcytic
Defective iron utilisation, Increased hepcidin in inflammation, Ferritin often elevated, Identifiable underlying disease, infection, inflammation, malignancy.

20
Q

causes of Normochromic normocytic anaemia

A

chronic infections - tb, osteomyelitis, inflammatory diseses - RA, malignant disease , endocrine hypo’s, renal failure, ACUTE BLOOD LOSS E.G. GI BLEED, HAEMOLYSIS, bone marrow hypoplasia, pregnancy.

21
Q

what factors effect normal values of Hb?

A

age, sex, race, altitude

22
Q

Hameolytic anaemia…

A

accelerated rbc destruction = low Hb, compensation by bone marrow = increase in retics, Level of Hb – balance between red cell production and destruction./

23
Q

congenital causes of Haemolytic anaemia?

A

Hereditary spherocytosis (HS), Enzyme deficiency (G6PD deficiency), Haemoglobinopathy (HbSS)

24
Q

acquired causes of haemolytic anaemia?

A

Auto-immune haemolytic anaemia (Extravascular), Mechanical eg.artificial valve, Severe infection/DIC (Intravascular), PET/HUS/TTP

25
Q

test to see if there are antibodies on the surface of RBC’s?

A

Direct antiglobulin test (Coombs test)- Reagent binds to Ab (or complement) on red cell surface and causes agglutination in vitro

26
Q

Dagt positive / negative …

A

positive = immune mediated haemoyltic anaemia, negative = non-immune mediated haemolytic anaemia

27
Q

a blood transfusion reac tion produces what type of antibodies?

A

Alloantibodies

28
Q

what does immune haemolysis look like on a blood film?

A

Spherocytes on film, Agglutination in cold AIHA

29
Q

what does intravascular haemolysis look like on a blood film?

A

rbc fragments (schistocytes)

30
Q

what Ix done to see if the patient is haemolysing?

A

Coombs test (positive = autoimmune haemolysis), FBC, reticulocyte count (raised), blood film, Serum bilirubin (raised) (direct/indirect), LDH (high), Serum haptoglobin (reduced)

31
Q

Mx of Haemolytic anaemia

A

Support marrow function - Folic acid
Correct cause - Immunosuppression if autoimmune, Steroids, Treat trigger eg.CLL, Lymphoma
Remove site of red cell destruction - Splenectomy
Treat sepsis, leaky prosthetic valve, malignancy etc. if intravascular, Consider transfusion

32
Q

Macrocytic anaemia Ix

A

B12/folate assay low = megaloblastic anaemia, normal = myeloblastic, marrow infiltration, drugs

33
Q

causes of macrocytic anaemia?

A

B12 deficiency/ folate deficiency, alcohol, liver disease, hypothyroidism, pregnancy, reticulocytosis

34
Q

what deos b12 bind to?

A

intrinsic factor. 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.
Lack of B12 is called Pernicious anaemia - it is tested for by using the Schilling test.

35
Q

what can a B12/folate deficiency cause?

A

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

36
Q

causes of B12 deificency?

A

Pernicious anaemia, Gastric/ileal disease, dietary - vegans, reduced gi absorption - gastrectomy, CD, UC, Drugs - metformin. Tapeworms

37
Q

causes of folate deificency?

A

Dietary, Increased requirements (haemolysis), GI pathology (eg.coeliac disease)

38
Q

where is B12 primarily absorbed?

A

Terminal ileum

39
Q

gait seen in pt with longterm b12 deficiency?

A

High stepping

40
Q

Sx/Sy of megaloblastic anaemia

A

“Lemon yellow” tinge, Bilirubin, LDH, Red cells friable

41
Q

what is pernicious anaemia?

A

Commonest cause of B12 deficiency in western populations, Autoimmune disease
Antibodies against intrinsic factor (diagnostic), gastric parietal cells (less specific)
Malabsorption of dietary B12 - Symptoms/signs take 1-2 years to develop. Do a Schilling test.

42
Q

Macrolytic anaemia Tx

A

Replace vitamin B12 deficiency give a B12 intramuscular injection, Loading dose then 3 monthly maintenance
Folate deficiency - Oral folate replacement, Ensure B12 normal if neuropathic symptoms. IF IN DOUBT GIVE BOTH.

43
Q

other causes of Macrocytosis/ DDX

A

alcohol, drugs - Methotrexate, Antiretrovirals, hydroxycarbamide, Disordered liver function, Hypothyroidism, Myelodysplasia

44
Q

Methotrexate - how is it toxic and what ix need to be done if a patient is on Methotrexate?

A

LFT’s, FBC, may cause bone marrow supression, metabolised by the liver so it may disturb liver function

YEAR 3 HAEMATOLOGY (17 decks)

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