red cells 2 Flashcards
what factors influence normal range ?
age sex ethnicity time of day sample is taken time to analysis
what are clinical features of anaemia ?
tiredness pallor SOB ankle swelling dizziness chest pain
what anaemic features relate to underlying cause ?
evidence of bleeding - menorrhagia, dyspepsia, PR bleeding
symptoms of malabsorption - diarrhoea, weight loss
jaundice
splenomealy/lymphadenopathy
what are the red cell indices ?
MCH - mean cell haemoglobin (27-32)
MCV - mean cell volume - cell size (82-99)
what further test do you do for hypochromic, microcytic RBC ?
serum ferritin
what results from serum ferritin indicate ?
low - iron deficiency
normal/increased - thalassaemia/secondary anaemia
what is the role of hepcidin ?
blocks ferroportin so reduces iron absorption from the gut
what history features are typical for iron deficiency anaemia ?
dyspepsia/GI bleeding
menorrhagia
diet - child/elderly
increased requirement - pregnancy
what are clinical features of iron deficiency ?
atrophic tongue
angular cheilitis
koilonychia
pencil/rod cells blood film
how do you manage iron deficiency ?
oral iron, IV if intolerant
correct the cause
what is the further investigation for normochromic, normocytic anaemia ?
reticulocyte count
what do the results for reticulocyte count indicate ?
increased - acute blood loss/haemolysis
normal/low - secondary anaemia, hypoplasia, marrow infiltration
what is secondary anaemia ?
anaemia of chronic disease
increased hepcidin in inflammation, elevated ferritin
what can cause haemolytic anaemia ?
congenital - hereditary spherocytosis, G6PD deficiency, HbSS
acquired - autoimmune (extravascular)
mechanical valve, DIC (intravascular)
what tests should be done for haemolytic anaemia and what do results indicate ?
direct antiglobulin test
positive - immune mediated
negative - non-immune mediated
what are the different ‘types’ of antibody in immune haemolysis and what do they indicate ?
warm - autoimmune, drugs, CLL
cold - CHAD, infection, lymphoma
alloantibody - transfusion reaction
what other tests are useful to check if patient is haemolysing ?
serum bilirubin
serum haptoglobin
how do you manage haemolytic anaemia ?
folic acid - support marrow function
correct cause
immunosuppression is autoimmune - steroids, treat CLL, lymphoma
remove site of red cell destruction - splenectomy
what further tests should you do for macrocytic anaemia ?
B12/folate assay
blood film/bone marrow
what do the results of blood film/bone marrow indicate ?
megaloblastic - B12/folate deficiency
non-megaloblastic - myelodysplasia, marrow infiltration, drugs
what are clinical features of B12/folate deficiency ?
anaemia
neurological symptoms
what causes B12/folate deficiency /
B12 - pernicious anaemia, gastric/ileal disease
folate - dietary, haemolysis, GI pathology
how do you treat megaloblastic anaemia ?
replace vitamin
B12 - IM injection 3 month
folate - oral folate
what are other causes of macrocytosis ?
alcohol drugs - MTX, antiretrovirals, hydroxycarbamide liver function impairment hypothyroidism myelodysplasia
