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year 3 haematology > Red cells 2 - acquired anaemias > Flashcards

Red cells 2 - acquired anaemias Flashcards

1
Q

What does normal haemoglobin depend on?

A

sex, age, ethnicity, time sample taken etc..

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2
Q

Normal male Hb values

A

12-70 (140-180)

>70 (116-156)

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3
Q

Normal female Hb values

A

12-70 (120-160)

>70 (108-143)

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4
Q

clinical features of anaemia

A 
SOB 
pallor
tiredness 
dizziness 
ankle swelling
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5
Q

Underlying causes clinical features of anaemia

A

bleeding eg menorrhagia, GI bleed
malabsorption eg diarrhoea
splenomegaly and jaundice

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6
Q

bone marrow pathophysiology anaemia

A

cellularity, stroma, nutrients

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7
Q

RBC pathophysiology anaemia

A

membrane, enzymes, haemoglobin

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8
Q

destruction/loss anaemia pathophysiology

A

bleeding
haemolysis
hypersplenism

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9
Q

MCV

A

mean cell volume = cell size

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10
Q

MCH

A

mean cell haemoglobin

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11
Q

3 morphological types of anaemia

A

hypochromic microcytic
normochromic normocytic
macrocytic

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12
Q

What you would measure in each of the 3 morphological types of anaemia

A 
Hm = Serum ferritin 
Nn = Reticulocyte count
M = Vit B12/folate or bone marrow
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13
Q

serum ferritin results and what they mean

A 
low = iron deficiency anaemia 
normal/high = secondary anaemia, thalassaemia
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14
Q

Is there a pathway for excess iron excretion?

A

no

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15
Q

What happens to absorbed iron?

A

bound to mucosal ferritin and shedded OR

transported across basement membrane by ferroportin

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16
Q

What is iron bound to in plasma?

A

transferrin

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17
Q

What is iron stored in cells as?

A

ferritin

18
Q

hepcidin

A

produced by hepatocytes
bind to ferroportin and stop iron absorption
chronic anaemia of inflammatory diseased

19
Q

History - iron deficiency anaemia

A

dyspepsia/Gi bleed, menorrhagia, diet, increased requirement eg pregnancy, malabsorption eg coeliac

20
Q

Examination - iron deficiency anaemia

A

koilonychia
tongue atrophy and angular cheilitis
abdominal and rectal

21
Q

managing iron deficiency anaemia

A

oral iron (IV if intolerant)
rarely blood transfusion
diet, ulcer therapy, gynae etc..

22
Q

Reticulocyte findings and what it means

A

increased - acute blood loss/haemolysis

decreased - marrow infiltration , secondary anaemia

23
Q

haemolytic anaemia - 2 main things

A

increased red cell destruction = decrease Hb

compensation by bone marrow = increase Reticulocyte count

24
Q

extravascular and intravascular haemolysis

A 
extravascular = reticuloendothelial system and immune mediated 
intravascular = in vessels, non immune mediated
25
Q

congenital haemolysis

A

hereditary spherocytosis
enzyme deficiency
haemoglobinopathy

26
Q

acquired haemolysis

A 
autoimmune 
mechanical (heart valve), PET, DIC, infection
27
Q

Direct antiglobulin test

A

detects antibody or complement on RBC

reagent is anti human IgG or anti complement

28
Q

DAGT results and what they mean

A 
\+ve = immune mediated 
-ve = non-immune mediated
29
Q

How to find out if patient is haemolysing

A 
FBC 
reticulocyte count 
blood film 
serum bilirubin 
heptaglobin
30
Q

How to find out the mechanism of haemolysis

A

AGT, urine, blood film

31
Q

managing haemolysis

A

support marrow function - folic acid
autoimmune - steroids
splenectomy, transfusion?
remove valve, infection, sepsis etc

32
Q

secondary anaemia type

A

normochromic normocytic

33
Q

megaloblastic anaemia

A

B12/folate deficiency

34
Q

non-megaloblastic anaemia

A

marrow infiltrate

drugs

35
Q

appearance of megaloblastic anaemia

A

yellow tinge - bilirubin

36
Q

Vitamin B12 absorption

A

binds to intrinsic factor made by parietal cells

absorbed in distal ileum

37
Q

commonest cause of B12 deficiency

A

pernicious anaemia

38
Q

pernicious anaemia

A

auto antibodies directed against INTRINSIC FACTOR

39
Q

How long does it take for pernicious anaemia symptoms to appear?

A

1-2 years

40
Q

megaloblastic anaemia treatment

A

B12 - im injection

oral folate –> ensure B12 levels normal if neuropathic symptoms

41
Q

other causes of macrocytosis

A

drugs eg ART, methotrexate
hypothyroidism
alcohol
disordered liver function

year 3 haematology (18 decks)

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