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Haematology > Red cells 3 (anaemia) > Flashcards

Red cells 3 (anaemia) Flashcards

1
Q

Factors influencing the normal range for haemoglobin

A
  • Age
  • Sex
  • Ethnicity
  • Time of day sample is taken
  • Time to analysis
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2
Q

Normal haemglobin range for males

A
  • 12-70 = 140-180

- >70 = 116-156

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3
Q

Normal haemoglobin range for females

A
  • 12-70 = 120-160

- >70 = 108-146

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4
Q

Clinical features of anaemia due to reduced O2 delivery to tissues

A
  • Tiredness/pallor
  • Breathlessness
  • Ankle oedema
  • Dizziness
  • Chest pain
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5
Q

Clinical features of anaemia related to underlying cause

A

-Evidence of bleeding
Menorrhagia, PR bleeding, Dyspepsia

-Symptoms of malabsorption
Diarrhoea, Weight loss

  • Jaundice
  • Splenomegaly/Lymphadenopathy
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6
Q

What causes destruction/loss of blood leading to anaemia

A
  • Haemorrhage (blood loss)
  • Haemolysis
  • Hypersplenism (overactive spleen)
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7
Q

What problems with RBCs themselves can lead to anaemia

A
  • Membrane
  • Haemoglobing
  • Enzymes
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8
Q

What is MCV + MCH

A
  • MCV = Mean Cell Volume (size)
  • MCH = Mean Cell Haemoglobin
  • Can give morphological discription of anaemia
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9
Q

3 types of anaemia

A
  • Hypochromic Microcytic Anaemia
  • Normochromic Normocytic Anaemia
  • Macrocytic Anaemia
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10
Q

What investigations are used to distinguish between types of anaemia

A
  • Red cell indices

- Blood film

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11
Q

What investigation is done when Hypochromic Microcytic anaemia is diagnosed

A

Serum ferritin

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12
Q

What investigation is done when Normochromic Normocytic anaemia is diagnosed

A

Reticulocyte count

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13
Q

What investigation is done when Macrocytic anaemia is diagnosed

A
  • Serum B12 + Folate assay

- ?Bone marrow biospy?

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14
Q

If serum ferritin is high or low in Hypochromic Microcytic anaemia what is the cause

A
  • Low = Iron deficiency

- High = Thalassaemia/Secondary anaemia/?sideroblastic anaemia?

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15
Q

How does Iron move around the blood

A
  • In haemoglobin

- Bound to Transferrin

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16
Q

How is iron stored in most cells

A

Ferritin

17
Q

How is iron transported from enterocytes + macrophages

A

Ferroportin

18
Q

What is hepcidin and where is it made

A
  • Synthesised in Hepatocytes
  • Responds to inflammation (and increased Fe levels)
  • Blocks ferroportin, so reduces intestinal Fe absorption
19
Q

What do high + low levels of hepcidin cause

A
  • High = Anaemia

- Low = Haemochromatosis

20
Q

What is ferroportin

A
  • Transmembrane portein

- Transports iron from inside a cell to outside (i.e. out of gut cells into blood)

21
Q

Commonest cause of anaemia worldwide

A

Iron deficiency anaemia

DISCRIPTION, NOT A DIAGNOSIS, MUST ESTABLISH A CAUSE

22
Q

Hx for iron deficiency anaemia

A
  • Dyspepsia, GI bleeding
  • Other bleeding, e.g. menorrhagia
  • Diet (N.B. children + elderly)
  • Increased requirement e.g. pregnancy
23
Q

Signs of iron deficiency

A
  • Koilonychia
  • Angular stomatitis
  • Atrophic tongue (smooth + glossy can be tender/painful)
24
Q

Causes of iron deficiency anaemia

A
  • GI blood loss (worms)
  • Menorrhagia
  • Malabsorption (Gastrectomy, coeliac disease)
25
Q

Management of iron deficiency anaemia

A

Correct cause

  • Diet
  • Ulcer therapy
  • Surgery if bleeding
  • ?COC pill if menorrhagia?

Correct anaemia

  • Oral iron supplement ussually adequate
  • Possible need of transfusion
26
Q

If reticulocyte count is high or low in Normochromic Normocytic anaemia what is the cause

A
  • High = Acute blood loss or Haemolysis

- Low = Secondary anaemia, hypoplasia, marrow infiltration

27
Q

Causes of haemolytic anaemia

A

Congenital

  • Hereditary spherocytosis (HS)
  • G6PD deficiency

Acquired
-Auto-immune haemolytic anaemia (extravascular)

Intravascular (also acquired)

  • Mechanical (artificial valve)
  • Severe infection
  • Drugs
28
Q

2 ways of categorising acquired haemolytic anaemia

A
  • Immune (mostly extravascular)

- Non-mmune (mostly intravascular)

29
Q

How to test for auto-immune haemolytic anaemia

A
  • Direct antiglobin test
  • Casuses agglutination in vitro

(if -ve suggests the haemolytic anaemia is not immune mediated)

30
Q

What is seen on a blood film in intravascular haemolysis

A

Shcistocytes (red cell fragments)

31
Q

Management of haemolytic anaemia

A

-Folic acid (support marrow function)
Correct cause
-Immunosupression if autoimmune (?Prednisolone?)(treat trigger CLL, lymphoma)
-Remove site of destruction (splenectomy)
-Treat sepsis, leaky prosthetic valce, malignancy etc

-Consider transfusion

32
Q

Describe secondary anaemia

A
  • “Anaemia of chronic disease”
  • 70% normochromic normocytic, 30% hypochromic microcytic
  • Defective iron utilisation
  • Identifiable underlying disease (infection, inflammation, malignancy)
33
Q

If there is megaloblastic changes or no megaloblastic changes in bone marrow in Macrocytic anaemia what is the cause

A
  • Megaloblastic change = B12 + Folate deficiency

- Non-megaloblastic = Marrow infiltration, Myelodysplasia, Drugs

34
Q

Causes of B12 deficiency

A
  • Pernicious anaemia

- Gastric/ileal disease

35
Q

Causes of folate deficiency

A
  • GI disease (coeliac disease)
  • Increased requirement (haemolysis)
  • Dietary
36
Q

What happens to the skin in megaloblastic anaemia

A

Lemon yellow tinge

37
Q

What causes pernicious anaemia

A

Antibodies against intrinsic factor (auto-immune)

38
Q

Rx for megaloblastic anaemia

A

Replace vitamin

  • B12 deficiency = B12 IM injection, loading dose then 3 monthly maintenance
  • Folate deficiency = Oral folate replacement

Haematology (24 decks)

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