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Year 3 - CR > Review of Anaemia > Flashcards

Review of Anaemia Flashcards

1
Q

What is the definition of anaemia

A

Number of red cells or their oxygen-carrying capacity: insufficient to meet physiological needs

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2
Q

What is the most common disorder globally

A

anaemia

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3
Q

How many people does anaemia effect

A
  • it effects 1.6 billion people
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4
Q

where are red blood cells produced

A

RBCs produced in the bone marrow (BM) from myeloid progenitor cells

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5
Q

What do red blood cells need to be produced

A
  1. permissive BM micro-environment
  2. adequate substrate :
    - iron
    - vitamin B12
    - folate
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6
Q

What is erythropoiesis

A

Production of red blood cells

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7
Q

What controls erythropoiesis

A

= Erythropoietin

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8
Q

Where is EPO synthesised

A

= Synthesis at peritubular fibroblasts in the renal cortex

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9
Q

What is the aim of EPO

A

reduction of oxygen tension

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10
Q

How do you classify anaemia

A

based on red cell size and morphology

  • Microcytic - under 80fl
  • macrocytic - over 96
  • normochromic - 80-96fl

or

Decreased BM production/output

  1. BM aplasia/infiltrate
  2. ineffective haematopoiesis such as HIV, MDS
  3. substrate deficiency e.g. iron or folate deficiency
  4. EPO insufficiency

or

underlying mechanism - peripheral loss/destruction

  1. bleeding
  2. sequestration
  3. haemolysis
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11
Q

What is the differenced in how anaemia is investigated by pulmonologists and cardiologists

A
  • Pulmonologists and Cardiologists - hypoxia on anatomical level
  • Haematologists – hypoxia at molecular and cellular levels
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12
Q

what are the general symptoms of anaemia

A
  1. increased tiredness/fatigue
  2. dyspnoea
  3. decreased effort tolerance
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13
Q

What does the severity of symptoms of anaemia depend on

A
  1. degree of anaemia

2. rate of haemoglobin decrease

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14
Q

What should you include in a history with anaemia

A
  • information about the presenting complaint and duration of the problem
  • transfusion history
  • dietary history including pica(craving for unusual food items, generally associated with iron deficiency)
  • travel history (to endemic malarial or other infectious areas)
  • change in bowel habits
  • bleeding (such as GI and genito-urinary)
  • drug history (e.g. anticoagulants, antiplatelet agents, Reno toxic agents)
  • chronic disease (e.g. HIV and TB)
  • Surgery (e.g. gastrectomy, small-bowel surgery, bariatric surgery)
  • current or recent pregnancy
  • family history
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15
Q

What are the clinical signs in a clinical examination of anaemia

A

Skin and mucous membrane

  • Pallor is the cardinal clinical sign
  • angular stomatitis - caused by iron deficiency
  • glossitis in nutritional deficiency - B12 deficiency
  • Kolionychia (spoon-shaped nails) - caused by iron deficiency
  • premature greying
  • scleral icterus
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16
Q

What causes angular stomatitis and koilonychia

A

iron deficiency

17
Q

What deficiency causes glossitis

A

B12 deficiency

18
Q

what would you find of a neuromuscular clinical examination on someone with anaemia

A
  1. Muscle weakness
  2. Headache, lack of concentration, drowsiness
  3. Tinnitus
  4. Paraesthesias, peripheral neuropathy, ataxia and loss of vibration sense
19
Q

Name some cardiovascular examination findings that you would find on someone with anaemia

A
  1. Hyperdynamic circulation with ‘flow’ murmurs

2. Cardiac failure

20
Q

Name the clues for infection and malignancy that you can find on someone who is anaemic

A
  1. Hepatosplenomegaly
  2. Lymphadenopathy
  3. Bleeding manifestations (petechiae, purpura, ecchymosis)
21
Q

what laboratory tests do you carry out

A
  • FBC
  • Reticulocyte counts
  • microscopic blood smear
22
Q

What is the normal range of haemoglobin for males, females and pregnancy

A

• Male Hb: 13.8 - 17.9 g/dL (anaemia <13 g/dL)
• Female Hb: 12.4 - 15.5 g/dL (anaemia <12
g/dL;
• Pregnancy <11 g/dL).

23
Q

What is hematocrit

A
  • the volume percentage of red blood cells in blood
24
Q

What is the percentage of hematocrit in adult males and women

A
  • Adult males: 42%-54%

* Adult women: 38%-46%

25
Q

What is MCV

A
  • Mean corpuscular volume or mean cell volume = this is the average volume of a red blood cell
26
Q

How do you work out the MCV

A 
the hematocrit (Hct) is divided by the
concentration of RBCs
27
Q

What is the MCH

A

mean corpuscular haemoglobin

- this is the average mass of haemoglobin per red blood cell

28
Q

How do you work out the MCH

A
  • calculated by dividing the total mass of haemoglobin by the number of red blood cells in a volume of blood
29
Q

What can cause microcytic anaemia

A
  • iron deficiency anaemia
  • lead poisoning
  • anaemia of chronic inflammation
  • sideroblastic anaemia
30
Q

What can cause normocytic anaemia

A
  • haemolytic anaemias
  • bone marrow disorders
  • hypersplenism
  • acute blood loss
  • anaemias of chronic disease
31
Q

What can cause macrocytic anaemia

A
  • Vitamin B12 deficiency
  • folic acid deficiency
  • Liver disease
  • hypothyroidism
  • reticulocytosis
32
Q

What should you do if bone marrow pathology is suspected

A
  • Bone marrow aspirate: morphological assessment in cellular detail but the architecture is disrupted
  • trephine biopsy sections - the architecture is preserved - detect pathology such as granulomata and fibrosis
33
Q

When should you use a trephine biopsy

A
  • the architecture is preserved - detect pathology such as granulomata and fibrosis
34
Q

What is the difference between a trephine biopsy and a bone marrow aspirate

A

Bone marrow aspirate

  • assessment in cellular detail
  • architecture is disrupted

trephine biopsy
- architecture is preserved

Year 3 - CR (44 decks)

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