Tennis anaemia tut Flashcards
How do you tell the difference between B12 deficiency and folate deficiency?
With folate deficiency there are muted or no neuro signs
What specific bloods might you when investigating anaemia?
FBC Transferrin Ferritin Total iron binding capacity Serum lead Intrinsic factor antibodies Anti ttg antibody Serum 12 Serum folate
What is Hb, MCV, transferrin and ferritin microcytic anaemia? what else is seen on bloods
Low haemoglobin, low MCV, transferrin and ferritin
High reticulocytes
If anti ttg its coeliacs
Who is coeliacs disease prominent in?
Young men
What is total iron binding capacity high in iron deficiency anaemia?
There is low iron so theres lots of space
What is MCV, iron, TIBC and transferrin in thalassemia?
V low MCV
Normal or higher iron
Total iron binding capacity is low
Transferrin high
What is ferritin in anaemia of chronic disease?
High
What is seen on bloods in macrocytic anaemia?
High MCV
Pancytopenia in megaloblastic
When is pancytopenia seen in anaemia?
Megaloblastic
What order are antibodies ordered in anaemia? Why
First line intrinsic factor antibodies- specific
Second line gastric parietal- sensitive
What special test is used in pernicious anaemia
Shilling test
How is total iron binding capacity calculated?
When do you consider transfusion?
When iron is below 70
When iron is below 80 if they have ACS or any cardiac issues
What is sideroblastic anaemia?
Abnormal heam synthesis
What causes sideroblastic anaemia?
Inherited
Secondary to alcohol or drugs
How is normocytic anaemia managed?
If renal cause refer
Prescribe erythopoeitin
Do you treat B12 or folate deficiency first?
B12
What is aplastic anaemia?
Pancytopenia
What is pancytopenia?
all 3 cellular components of blood are not produced (this inc RBC, platelets and white cells)
Who is more likely to get aplastic anaemia?
30 y/o men
What cell abnormalities are seen in aplastic anaemia?
Normochromic
Normocytic
Leukopenia
Thrombocytopenia
How do you differentiate purpura and petechiae?
Purpura= 4mm-10mm Petechiae= less than 4mm
What is seen on bloods in aplastic anaemia?
Everything low
MCV normal
What are the 2 hereditary haemolytic anaemias
Membrane defects- hereditary spherocytosis
Metabolic defects- G6 PD
What is seen on blood film in G6PD deficiency?
heinz bodies
What are the causes of acquired anaemia
MAID Microangiopathic Autoimmune Infection Drugs
What infections cause acquired anaemia?
Malaria
Sepsis
What is the difference between cold and warm autoimmune anaemia?
Cold- at cold temps- they get raynauds
Warm- at normal body temp
What organomegaly do you get with cold and warm autoimmune anaemia?
Hepatosplenomegaly
In haemolytic anaemia what do you get alongside normal anaemia symptoms
Jaundice
Haematuria
Hepatospenlomegaly
What test is used to test for autoimmune haemolytic anaemia
Direct coombs test
What is MCV in micro/normo/macrocytic anaemia?
Micro= <80 Normo= 80-100 Macro= >100
What is the most common type of microcytic anaemia?
Iron deficiency
What are some ways microcytic iron deficiency anaemia may arise?
Blood loss eg GI
Reduced absorption eg small bowel disease
Increased demand eg pregnancy, growth
Reduced intake eg vegans
What are the main types of microcytic anaemia?
Iron deficiency Anaemia of chronic disease Thalassaemia Sideroblastic Lead poisioning
What are the main types of normocytic anaemia?
Anaemia of chronic disease CKD Aplastic Sickle cell Haemolytic Acute blood loss Pregnancy Fluid overload
What type of anaemia is anaemia of chronic disease usually?
Normocytic but it can be microcyti
What are the 2 types of macrocytic anaemia?
Megaloblastic and normoblastic
What type of anaemia is megaloblastic and what is it caused by?
It is a type of macrocytic anaemia caused by B12 or folate deficiency or drugs
What are some ways normoblastic macrocytic anaemia arises?
Alcohol excess Liver disease Myelodysplasia Hypothyroidism Alcoholics may have liver failure
What drug most commonly causes megaloblastic anaemia?
Methotrexate
What drugs cause megaloblastic anaemia?
Methotrexate
Hydroxyurea
Azothioprine
Zidovudine
What are causes of megaloblastic anaemia?
Reduced GI absorption of B12/folate- terminal ileum disease or jejunal disease (coeliacs), gastrectomy etc
Reduced intake- vegans, alcoholics, malnutrition, eating disorders
Very recent alcohol intake
Increased demand= not enough absorption eg pregnancy, malignancy
What is a common jejunal disease that causes anaemia?
Coeliacs
How does anaemia present?
Tiredness Lethargy Dyspnoea Malaise Tachycardia Pallor
What are specific sign and symptoms of lead poisoning anaemia?
Anorexia Nausea and vomitting Abdo pain Constipation Peripheral nerve lesions (foot or wrist drop) Blue gumline Convulsions
What are specific sign and symptoms of pernicious anaemia?
Family hx of autoimmune disease Mild jaundice Glossitis Angular stomatitis Weight loss
What are signs of B12 deficiency?
Peripheral neuropathy
Ataxia
Gait disturbance
How is normocytic anaemia diagnosed?
Do FBC to exclude micro or macrocytic anaemia
Check for hx of haemorrhage
Check for reticulocytes (raised in sickle cell)
What type of anaemia do those with sickle cell have? Why?
Normocytic- abnormal cells are destroyed so remaining are normal cells but they are reduced in number
In what disease do you get normocytic anaemia with raised reticulocyte count?
Sickle cell
What will you see on bloods in megaloblastic anaemia?
Pancytopenia
What LFT will be deranged and how in macrocytic anaemia?
Bilirubin will be high
What test is used to test for pernicious anaemia?
Schilling
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in iron deficiency anaemia
Iron= low MCV= low TIBC= high Ferritin= low Transferrin sat= low
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in thalassaemia
Iron= very low MCV= high TIBC= low Ferritin= high Transferrin sat= very high
Why is ferritin high in thalassaemia?
Due to multiple iron transfusions
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in anaemia of chronic disease
Iron= normal or low MCV= normal TIBC= low Ferritin= normal or high Transferrin sat= normal or low
How do you calculate transferrin sat?
Iron level/ total iron binding capacity
What test is similar to TIBC?
Transferrin
How do you differentiate between anaemia of chronic disease and iron deficiency anaemia?
Ferritin in IDA= low and in ACD= normal or high
TIBC in IDA= high and in ACD= low
ACD is often normocytic
What do you see on blood film in microcytic anaemia?
Hypochromia
Anisocytosis
Poikilocytosis
How is iron deficiency anaemia managed?
Oral suppplements
Blood transfusion and iron chelation if hb <70g/L
How is sideroblastic anaemia managed?
Treat the cause
Pyridoxine in inherited forms
What drug is used to treat inherited sideroblastic anaemia?
Pyridoxine
How is lead poisoning anaemia managed?
Remove the source of lead
Dimercaprol
D- penicillinamine
How is renal related normocytic anaemia managed?
refer to renal team
prescribe EPO
How is b12 deficiency anaemia managed?
IM 1mg hydroxycobalamin every 2-3 months
Dietary advice
Oral cyanocobalamin
How is folate deficiency anaemia managed?
Oral folic acid
What is aplastic anaemia?
Pancytopenia and hypoplastic bone marrow
What anaemia is pancytopenia associate with?
Aplastic and macrocytic
What are causes of aplastic anaemia? Which is most common
Idiopathic- 40%
Acquired- drugs eg methotrexate
Inherited
Who is aplastic anaemia more common in?
30 y/o men
What are the main features of aplastic anaemia?
Normocytic anaemia- fatigue, dyspnoea, pallor
Leukopenia- infections
Thrombocytopenia- spontaneous bleeding
What will Hb, platelets, WCC, MCV and reticulocytes be in aplastic anaemia?
Hb= low Platelets= low WCC= low MCV= low Reticulocytes= low or absent
What is haemolytic anaemia?
Premature erythrocyte breakdown causing shortened erythrocyte life span (<120) with anaemia
What will RBC lifespan be in haemolytic anaemia?
<120 days
What are causes of haemolytic anaemia?
Hereditary spherocytosis Metabolic defects G6PD deficiency Pyruvate kinase deficiency Cold and warm autoimmune anaemia Drugs Trauma Infection
What drugs cause haemolytic anaemia?
Penicillin and quinine
What infections cause haemolytic anaemia?
Malaria and sepsis
What is hereditary spherocytosis?
An inherited disorder where there RBCs are small, round, lack central pallor and are therefore removed prematurely by the spleen causing haemolytic anemia
What type of anaemia does hereditary spherocytosis cause?
Haemolytic
How will someone with hereditary spherocytosis present?
Anaemia- SOB, pallor, fatigue Intermittent scleral icterus Jaundice Dark urine Viral infections
What test is used to help diagnose hereditary spherocytosis?
Osmotic fragility test
What is an osmotic fragility test?
When RBCs are exposed to varying concs of saline to see how likely they are to breakdown
In what demographic is G6PD deficiency prominent?
African countries
What is seen on blood film in G6PD deficiency?
Heinz bodies
How will G6Pd deficiency present in children?
With jaundice and anaemia
What should those with G6Pd deficiency be told not to eat?
Flava beans
What is cold autoimmune anaemia?
Haemolysis at cold temps
Presents with raynaud’s phenomenon
What is warm autoimmune anaemia? What organomegaly is seen?
Haemolysis at extravascular sites at body temp
Hepatosplenomegaly as haemolysis is markedly in the spleen
What additional signs and symptoms of anaemia do you get in autoimmune haemolytic anaemia?
Jaundice
Haematuria
Hepatosplenomegaly
What is the first line investigation for autoimmune haemolytic anaemia?
Bloods
What are the diagnostic investigations for autoimmune haemolytic anaemia?
Bloods and blood film
Can do direct coombs test
In what type of anaemia might you do direct coombs test?
Autoimmune haemolytic anaemia
What will you see in urine in autoimmune haemolytic anaemia?
High urobilinogen
Haemoglobinuria
What does high ferritin mean? When might it be seen
It means there is excess storage of iron in the body and this is a bad thing.
May be seen in anaemia of chronic disease and haemochromatosis
What are iron levels and iron availability in anaemia of chronic disease?
Iron levels are high
Availability of this iron is low which explains why TIBC is low but ferritin is high
