The FBC and common anaemias Flashcards
Mature RBCs?
Erythrocytes
Commonest wbc?
Neutrophil
Components of blood?
Rbc
Wbc
Platelets
Components of RBCs?
Membrane
Enzymes
Haemoglobin
(No nucleus)
Shape of rbc?
Biconcave disc shape
Haemoglobin at peripheries
When do eosinophils increase?
Allergies
Inflammatory/malignancy
Myeloproliferative disease disease (blood disorder)
What is it called if pt has low platelet count?
Thrombocytopenia
Platelet clumping?
In lab due to edta
Artefact low plated count
Consequence of low platelet count?
Bleeding disorder
What can can cause Thrombocytopenia?
Viral infection
Cancer
Medications
Key things to focus on in blood results?
Hb
Plt
Wbc
Anaemia?
Reduction in red cells or their Haemoglobin content
anaemia is not a diagnosis but a description
Causes of anaemia?
Blood loss
Increased destruction
Lack of production
Defective production
Normal range of Haemoglobin for males?
140-180 g/l (12-70)
116-156 g/l (age over 70)
Normal Haemoglobin for female?
120-160 g/l (12-70)
108-143 (age over 70)
Symptoms an signs of anaemia?
Tiredness/fatigue
Dizziness/lightheadnedness (cerebral hypoxia)
Breathlessness (on exertion)
Chest pain
Pallor (mucous membranes and conjunctiva)
Glossitis
Angular stomatitis
Koilonychia (spoon shaped nails)
MCV?
Mean cell volume (cell size)
MCH?
Mean cell Haemoglobin
Reticulocytes?
Young red cells
Macrocytic anaemia
Large cells
high MCV
Microcytic anaemia
Small cells
Low MCV
When is reticulocyte count increased?
If marrow is able to react with anaemia
occurs in haemolytic anaemias
bone marrow increases synthesis of reticulocytes to combat RBC destruction
Commonest cause of hypochromic Microcytic anaemia?
- Iron deficiency
- test by checking serum ferratin (store iron inside cells)
- Small pale cells
- low MCV and MCH
How to check iron levels?
CHECK Serum ferritin levels (stored iron in cells)
What is raised with macrolytic cells?
Raised MCV
Common causes of iron deficiency?
Commonest case - fe deficiency - low ferritin
Blood loss
- GI, menstrual
Increased requirements
- pregnancy
Reduced intake
- dietary, malabsorption
Hypochromic, microcytic with normal ferritin
- thalassaemia
What affects the colour of RBCs?
MCH
Mean cell Haemoglobin
Causes of macrocytic anaemia?
mostcommon cause is:
Megaloblatic anaemia, caused by
-B12 deficiency
- Folate deficiency
Also: myelodysplasia
Also: macrocytosis without anaemia
- Large normal coloured cells
- Raised MCV
Causes of folate deficiency?
Dietary
Malabsorption (e.g. coeliac disease)
Increased requirements (haemolysis)
Can pernicious anaemia (B12 deficiency) have slow onset of symptoms?
Yes, gradually pale and fatigued
cant absorb B12
Treatment of b12 deficiency?
Cautious transfusion
Gradual blood transfusion
REPLACE B12 IM
Causes of macrocytosis without anaemia? (macrocytic anaemia)
Liver disease
Drugs
Alcohol
Thyroid disease
What would you test in normochromic normocytic anaemia?
Reticulocyte count
Causes of jaundice
Liver disease
Haemolytic disease
Causes of haemolytic anaemia?
Congenital
Acquired
Common cause for acquired haemolytic anaemia?
Auto-immune haemolytic anaemia (extravascular/exaggerated normal)
Intravascular - sick pts
- Mechanical (artificial valve)
- Severe infection
- Pet/hus/ttp
Common causes of congenital haemolytic anaemia?
Hereditary spherocytosis
Enzyme deficiency
Haemoglobinopathy (HbSS)
Cause of increased reticulocytes?
Achieved blood loss
Haemolysis (destruction of RBC)
when does low/normal reticulocyte occur?
problem with bone marrow due to:
- due to malignancy
- leukaemia
- non-haemological malignancy
- aplastic anaemia (bone marrow just not making blood properly)
- secondary anaemia (e.g. renal anaemia)
What does red cell indices tell you?
morphological description and clue to the cause
How to describe MCH?
hypochromic or hyperchromic
What are normochromic normocytic cells?
normal cells but less of them
normal MCV and MCH
What causes/ what to test for in normochromic and normocytic cells?
reticulocyte count
Thalassemia?
is the name for a group of inherited conditions that affect a substance in the blood called haemoglobin.
People with thalassaemia produce either no or too little haemoglobin, which is used by red blood cells to carry oxygen around the body.
This can make them very anaemic (tired, short of breath and pale).
As a dentist, what are symptoms of iron deficiency?
glossitis (sore tongue)
angular stomatitis
Why may a pt have b12 folate deficiency? causes of megaloblastic anaemia?
pt has megaloblastic anaemia could be due to…
B12 deficiency
- autoimmune condition: pernicious anaemia
- gastric/ileal disease
Folate deficiency
- dietary
- malabsorption (coeliac disease)
- increased requirements (haemolysis)
Causes of myelodysplasia?
causes macrocytic anaemia!
abnormal RBC normal B12 and folate
it is a bone marrow problem - cat make RBC normally and look dysplastic
What usually accompanies myelodysplasia?
often with other cytopenias
- neutropenia
- thrombocytopenia
Why test reticulocyte count in normochromic normocytic anaemia?
decide if you are nit making enough normal RBC
or normal RBC are being destroyed
secondary anaemia?
renal anaemia causes low reticulocyte count
Haemolytic anaemia? (haemolysis)
accelerated RBC destruction
Usually get compensation by bone marrow reticulocyte count
a fine balance
Where can haemolysis occur?
extravascular or intravascular
What breaks down RBC?
macrophage
process of haemolysis and RBC?
RBC after around 120 days
macrophage breakdown RBC
into bilbubin
liver breaks this down and excreted in stool
What haemolysis do we not want?
intravascular
you get free haemoglobin
not good for kidneys and blood vessels
Why do you appear yellow with jaundice?
haemolytic anaemia - increased bilirubin
= yellow an dark pee and yellow sclera
Causes of intravascular haemolytic anaemia?
mechanical or toxins
