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bsms 103 > Theme 2 - Anaemia > Flashcards

Theme 2 - Anaemia Flashcards

1
Q

what are the signs of anaemia (seen by doctor)

A
  • increased pulse and respiratory rate
  • spoon nails (kolionychia)
  • pale conjunctiva
  • tachycardia
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2
Q

What are the symptoms of anaemia (described by the patient)

A

NON SPECFIC SYMPTOMS

  • lethargy
  • palpitations
  • dyspnoea
  • headaches
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3
Q

what defines anaemia?

A

a fall in Hb concentration below defined levels (160g/L for women and 180g/L in men) therefore insufficient oxygen delivery to tissues

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4
Q

what are the five broad causes of anaemia?

A

1) bleeding
2) deficiencies - iron, folic acid, B12
3) haemolysis - red cell fragility
4) BM dysfunction - myelodysplasia
5) poor oxygen utilisation or carriage in blood

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5
Q

what are three questions that should be asked when investigating anaemia?

A

1) Red cell size (MCV)?
2) is it acute or chronic?
3) what is the underlying aetiology?

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6
Q

what is the most common type of anaemia and what is its main cause?

A

Iron deficiency caused by bleeding (can also be caused by deficiencies or increased requirements eg in pregnancy)

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7
Q

how is occult bleeding diagnosed?

A

melenaea - dark stool

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8
Q

what are the four principle iron studies two confirm iron deficiency?

A

1) serum ferritin
2) serum iron
3) serum transferrin
4) % transferrin saturation

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9
Q

how is serum ferritin implicated in anaemia?

A

IT IS DECREASED

  • is the storage form of iron
  • increased in iron overload and decreased in iron deficiency
  • can also be affected by genetics or in a blood transfusion
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10
Q

what is serum transferrin and how is implicated in anaemia?

A

IT IS INCREASED

  • carrier molecule for iron
  • picks up iron from the gut
  • if there is iron deficiency then the body up regulates it
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11
Q

how is serum iron implicated in anaemia?

A

ISNT REALLY

- only reflects recent iron intake therefore if its normal it doesn’t exclude a deficiency

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12
Q

how is % transferrin saturation implicated in anaemia?

A

GOOD and SENSITIVE MEASURE - LOW IN DEFICIENCY

  • shows how much transferrin actually has iron bound to it
  • lower if patient is iron deficient
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13
Q

what are the three characteristics in FBC of iron deficiency?

A
  • low serum ferritin (can be normal)
  • increased serum transferrin
  • low transferrin saturation
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14
Q

how is anaemia of chronic disease characterised?

A

patient has problem getting iron from the stores to the RBC

  • not an iron deficiency
  • low transferrin and high or normal ferritin, low serum iron
  • %TF saturation is normal
  • low EPO (kidney failure)
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15
Q

what generally happens to EPO levels in anaemia?

A

It is increased as it is released in response to low oxygen levels (as Hb is lower in anaemia)

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16
Q

how much iron taken in from the diet is absorbed and where?

A

1% absorbed in the duodenum

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17
Q

how long do B12 body stores last?

A

3-4 years

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18
Q

how long two body folate stores last?

A

a few months

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19
Q

where is B12 absorbed and how?

A

in the terminal ileum by receptors for intrinsic factor

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20
Q

how is microcytic anaemia characterised?

A
  • Low MCV (<80)
  • Iron deficiency
  • beta thalassemia
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21
Q

how is macrocytic anaemia characterised?

A
  • large MCV (>100)
  • B12 or folate deficiency (megaloblastic)
  • alcoholic liver disease (non megaloblastic)
22
Q

What is normocytic anaemia caused by?

A
  • anaemia of chronic disease

- haemorrhage

23
Q

How is the underlying cause of anaemia identified?

A

on a blood film

24
Q

what can be identified on a blood film?

A

the underlying cause of anaemia

  • deficiencies due to cell size
  • Haemoglobinopathies eg SCA
  • polychromasia - high reticulocytes (red cell fragility)
25
Q

What does the level of reticulocytes show ?

A

the rate of production of RBC by the BM

26
Q

what proportion of blood cells should be reticulocytes and what conditions is this increased in?

A

should be 1%

  • > 10% in SCA
  • chronic bleeding and haemolysis
27
Q

what effect does iron deficiency or bone marrow infiltration have on reticulocytes?

A

decreased reticulocyte numbers

28
Q

what is pernicious anaemia?

A

autoimmune condition due to parietal cell loss

  • causes deficiency of intrinsic factor
  • cells cant absorb B12 from the terminal ileum
29
Q

how can you test for pernicious anaemia?

A

with autoantibodies against intrinsic factor

30
Q

how do you treat pernicious anaemia?

A

B12 injections

31
Q

what are 5 causes of anaemia of chronic disease?

A

1) inflammatory conditions (RA)
2) infections (TB)
3) cancer
4) renal failure
5) autoimmunity

32
Q

how is anaemia of chronic disease characterised?

A

POOR UTILISATION OF IRON

  • not iron deficient
  • iron gets stuck in macrophages
33
Q

how is EPO implicated in anaemia of chronic disease?

A

blunted response to EPO

- not making enough rd cells even though iron is. present

34
Q

how is transferrin implicated in anaemia of chronic disease?

A

low transferrin and high hepcidin

35
Q

what type of anaemia is anaemia of chronic disease?

A

normocytic

36
Q

what mutation characterises sickle cell anaemia?

A

point mutation in beta globin gene (autosomal recessive)

37
Q

what are the main features of sickle cell anaemia?

A
  • unstable Hb
  • increased red cell turnover (20 days)
  • high reticulocyte numbers
  • low blood oxygen
  • occlusions in blood vessels
38
Q

what are the symptoms of sickle cell anaemia?

A

ischaemia, pain, necrosis, organ damage

39
Q

how is anaemia managed?

A

hydration, analgesics, transfusion

40
Q

what causes the abnormal shaped cells in sickle cell anaemia?

A

sickle Hb forms filamentous strands which makes inflexible and spiky cells

41
Q

what are the advantages of being a sickle cell anaemia carrier?

A

resistance to malaria

42
Q

how is thalassemia characterised?

A

inadequate production of Hb due to imbalance of alpha and beta globin

43
Q

How is Hb implicated in thalassemia?

A

not enough normal Hb therefore

44
Q

how to cells appear in thalassemia?

A

microcytic and hypo chromic as not enough normal Hb

45
Q

is thalassemia dominant or recessive?

A

recessive

46
Q

what are the symptoms of thalassemia?

A

enlarged spleen, liver and heart

47
Q

how is beta thalassemia major diagnosed?

A

with Hb electrophoresis and blood films

- need lifelong blood transfusions

48
Q

what symptoms are seen alongside myeloma?

A

anaemia, hypercalcaemia and renal failure

49
Q

where are BM samples taken from?

A

iliac crest

50
Q

how is acute anaemia managed?

A
  • guide by symptoms not Hb levels

- blood transfusion if needed

51
Q

how is chronic anaemia managed?

A

find cause then replenish whats missing

  • usually few symptoms as body compensates well
  • renal failure patients get recombinant EPO
52
Q

what are the long term risks of blood transfusions?

A

iron overload (deposits in organs), allosensitivity and autoantibody production against transfused cells

bsms 103 (23 decks)

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