Treatment of anaemia Flashcards
When is transfusion ordered?
Only indicated in the case of circulatory compromise i.e. acute severe blood loss or circulatory failure (particularly elderly)
We can replace the missing ___, ____ and ____ or rectify the ________ in the case of haemolysis.
Replace iron, B12 and folate. Rectify shortened life span (haemolysis)
In the case of severe systemic illness, what is the aim?
To just treat the underlying condition.
Scenario 1: 47 year old bank teller with recent tiredness and exertional dyspnoea. menorrhagia, 2 periods during the last month (no bleeding tendency). Hb is showing significant anaemia (77), and MCV is low. The WCC and platelet count is normal.
Describe the blood film and discuss.
Discuss the blood level numbers.
The blood film shows a neutrophil for a point of reference, and the RBCs are smaller than usual.
Hb is actually missing from these cells - instead of 1/3rd of the RBC being pale, the RBC is almost completely empty of Hb (hypochromia - reduced colour - not enough Hb).
Variation in size and shape (anisopoikilocytosis).
Ferritin and transferrin are low. (Ferritin stores iron, transferrin is carrier protein).
Serum iron is low. Transferrin level increases to compensate (but isn’t working).
Diagnosis: iron deficiency anaemia. Replenish the iron and stop menorrhagia.
Scenario 2: 31 year old croupier at Star Casino p/w tiredness and exertional dyspnoea. Feet on fire akin to walking on hot sand and difficulty shuffling cards at high speed (coordination was no longer normal). FBC shows significant anaemia (80). The MCV is high. The WCC is a little bit reduced, and platelet count is normal.
Describe blood film and diagnosis?
The blood film shows really large red cells, which are the size of the neutrophils. These are called oval macrocytes. There is also a variation in the size and shape of the RBCs. The overall issue is that the MCV is high. We also have a hypersegmented neutrophil. The reticulocyte count – looking to see if she is haemolysing – but this count is low. So in this case she is lacking something – vitamin B12. Vitamin B12 deficiency due to pernicious anaemia.
Scenario 3: 33 year old man, blurred vision, 10 cm splenomegaly. A bit anaemic - but the white cell count is enormous - and blurred vision comes from incrased viscosity. So the most obvious abnormality in this case is the WCC - so leukemia. There is an anaemia - and thrombocytopaenia - so this is a bone marrow abnromality.
Diagnosis?
Chronic myeloid leukaemia
