Types of anaemia Flashcards
Microcytic anaemia
TAILS
T - thalassaemia
A - anaemia of chronic disease
I - iron deficiency
L - lead poisoning
S - sideroblastic anaemia
Normocytic anaemia
AAAH
A - anaemia of chronic disease
A - acute blood loss
A - aplastic anaemia
H - haemolysis
Macrocytic anaemia
ABCDEF
A - alcohol/chronic liver
B - B12 deficiency
C - compensatory reticulocytosis (in haemolysis)
D - drugs (methotrexate, phenytoin)
E - endocrine (hypothyroidism)
F - folate deficiency
Iron deficiency anaemia definition
- microcytic, hypochromic anaemia
- low iron levels in the body lead to decreased red blood cell production
Iron deficiency anaemia risk factors
- pregnancy
- menorrhagia
- poor oral intake
- vegetarian or vegan diet
- malabsorption (e.g., coeliac disease)
- malignancy
Iron deficiency anaemia presentation
- dyspnoea
- fatigue
- chest pain
- palpitations
- cognitive dysfunction
- restless leg syndrome
- vertigo
Iron deficiency anaemia investigations
- FBC (low Hb, low MCV, low MCHC)
- low serum ferritin, high TIBC
- blood film shows microcytic hypochromic cells
Iron deficiency anaemia management
- treat underlying cause
- oral iron replacement 50-100mg ferrous sulphate TDS
- IV iron replacement if IBD etc
B12 food sources
- eggs
- meat
- salmon
- cod
- milk and dairy products
B12 deficiency anaemia definition
- leads to a megaloblastic anaemia (red blood cells with immature nuclei)
B12 deficiency anaemia causes
- decreased dietary intake (e.g. vegans)
- decreased gastric breakdown (gastric surgery, PPIs, H2 antagonists)
- malabsorption (Crohn’s etc) - B12 is absorbed in the terminal ileum
B12 deficiency anaemia presentation
- dyspnoea
- fatigue
- chest pain
- palpitations
- symmetrical neuropathy
- psychiatric disturbances
- indigestion
- glossitis
B12 deficiency anaemia investigations
- low Hb and high MCV
- vitamin B12 < 200ng/L
- anti-intrinsic factor antibodies in pernicious anaemia
- hypersegmented neutrophils, oval macrocytes, megaloblasts
B12 deficiency anaemia management
- find cause and give dietary advice
- if neuro symptoms - hydroxocobalamin 1 mg IM every other day (min 3 weeks), then every 2 months
- else hydroxocobalamin 1 mg IM 3x a week for 2 weeks then 3 months
- if diet related - oral hydroxocobalamin 50–150 microg daily
Folate deficiency anaemia definition
- macrocytic megaloblastic anaemia
- usually no neurological signs
Folate food sources
- leafy green vegetables
- asparagus
- broccoli
- brown rice
- brussels sprouts
- chickpeas and peas
Folate deficiency anaemia causes
- increased requirements (malignancy, haemolysis)
- increased urinary excretion (congestive heart failure, acute liver)
- malabsorption
- nutritional
- drugs (methotrexate, trimethoprim)
Folate deficiency anaemia presentation
- dyspnoea
- fatigue
- chest pain
- palpitations
Folate deficiency anaemia investigations
- low Hb, high MCV
- folate under 3 micrograms/L
- hypersegmented neutrophils, oval macrocytes, megaloblasts
Folate deficiency anaemia management
- find underlying cause and rule out B12 deficiency
- give dietary advice
- oral folic acid 5 mg for 4 months
- pregnancy 400 mcg/day until week 12
Haemolytic anaemia definition
- increased rate of RBC destruction
Haemolytic anaemia inherited causes
- red blood cell enzyme abnormalities (G6PD deficiency)
- RBC membrane abnormalities
- haemoglobin abnormalities (thalassaemia, sickle cell)
Haemolytic anaemia acquired causes
- drugs
- transfusion reaction
- microangiopathic haemolytic anaemia (thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS), disseminated intravascular coagulation (DIC)
Haemolytic anaemia presentation
- dyspnoea
- fatigue
- chest pain
- palpitations
- jaundice
- splenomegaly
- passing dark urine
Haemolytic anaemia investigations
- low Hb, high MCV
- raised reticulocyte count
- high LDH and unconjugated bilirubin
- low haptoglobin (binds free Hb - if low suggests increased free Hb)
- blood film - spherocytes, fragments etc
- direct antiglobulin (Coomb’s) test for autoimmune anaemia
Autoimmune haemolytic anaemia management
- presents like haemolytic anaemia but with high haptoglobin
- corticosteroid until remission, then taper down
- rituximab if unresponsive to steroids
- immunosuppression e.g. azathioprine
Sickle cell disease definition
mutation in beta chains of haemoglobin leading to Hb S formation - low affinity for oxygen
Sickle cell disease presentation
- vaso-occlusive crisis (pain, priapism)
- acute chest crisis
- stroke
- haemolytic anaemia
- aplastic crisis (profound anaemia)
- splenic sequestration
- leg ulcers
Sickle cell disease investigations
- FBC (Hb 60–90 g/L)
- high LDH and reticulocytes
- high unconjugated bilirubin
- blood film - sickle cells, target cells, Pappenheimer bodies (granules of iron), Howell-Jolly bodies (DNA remnants)
- haemoglobin electrophoresis - Hb S
- CXR and ABG in acute chest syndrome
Sickle cell disease management
- prevent sickle cell crisis
- avoid cold weather, dehydration, infection, hypoxia
- vaccination
- prophylactic hydroxycarbamide
- vaso-occlusive crisis - oxygen, IV fluids, pain management with WHO ladder
Thalassaemia definition
- genetic disorder leading to an imbalance of haemoglobin chains (deficiency of either α or β chains)
Thalassaemia risk factors
- family history
- ethnic origin (e.g. Mediterranean, Southeast Asian, African)
Thalassaemia presentation
- major (often in childhood) - failure to thrive, hepatosplenomegaly, bone expansion (classically, frontal bossing), jaundice, gallstones
- trait - usually asymptomatic or mild anaemia, dyspnoea, fatigue, headache
Thalassaemia investigations
- low Hb, MCV, MCHC, MCH
- high RBC due to reticulocytosis
- blood film - microcytic hypochromic cells with target cells, reticulocytosis
- haemoglobin electrophoresis shows Hb chains
Thalassaemia management
- trait - avoid iron unless deficient
- major - regular transfusions, iron chelation (desferrioxamine)
