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Finals - haematology > Types of anaemia > Flashcards

Types of anaemia Flashcards

1
Q

Microcytic anaemia

A

TAILS
T - thalassaemia
A - anaemia of chronic disease
I - iron deficiency
L - lead poisoning
S - sideroblastic anaemia

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2
Q

Normocytic anaemia

A

AAAH
A - anaemia of chronic disease
A - acute blood loss
A - aplastic anaemia
H - haemolysis

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3
Q

Macrocytic anaemia

A

ABCDEF
A - alcohol/chronic liver
B - B12 deficiency
C - compensatory reticulocytosis (in haemolysis)
D - drugs (methotrexate, phenytoin)
E - endocrine (hypothyroidism)
F - folate deficiency

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4
Q

Iron deficiency anaemia definition

A
  • microcytic, hypochromic anaemia
  • low iron levels in the body lead to decreased red blood cell production
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5
Q

Iron deficiency anaemia risk factors

A
  • pregnancy
  • menorrhagia
  • poor oral intake
  • vegetarian or vegan diet
  • malabsorption (e.g., coeliac disease)
  • malignancy
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6
Q

Iron deficiency anaemia presentation

A
  • dyspnoea
  • fatigue
  • chest pain
  • palpitations
  • cognitive dysfunction
  • restless leg syndrome
  • vertigo
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7
Q

Iron deficiency anaemia investigations

A
  • FBC (low Hb, low MCV, low MCHC)
  • low serum ferritin, high TIBC
  • blood film shows microcytic hypochromic cells
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8
Q

Iron deficiency anaemia management

A
  • treat underlying cause
  • oral iron replacement 50-100mg ferrous sulphate TDS
  • IV iron replacement if IBD etc
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9
Q

B12 food sources

A
  • eggs
  • meat
  • salmon
  • cod
  • milk and dairy products
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10
Q

B12 deficiency anaemia definition

A
  • leads to a megaloblastic anaemia (red blood cells with immature nuclei)
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11
Q

B12 deficiency anaemia causes

A
  • 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
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12
Q

B12 deficiency anaemia presentation

A
  • dyspnoea
  • fatigue
  • chest pain
  • palpitations
  • symmetrical neuropathy
  • psychiatric disturbances
  • indigestion
  • glossitis
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13
Q

B12 deficiency anaemia investigations

A
  • low Hb and high MCV
  • vitamin B12 < 200ng/L
  • anti-intrinsic factor antibodies in pernicious anaemia
  • hypersegmented neutrophils, oval macrocytes, megaloblasts
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14
Q

B12 deficiency anaemia management

A
  • 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
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15
Q

Folate deficiency anaemia definition

A
  • macrocytic megaloblastic anaemia
  • usually no neurological signs
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16
Q

Folate food sources

A
  • leafy green vegetables
  • asparagus
  • broccoli
  • brown rice
  • brussels sprouts
  • chickpeas and peas
17
Q

Folate deficiency anaemia causes

A
  • increased requirements (malignancy, haemolysis)
  • increased urinary excretion (congestive heart failure, acute liver)
  • malabsorption
  • nutritional
  • drugs (methotrexate, trimethoprim)
18
Q

Folate deficiency anaemia presentation

A
  • dyspnoea
  • fatigue
  • chest pain
  • palpitations
19
Q

Folate deficiency anaemia investigations

A
  • low Hb, high MCV
  • folate under 3 micrograms/L
  • hypersegmented neutrophils, oval macrocytes, megaloblasts
20
Q

Folate deficiency anaemia management

A
  • 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
21
Q

Haemolytic anaemia definition

A
  • increased rate of RBC destruction
22
Q

Haemolytic anaemia inherited causes

A
  • red blood cell enzyme abnormalities (G6PD deficiency)
  • RBC membrane abnormalities
  • haemoglobin abnormalities (thalassaemia, sickle cell)
23
Q

Haemolytic anaemia acquired causes

A
  • drugs
  • transfusion reaction
  • microangiopathic haemolytic anaemia (thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS), disseminated intravascular coagulation (DIC)
24
Q

Haemolytic anaemia presentation

A
  • dyspnoea
  • fatigue
  • chest pain
  • palpitations
  • jaundice
  • splenomegaly
  • passing dark urine
25
Q

Haemolytic anaemia investigations

A
  • 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
26
Q

Autoimmune haemolytic anaemia management

A
  • presents like haemolytic anaemia but with high haptoglobin
  • corticosteroid until remission, then taper down
  • rituximab if unresponsive to steroids
  • immunosuppression e.g. azathioprine
27
Q

Sickle cell disease definition

A

mutation in beta chains of haemoglobin leading to Hb S formation - low affinity for oxygen

28
Q

Sickle cell disease presentation

A
  • vaso-occlusive crisis (pain, priapism)
  • acute chest crisis
  • stroke
  • haemolytic anaemia
  • aplastic crisis (profound anaemia)
  • splenic sequestration
  • leg ulcers
29
Q

Sickle cell disease investigations

A
  • 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
30
Q

Sickle cell disease management

A
  • prevent sickle cell crisis
  • avoid cold weather, dehydration, infection, hypoxia
  • vaccination
  • prophylactic hydroxycarbamide
  • vaso-occlusive crisis - oxygen, IV fluids, pain management with WHO ladder
31
Q

Thalassaemia definition

A
  • genetic disorder leading to an imbalance of haemoglobin chains (deficiency of either α or β chains)
32
Q

Thalassaemia risk factors

A
  • family history
  • ethnic origin (e.g. Mediterranean, Southeast Asian, African)
33
Q

Thalassaemia presentation

A
  • major (often in childhood) - failure to thrive, hepatosplenomegaly, bone expansion (classically, frontal bossing), jaundice, gallstones
  • trait - usually asymptomatic or mild anaemia, dyspnoea, fatigue, headache
34
Q

Thalassaemia investigations

A
  • low Hb, MCV, MCHC, MCH
  • high RBC due to reticulocytosis
  • blood film - microcytic hypochromic cells with target cells, reticulocytosis
  • haemoglobin electrophoresis shows Hb chains
35
Q

Thalassaemia management

A
  • trait - avoid iron unless deficient
  • major - regular transfusions, iron chelation (desferrioxamine)

Finals - haematology (4 decks)

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