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1: Diagnostic approach to anaemia Flashcards

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1
Q

What is anaemia

A

Deficiency in haemoglobin

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2
Q

How can anaemia be classified

A
  1. By aetiology

2. Morphology

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3
Q

What is required to classify anaemia by morphology

A

FBC: Hb, MCV, MCHC

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4
Q

What defines anaemia in males

A

Hb < 135

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5
Q

What defines anaemia in females

A

Hb <115

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6
Q

What defines anaemia in the first-trimester of pregnancy

A

Hb < 110

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7
Q

What defines anaemia in the second or third trimester of pregnancy

A

Hb <105

Remember 2 + 3 trimester = 5

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8
Q

What defines post-natal anaemia

A

Hb < 100

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9
Q

After investigating for anaemia, what is performed next

A

MCV

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10
Q

What MCV defines microcytic anaemia

A

Less-than 80

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11
Q

What is a mnemonic to remember causes of microcytic anaemia

A

TINS

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12
Q

What are the 4 causes of microcytic anaemia

A

Thalasemia
IDA
Normocytic anaemia/ anaemia chronic disease (initially)
Sideroblastic

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13
Q

What MCV defines normocytic anaemia

A

80-100

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14
Q

What is a mnemonic to remember causes of normocytic anaemia

A

HARP-B

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15
Q

What are the causes of normocytic anaemia

A 
Hypothyroidism (or microcytic) 
Haemolysis (or microcytic)
Anaemia of chronic disease 
Renal failure 
Pregnancy
Bone marrow failure
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16
Q

What MCV defines macrocytic anaemia

A

> 100

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17
Q

What is the mnemonic to remember macrocytic anaemia

A

MR.CRAB

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18
Q

What are the causes fo macrocytic anaemia

A 
MDS or myeloproliferative
Reticulocytosis 
Cytotoxic drugs (hydroxycarbamide)
Relatively low thyroid 
Anti-folate medications (methotrexate, phenytoin, trimethoprim) 
B12 or folate deficiency
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19
Q

If a person has microcytic anaemia, what should be looked at next

A

Ferritin

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20
Q

What does a microcytic anaemia, with low ferritin indicate

A

IDA

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21
Q

explain transferrin saturation in IDA

A

Transferrin saturation will be low. As low iron means less RBC and therefore less sites on transferrin occupied

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22
Q

explain TIBC in IDA

A

TIBC will be high. As less RBC, there will be more spaces on transferrin to be occupied by RBC

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23
Q

explain RDW in IDA

A

Wider - as more RBC produced

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24
Q

how will reticulocyte count present in IDA

A

Decreased - as insufficient iron to produce RBC

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25
how will the following present in IDA: a. Ferritin b. TIBC c. Transferrin saturation d. RDW
a. Low b. High c. Low d. High
26
If microcytic anaemia, ferritin is normal - what is looked at next
TIBC
27
if TIBC is low in microcytic anaemia and ESR/ CRP is high, what does it likely indicate
Anaemia of chronic disease (early stages)
28
If TIBC is low in microcytic anaemia and Hb electrophoresis is abnormal what does it likely indicate
Thalasemia
29
What is a characteristic feature of sideroblastic anaemia
Basophilic stippling
30
How will the following present in thalassemia a. Ferritin b. Transferrin saturation c. TIBC d. RDW
a. Normal b. Normal c. Low d. Normal
31
How will the following present in anaemia of chronic disease a. Ferritin b. Transferrin c. TIBC d. RBW
a. High b. Low c. Low d. Normal
32
How will the following present in sideroblastic anaemia a. Ferritin b. Transferrin saturation c. TIBC d. RDW
a. High b. High c. Low d. High
33
If an individual has normocytic anaemia what should be looked at next
reticulocytes
34
If reticulocytes are high, what is looked at
EPO
35
if reticulocytes are high, EPO low, what is the likely cause
- CKD
36
If reticulocytes are high, EPO high, what is the likely cause
- Aplastic anaemia
37
if reticulocytes are low what is looked at
Markers of haemolysis
38
what are signs of haemolysis
- Low haptoglobin | - High LDH
39
what does no signs of haemolysis indicate
Blood loss
40
what do signs of haemolysis indicate
Haemolytic anaemia
41
what is performed if megaloblastic anaemia
Peripheral Blood Smear
42
what causes a megaloblastic macrocytic anaemia
- B12 Deficiency | - Folate Deficiency
43
what causes a non-megaloblastic macrocytic anaemia
- Reticulocytosis - Multiple myeloma - Alchoholism - MDS - Hypothyroidism
44
what do symptoms of anaemia depend on
- Fall in Hb | - Rate of fall in Hb
45
what are symptoms of anaemia
- Lethargy - Dizziness - Syncope - Dyspnoea - Pallour - Palpitations - Angina - if predisposing coronary artery disease
46
what are 4 signs of anaemia
- Conjunctival pallour - Kolonychia - Angular stomatitis - Glossitis
47
how may a Hb below 80 present
Bounding pulse, Tachycardia, Postural Hypotension
48
when are Howell-jolly bodies seen on peripheral blood film
Hyposplenism: Coeliac, Sickle Cell, Crohn's Post-Splenectomy
49
what are pappenherimer bodies
granules of siderocytes containing iron
50
when are pappenheimer bodies seen
- Lead-poisoning | - Post-splenectomy
51
what is poikilocytes
variation in RBC shape and size
52
when are poikilocytes seen
IDA
53
what is rouleaux formation
when RBC aggregate together
54
when is rouleaux formation seen
multiple myeloma
55
what are schistocytes
fragments RBC
56
what causes schistocyte formations
intra-vascular haemolysis
57
what are spherocytes
spherical shaped
58
what causes spherocytosis
Hereditary spherocytosis
59
what are target cells
RBC with central stain, ring of pallour and outer staining
60
when are target cells seen
- Liver disease - Hyposplenism - Thalasemia - IDA
61
what are tear-drop RBC characteristic of
myelofibrosis
62
what do Heinz bodies indicate
G6PD deficiency | Thalasemia
63
what are hyperhsegmented neutrophils characteristic of
Megaloblastic anaemia
64
if sideroblastic anaemia is suspected what is used to stain the bone marrow biopsy
prussian blue staining

Haematology (19 decks)

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