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Clinical Pathology > common cause of anaemia and thrombocytopenia > Flashcards

common cause of anaemia and thrombocytopenia Flashcards

1
Q

what are the main causes of anaemia

A 
haematinic deficiencies.
haemolysis
secondary to a chronic condition
alcohol, drugs
renal impairment -EPO
primary marrow disease- malignant, haemoglobin disorder, aplasia, congenital.
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2
Q

causes of macrocytic anaemia

A

B12, folate, metabolic (e.g. thyroid/liver disease), marrow damage (alcohol, drugs, marrow disease), haemolysis (due to reticulocytosis)- breaking down RBC.

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3
Q

causes of normocytic anaemia

A

anaemia of chronic disease/inflammatory.

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4
Q

causes of microcytic anaemia

A

iron deficiency, haemoglobin disorders- sickle cell anaemia, thalassemia

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5
Q

is iron excreted from the body

A

no

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6
Q

how is iron balance controlled

where is iron levels controlled

A

gut mucosa

most iron is absorbed in the duodenum

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7
Q

what molecule transfers iron

A

transferrin

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8
Q

what molecule is iron stored in

A

ferrtin/haemosiderin

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9
Q

what food products contain iron

A 
red meat
chicken contains some iron
baked beans
boiled eggs
canned sardiness, oily fish and mussels.
breakfast cereals with added vitamins
green leafy vegetables, dried fruit, wholemeal bread, lentils, beans, peas and nuts.
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10
Q

what lab tests establish low iron

A 
FBC and film
ferritin- key marker (for iron deficiency)
Hypochromic cells
serum iron/TIBC
marrow.
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11
Q

what can causes anaemia

not individual factors general factors

A

blood loss- gut, respiratory
increased demand- pregnancy and growth
reduced intake- diet and malabsorption.

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12
Q

in children what are the main causes of anaemia

A

diet, growth, malabsorption

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13
Q

in young women what are the main causes of anaemia

A

menustral loss, pregnancy, diet

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14
Q

in the elderly what are the main causes of anaemia

A

bleeding, GI problems (ulcer, gastritis, aspirin, malignancy, diverticulis, GI surgery of various types)

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15
Q

main side effect of oral iron

A

stomach upset

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16
Q

main side effect of IM iron

A

painful

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17
Q

most common cause of megaloblastic change.

A

B12 and/ Folic acid and deficiency- most common cause.

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18
Q

causes of megalobastic change

A

alcohol, drugs, haematological malignancy, congenital rarities

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19
Q

pathogenesis of folate and B12 anaemia

A

DNA= purine and pyrimidine bases.
folate required for DNA base synthesis.
B12 needed for folate synthesis.
so deficiency in either starves DNA bases.

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20
Q

what source does B12 come from

A

animal source

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21
Q

what cells and factors are involved in B12 absorption

A

gastric parietal cells
Intrinsic factor produced by parietal cells
receptors in terminal ileum which internalise B12.

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22
Q

most common causes for B12 deficiency

A

nutritional- vegans
gastric problems- gastrectomy or pernicious anaemia
small bowel problem- terminal ileum resection, crohn’s, jejunal diverticulosis, fish tapeworm.

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23
Q

what sources contain folic acid

A

green veg, beans, peas, nuts and liver

24
Q

where is folic acid absorbed

A

upper small bowel

25
Q

how long would the body’s store of folic acid last before it runs out

A

4 months.

26
Q

main causes of folic acid deficiency

A

Mainly dietary / malnutrition
Malabsorption / small bowel disease
Increased usage-preganancy, haemolysis and inflammatory conditions, drug use

27
Q

main cause of B12 deficiency

A

problem in absorption

28
Q

symptoms of B12 or folate deficiency.

A

Megaloblastic anaemia, panctopenia, mild jaundice, glosstiis and angular stomatitis
anoexia
sterility

29
Q

Lab features of B12 and folate deficiency

A 
•	Blood count and film - marrow sometimes
•	Bilirubin and LDH - ‘haemolysis’
•	B12 and folate levels
•	Antibodies
•	B12 absorption tests +/- IF- no longer used.
•	GI investigations:
–	Crohn’s 
–	malabsorption
–	blind loop etc
30
Q

cause of perincious anaemia

A

B12 deficency

31
Q

SADC (subacute combined degeneration of the cord) occurs due to

A

severe B12 deficency.

32
Q

pathogenesis of subacute combine degeneration of the cord.

A

Demyelination of dorsal + lateral columns

33
Q

symptoms of subacute combined degeneration of the cord

A
  • Peripheral neuropathy / Paraesthesiae
  • Numbness and distal weakness
  • Unsteady walking
  • Dementia
34
Q

treatment for B12 deficiency.

A
  • B12 + Folate until B12 deficiency excluded
  • B12 x5 then 3 monthly for life for PA
  • Folic acid 5mg daily to build stores
35
Q

why is it important to give a patient both folic acid and B12 until the cause of anaemia has be diagnosed as one or the other/

A

Folic acid in isolation without knowing B12 status- can exacerbate B12 neuropathy

36
Q

define haemolysis

A

breakdown of RBC

37
Q

causes of haemolysis inside the RBC

A 
haemoglobinopathy (sickle cell)
Enzyme defects (G6PD)
38
Q

causes of haemolysis in the RBC membrane

A

Hereditary Spherocytosis / elliptocytosis

39
Q

causes of haemolysis outside the RBC

A

Antibodies (warm / cold)
Drugs, toxins
Heart valves
Vascular / vasculitis / ‘microangiopathy’

40
Q

what tests show that haemolysis is present

A

anaemia
high MCV, macrocytic.
high reticulocytes
blood film
raised billirubin and LDH- present due to breakdown of RBC an recycle of haemoglobin.
low haptoglobins used in haemolysis
Urinary Haemosiderin- haemoglobin comes out in urine.

41
Q

what is the treatment for autoimmune haemolytic anaemia

A

steroids

42
Q

why is transfusion of blood difficult in autoimmune haemolytic anaemia

A

blood is difficult to match.

43
Q

what is the MCV in anaemia of the chronic disease

A

normal

44
Q

why do you have reduced RBC production in anaemia of the chronic disease.

A

Abnormal iron metabolism, poor erythropoetin response and blunted marrow response.

45
Q

where is hepcidin produced

A

liver

46
Q

what is the function of hepcidin

A

regulator of iron absorption and release from macrophages

47
Q

diagnosis of anaemia of a chronic disease

A
  • No other causes of anaemia
  • No test, so diagnosed by excluding other causes.
  • Usually mild anaemia, normal MCV
  • Often raised inflammatory markers
  • ESR, CRP, PV etc
  • Normal/high ferritin + low serum iron
  • Normal % Saturation transferrin
48
Q

treatment for anaemia of the chronic disease.

A

Erythropoetin (SC)
Iron (IV)
Transfusion in severe cases.

49
Q

common causes of thrombocytopenia

A
  • ITP (sometimes associated with lymphoma/CLL/HIV)
  • Other autoimmune diseases
  • Liver disease and / or hypersplenism
  • Pregnancy (physiological and a range of complications e.g. eclampsia)
  • Haematological / marrow diseases
  • Infections acute or otherwise e.g.
  • Acute sepsis / HIV / other viral infections (EBV and many others)
  • Disseminated Intravascular Coagulation (DIC)
  • Range of congenital conditions
50
Q

is Immune thrombocytopenic purpura (ITP) an immune disorder

A

yes

51
Q

treatment for immune thrombocytopenic purpra (ITP)

A

young children lower than 12 can get bruising, but it is self limiting, but is hemorrhagic can be treated with steroids, doesn’t come back.

52
Q

What causes immune thrombocytopenic purport in children, but not in adults

A

post viral infection

53
Q

common feature os immune thrombocytopenic purpaura in adults

A

relapsing and remitting.

54
Q

symptoms of immune thrombocytopenic purpura

A

bruising and petichae
plalatet count
•

55
Q

treatament for mmune thrombocytopenic purpura

A

steroid
IV immunoglobulin- saturating spleen with antibodies so that it cannot get rid of platelets which are coated with antibodies.
Immunosupresants or spleenectomy.
Newer thrombo-mimetics make more paltelets

56
Q

2 examples of thrombomimetics

A
  • Eltrombopag

* Romiplostin

57
Q

what symptoms alongside thrombocytopenia indicate thrombotic thrombocyotpenia

A
  • Fever
  • Neurological symptoms
  • Haemolysis (retics / LDH)

Clinical Pathology (45 decks)

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