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Clinical Pathology > Common causes of anaemia and thrombocytopenia > Flashcards

Common causes of anaemia and thrombocytopenia Flashcards

1
Q

What are the main causes of anaemia (other than blood loss)?

A
  • B12/folate def
  • Chronic disease-
    Haemolysis
  • Alcohol, drugs, toxins
  • Renal impairement - EPO
  • Haematological/marrow disorders e.g. malignant, haemoglopathies, aplasia, congenita
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2
Q

What conditions are associated with macrocytic, normocytic and microcytic RBC?

A

Macro - B12/folate def, marrow damage (alcohol/toxin, marrow disease), haemolysis (new ones are bigger than old ones)

Normo - chronic disease/inflammatiojn

Micro - Hb-opathies, iron def

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3
Q

Why is iron deficiency so common?

A

Iron is not absorbed easily (at duodenum) - mostly recycled

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4
Q

How is iron stored in in the body?

A

In ferritin

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5
Q

How is iron deficiency diagnosed?

A

LOW FERRITIN LEVELS

- low MCV, hypochromic (small, pale)

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6
Q

What causes iron deficiency?

A

Blood loss e.g. menstrual loss/periods, cancer, ulcer, GI etc

Increased demand e.g. growth/pregnancy

Malabsorption - diet/malabsorption

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7
Q

How is iron deficiency treated (best way!)?

A

IV iron

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8
Q

What is the cause of macrocytic RBCs?

A

Impaired DNA synthesis

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9
Q

Why does folate/B12 deficiency cause macrocytic RBCs?

A

Folate involved in purine/pyridamine synthesis

B12 required for folate synthesis

therefore, deficiency causes DNA synthesis impairment

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10
Q

How is B12 absorbed? What is the cause of B12 deficiency?

A

Parietal cells in stomach produce intrinsic factor which binds to B12

B12-intrinsic factor - absorbed in terminal ileum by specific factors

NOT cause by malnutrition, deficiency somewhere in this pathway

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11
Q

What are the main causes of B12 deficiency?

A

Stomach - pernicious anaemia , gastrectomy

Terminal ileum - churns disease, terminal ileum resection

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12
Q

How is folate deficiency caused?

A
  • Malnutrition
  • Increased demand e.g. pregnancy, haemolysis
  • Malabsorption/small bowel disease
  • Alcohol/toxins/ITU
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13
Q

What are the common features of B12/folate deficiency?

A
  • Megablastic anaemia
  • Pancytopenia (low RBCs, WBCs, platelets)
  • mild jaundice
  • anorexia/weight loss
  • sterility
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14
Q

What are lab features of B12 and folate deficiency?

A
  • Blood count and film
  • Bilirubin and LDH - haemolysis (do not last as long!)
  • Antibodies - pernicious anaemia
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15
Q

What is pernicious anaemia?

A

Autoimmune condition where body produces antibodies against parietal cells.

Intrinsic factor not produced so doesn’t bind to B12.

B12 not absorbed by terminal ileum - therefore, B12 deficiency

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16
Q

What is the over condition associated with severe B12 deficiency?

A

Subacute combined degeneration of the cord

Demyelination of dorsal and lateral columns

Peripheral nerve damage

Reversible cause of demenetion

17
Q

What is the treatment of B12 and folate deficiency?

A

B12 and folate infused (muscularly) until B12 deficiency excluded

DO NOT GIVE folate individually - can exacerbate B12 induced neuropathy

18
Q

What are the main causes of haemolysis?

A
  • Things wrong inside RBC
  • Things wrong with RBC membrane
  • Things wrong external to RBC
19
Q

What intrinsic RBC factors could cause haemolysis?

A 
Sickle cell disease
Enzyme deficiency (G6PD)
20
Q

What RBC membrane factors could cause haemolytic disease?

A

Hereditary sphereocytosis

21
Q

What external RBC factors could cause haemolysis?

A
  • Antibodies (autoimmune -haemolytic anaemia - COOMB’S TEST)
  • Vasculitis
  • Heart valves (mechanical)
  • Toxins/drugs
22
Q

What are the diagnostic markers for haemolysis?

A
  • Anaemia (?)
  • Macrocytic RBCs (increased reticulocytes)
  • RBC film - fragments, spherocytes
  • Raised Bilirubin/LDH
23
Q

What is the normally MCV for chronic disease?

A

Normocytic

24
Q

How is anaemia in chronic disease usually caused?

A

Inflammatory diseases reduces iron absorption and iron metabolism

Poor erthropoetin response

Blunted marrow response

25
Q

What inflammatory cytokine regulates iron absorption and release from macrophages?

A

Hepcidin

26
Q

What are the presentations of people with chronic diseases (in relation to anaemia?)

A

Normocytic; mild anaemia

No other cause for anaemia other than condition

27
Q

How do you treat anaemia in people with chronic disease?

A

Treat underlying cause

  • EPO/iron (IV)
  • Blood transfusion if severe
28
Q

What are the common causes of thrombocytopenia?

A
  • Alcohol
  • Immune thrombocytopenia (ITP)
  • Other autoimmune diseases
  • Pregnancy
  • DIC
  • Coagulation disorders
  • haematological/bone marrow disorders
29
Q

What is the difference between adult and childhood immune thrombocytopenia purport?

A

Child - viral prodrome, platelets go down to very low levels but self limiting - will fully recover after a few weeks

Adult - no viral prodrome - chronic and remitting

30
Q

What type of disorder is immune thrombocytopenia? What conditions is it associated with?

A

Immune disorder
- HIV
- other autoimmune conditions
Lymphomas

31
Q

What is the presentation of immune thrombocytopenia?

A

Bruising or petechiae or bleeding (depending on platelet count)

32
Q

How do you treat immune thrombocytopenia?

A

Steroids

IV immunoglobulin

Immunosuppressants/splenectomy- prevents spleen removal of platelets (by its removal or through saturation)

Thrombopoetins - make more platelets

33
Q

What are the clinical symptoms of thrombotic thrombocytopenia perpura? (TTP)

A 
F ever
A anaemia 
T hrombocytopenia
R renal disease
N urological symptoms
34
Q

What is TTP caused by?

A

Autoimmune condition - specifically against protease ADAMTS13

35
Q

What is TTP characterised by?

A

Clotting in small blood vessels of the body (thromboses), resulting in a low platelet count

36
Q

How is TTP treated

A

steroids

Clinical Pathology (50 decks)

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