Acquired Anaemias Flashcards

1
Q

Firstly define Anaemia

A

A haemoglobin below the normal range for Age/Sex/Ethnicity

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2
Q

What are the clinical features of anaemia

A
Think poor perfusion:
- Fatigue
- SOB
- Ankle Swelling
- Dizziness
- Chest Pain
Symptoms of the cause
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3
Q

What is your first test when suspecting anaemia?

A

A FBC

Tells you the haemoglobin and the MCV/MCH

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4
Q

How do we describe anaemias?

A

Morphologically based on MCH & MCV

1) Hypochromic, Microcytic
2) Normochromic, Normocytic
3) Macrocytic

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5
Q

FBC shows hypochromic, microcytic anaemia, what are the likely causes?

A

Most likely Fe-deficiency Anaemia, if you’re in any doubt do a serum Ferritin to check (should be low)

If Ferritin is fine then it may be a secondary anaemia or Thalassaemia

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6
Q

Fe-deficiency anaemia is not a diagnosis but must have a cause, what could cause it?

A

Malabsorption e.g. gastritis or coeliac

Blood loss e.g. GI or menorrhagia

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7
Q

What elements of a history/exam could suggest iron deficiency anaemia?

A

Evidence of bleeds e.g. dyspepsia, PR bleeding or menorrhagia
Diet (in kids/elderly)
Pregnancy (increases Fe need)

Koilonychia, atrophic tongue & angular stomatitis

Also do Abdo & rectal exam looking for the cause

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8
Q

What tests can we do if we get a case of Fe-deficiency anaemia?

A

Endoscopy & barium study can be done if there’s evidence of GI blood loss

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9
Q

How do you treat Fe-deficiency anaemia?

A

Oral Iron +/- transfusion

Treat the cause

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10
Q

Patient presents with a Normochromic, normocytic anaemia, how would you proceed?

A

Test their Reticulocyte count.
If it’s increased it means you’re losing RBCs and the marrow is compensating –> Blood loss of haemolysis

If its normal or low –> Secondary anaemia, marrow infiltration etc

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11
Q

So lets say this patient’s reticulocyte count is high and you suspect a haemolytic anaemia. What could cause that?

A

Autoimmune HA (Extravascular haemolysis)

Or an intravascular cause:

  • Mechanical e.g. art valve leaking
  • Severe inf
  • Pre-eclampsia, HUS or DIC
  • Drugs

Congenital causes e.g.:

  • G6PD deficiency
  • Hereditary Spherocytosis
  • Haemoglobinopathies e.g. Sickle cell
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12
Q

So we’ve done a FBC (normocytic/chromic) & a reticulocyte count (high).
How would we test a patient to see if they’re haemolysing?

A

Blood film = can see haemolysed cells
Serum Bilirubin = High
LDH = High
Serum Haptoglobin = low (eats up free haemoglobin)

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13
Q

How would we identify the cause of a haemolytic anaemia?

A

Coomb’s Test:
Detects Ab/complement on the red cell membrane so if +Ve suggests an immune source

Can also test urine for Haemosiderin & Urobilinogen

  • Haemosiderinuria in intravascular haemolysis
  • Extravascular haemolysis increases serum bilirubin –> high Urobilinogen
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14
Q

What can trigger an auto-immune haemolytic anaemia and how does coomb’s test help us with that?

A

Auto-antibodies from different triggers will agglutinate at different temperatures in coomb’s test so:

  • Warm temps = idiopathic, drugs or CLL
  • Cold Temps = CHAD, infection or lymphoma
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15
Q

How would we manage a haemolytic anaemia?

A

Support the marrow with Folic Acid
~Transfusion

Correct cause:

  • IV Abx if septic
  • Prosthetic valve replacement if leaky
  • Immunosuppression & treat trigger if immune

Can also remove the site of haemolysis i.e. spleen

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16
Q

Most secondary anaemias are Normochromic Normocytic, some are Hypochromic, microcytic. What causes them?

A

Something causes inflammation –> Increased hepcidin –> Decreased Fe absorption

Look for infection, inflammatory disorders and malignancy

17
Q

Ok so a FBC identifies a Macrocytic Anaemia, what would you do from there?

A

A blood film to test for Megaloblastic vs non-megaloblastic

18
Q

Megaloblastic anaemia? how would you proceed?

A

It’s probably a B12 or Folate Deficiency so do a B12/folate assay to identify which one

Also look out for neuro symptoms from Subacute Combined Degeneration of the cord in B12 deficiency

19
Q

What causes a B12 deficiency?

A

Gastric/ileal disease stopping absorption

More likely pernicious anaemia, an autoimmune attack on your gastric parietal cells/intrinsic factor

20
Q

What causes a folate deficiency?

A

Diet
Haemolysis
GI pathology e.g. Coeliac

21
Q

How do we treat a megaloblastic anaemia?

A

Oral Folate

B12 IM inj

22
Q

What could cause a non-megaloblastic Macrocytic anaemia?

A

Some problem with the marrow e.g. Myelodysplasia, Marrow infiltration or drugs:

  • Alcohol
  • MTX
  • Anti-retrovirals
  • Hydroxycarbamide