9: Approach to anaemia diagnosis Flashcards Preview

Haematology Week 1 2018/19 > 9: Approach to anaemia diagnosis > Flashcards

Flashcards in 9: Approach to anaemia diagnosis Deck (26)
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1

What is anaemia?

Reduction in Hb concentration

i.e a lack of red blood cells

2

Anaemia can be defined as having a Hb concentration of <__ population average.>

< 95%

3

In what physiological states can a person's Hb concentraiton decrease?

Childhood growth

Pregnancy

Menstruation

4

Apart from a full blood count, what other investigations exist for anaemia?

Reticulocyte count

Blood film

Vit B12 / Folate / Iron levels

Bone marrow biopsy

5

In which causes of anaemia is reticulocyte count raised?

Blood loss

Haemolytic anaemias

6

If reticulocyte count is raised, how would you tell the difference between anaemia caused by blood loss or haemolysis?

Breakdown products raised in haemolysis, not blood loss

so check serum bilirubin, iron

7

What causes hypochromic microcytic anaemia?

iron deficiency

thalassaemia

lead poisoning

congenital sideroblastic anaemia

8

What are some causes of macrocytic anaemia?

Megaloblastic - Vit B12 / folate deficiency; myelodysplasia

Non-megaloblastic - alcohol, liver disease, hypothyroidism

9

What are two causes of spurious macrocytosis?

Reticulocytosis

Cold agglutinins

10

What are some causes of normocytic anaemia?

Bone marrow failure

Malignancy

Renal impairment

Chronic disease

11

What is renal anaemia?

Anaemia caused by impaired kidney function i.e an inability to produce EPO

12

If the kidneys are damaged, which hormone will they struggle to produce?

What type of anaemia does this cause?

EPO

Hypoproliferative normocytic anaemia

13

___ disease can cause a normocytic anaemia.

Renal disease

Chronic disease

14

Which protein, released by the liver, inhibits iron exit from enterocytes?

Hepcidin

15

What can cause increased production of hepcidin leading to a lack of iron in the circulation?

Inflammation in chronic disease

16

In chronic disease, the ___ released during the inflammatory response can cause changes leading to anaemia.

cytokines

17

What happens to

a) iron availability

b) EPO production

c) bone marrow proliferation

in chronic disease?

a) Iron availability decreases

b) EPO production decreases

c) Bone marrow proliferation decreases

18

What type of anaemia does chronic disease cause?

Either normocytic due to hypoproliferation of RBCs

Or microcytic due to less available iron

19

Why do some patients with anaemia of chronic disease respond to iron supplementation?

Not all patients have anaemia due to less available iron

Chronic disease also causes hypoproliferative anaemia so iron might not be the problem

20

Is MCV absolutely or relatively low in microcytic anaemia?

Relatively low

So may not be below reference range but that doesn't mean the patient isn't iron deficient

21

What is the best measurement for diagnosing iron deficiency?

Serum ferritin

22

What are the problems with using serum ferritin to diagnose iron deficiency?

Serum levels are only a representation of levels within liver

Ferritin is an acute phase protein which increases in inflammation

23

What are some microscopic features of red blood cells in iron deficiency anaemia?

Target cells

Rod form / pencil cells

24

What must you think about when reticulocyte count is raised?

Blood loss and/or haemolysis

25

Why does reticulocytosis increase MCV without causing an actual macrocytic anaemia?

Reticulocytes are bigger than normal red cells

26

What are some microscopic features of megaloblastic anaemia?

Megaovalocytes

Hypersegmented neutrophils