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Medicine Y3 TCD 1-12 > 11. Anaemia > Flashcards

11. Anaemia Flashcards

1
Q

What is anaemia

A

defined as a low level of haemoglobin in the blood
an- means without
-aemia refers to blood

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2
Q

what does mean cell volume tell you (MCV)

A

the size of the RBC

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3
Q

what does the mean corpuscular haemoglobin (MCH) tell you

A

the average mass of Hb per RBC

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4
Q

what does mean corpuscular haemoglobin concentration (MCHC) tell you

A

the concentration of Hb in a given volume of packed red blood cells

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5
Q

What are the main causes of microcytic anaemias (mnemonic tails)

A 
Thalassaemia 
Anaemia of chronic disorders
Iron deficiency anaemia 
Lead poisoning 
Sideroblastic anaemia
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6
Q

What are the main causes of normocytic anaemia (3A and 2H)

A 
acute blood loss
anaemia of chronic disease
aplastic anaemia 
haemolytic anaemia
hypothyroidism
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7
Q

what is macrocytic megaloblastic anaemia

A

this is a result of impaired DNA synthesis preventing the cell from deciding normally and so it keeps growing into a larger, abnormal cell

Folate or B12 deficiency

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8
Q

what are some causes of normoblastic microcytic anaemia

A 
alcohol 
reticulocytosis 
hypothyroidism 
liver disease 
drugs such as azathioprine (immunosuppressant)
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9
Q

what are the generic symptoms of anaemia

A 
tiredness
SOB
headaches 
dizziness 
palpations 
worsening of other conditions such as angina, heart failure or peripheral vascular disease 
weakness
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10
Q

what are the symptoms/signs specific to IDA

A 
PICA which is dietary craving for abnormal things such as dirt 
Hair loss 
headache, especially with activity 
sore or smooth tongue 
brittle nails or hair loss 
spoon shaped nails
angular chelitiis
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11
Q

what are the generic signs of anaemia

A

pale skin
conjunctival pallor
tachycardia
raised RR

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12
Q

in what kind of anaemia does jaundice occur in

A

haemolytic anaemia

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13
Q

in what kind of anaemia does bone deformities occur in

A

Thalassaemia

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14
Q

in what kind of anaemia does koilinychia, angular chelitis, atrophic glossitis and brittle hair and nails occur in

A

iron deficiency anaemia

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15
Q

Define and describe hypochromia

A

the red blood cells are paler than normal ad this can be evaluated by the mean corpuscular haemoglobin (MCH)
note that in hypochromia the area of central pallor is increased

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16
Q

true or false: microcytic anaemias are associated with hypothermia ie they have less Hb in them than normal

A

true

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17
Q

Is adult dietary iron deficiency common

A

no, it is uncommon

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18
Q

why does normocytic anaemia from blood loss take several hours to be detected

A

the loss of blood volume will be replaced by either non-red cell containing fluids or by natural plasma expansion

note that it could be that there has been only limited fluid replacement

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19
Q

Why does rapid blood loss not immediately affect the Hb levels

A

the Hb is measured as a concentration of red cells in plasma and is not an absolute value

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20
Q

If you loose 1000ml of blood, this represents what amount of iron loss

A

500mg

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21
Q

B12 information:

Tell me about transcobalamin (TCN1), aka heptocorrin, R factor and R. protein

A 
it is a glycoprotein produced by the salivary glands of the mouth 
protects cobalamin (vitamin B12) form acid degradation in the stomach by binding to it
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22
Q

B12 information:

what happens to the B12-transcobalamin when it reaches the duodenum

A

pancreatic proteases degrade haptocorrin aka transcobalamin

free B12 bids to intrinsic factor (IF)

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23
Q

B12 information:

where is intrinsic factor produced from

A

stomach parietal cells

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24
Q

B12 information:

why do you need intrinsic factor

A

needed to be able to bind to enterocyte (cubulin receptors in the terminal ileum)

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25
Q

IDA:

in what scenarios are iron stores used up, making the patient iron deficient

A

insufficient dietary iron
iron requirements increase (for example pregnancy)
iron is being lost (for example slow bleeding from a colon cancer)
inadequate iron absorption

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26
Q

name 2 GI diseases that can affect the absorption of iron

A

coeliac disease

chron’s disease

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27
Q

IDA

what is the most common cause in adults

A

blood loss

  • (consider menorrhagia in women of childbearing age
  • in men and post menopausal women the most common cause is GI tract cancer
  • note that oesophagitis and gastritis are the most common causes of GI tract bleeding
  • IBD should also be considered
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28
Q

IDA:

how does iron travel around the blood

A

ferric ions (Fe3+) bound to a career protein called transferrin

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29
Q

IDA

What is total iron binding capacity (TIBC)

A

the total space on the transferrin molecule for the iron to bind

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30
Q

IDA

how do you calculate transferrin saturation and what does this tell us

A

the proportion of transferrin molecules that are bound to iron
= serum iron/ total iron binding capacity

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31
Q

IDA

what is the form that iron takes when it is deposited and stored in cells

A

ferritin

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32
Q

IDA

in what. situation would extra ferritin be released from cells

A

inflammation, such as with infection or cancer

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33
Q

IDA

in IDA what would you expect the TIBC and transferrin levels to be

A

increased

34
Q

IDA

what two things can increase the values of all the iron testing results, giving the impression of iron overload

A

supplementation with iron

acute liver damage (lots of iron is stored in the liver

35
Q

IDA

what are the treatment options that are considered to treat this

A

a blood transfusion will immediately correct the anaemia
iron infusion eg cosmofer
oral iron eg serous sulphate 200mg TD

36
Q

what is the main side effect with iron supplements

A

causes constipation and black coloured stools

37
Q

when correcting IDA you can. expect the Hb to rise by around _____ g/L a week

A

10

38
Q

what is a hematinic and what are the main 3

A

a hematinnic is a nutrient that is required for the formation of blood cells in the process of haematopoiesis

iron, B12 and folate

39
Q

why do a lot of babies have iron deficiency

A

milk affects the ability of the body to absorb iron

40
Q

in post-menopausal women or older male, what conditions can you not miss when someone has anaemia

A

cancer of the GI system

41
Q

Thalassaemia:

what is a normal Hb molecules consisting of

A

2 alpha and 2 beta globin chais (A1)

42
Q

Thalassaemia:

what is beta Thalassaemia minor and how is it diagnosed

A

have one abnormal beta globin gene and diagnosed by having a raised HbA2 which is the normal variant off Hb in which you have 2 alpha chains and 2 delta chains

43
Q

Thalassaemia:

what is beta Thalassaemia major

A

2 abnormal genes and so you have no adult Hb (HbA) only HbF (foetal)

44
Q

Thalassaemia:

describe what happens in alpha Thalassaemia depending on how many genes are deleted (note there are 4)

A

o 1 gene deleted- clinically silent
o 2 gene deleted- alpha thalassaemia trait
o 3 gene deleted- haemoglobin H disease (moderately severe anaemia develops due to reduced formation of alpha globin chains)
o 4 genes deleted- barts hydrops fetalis (foetus usually dies)

45
Q

name some causes of IDA

A

Rapid growth, menarche, pregnancy
prematurity, low birth weight
cows milk in toddlers
GIT: GI bleed (could be taking a lot of NSAIDs)
menorrhagia
• Misc causes: renal tract bleeding, idiopathic pulmonary haemosiderosis, bleeding diathesis

46
Q

True or false: a low ferritin at times of rapid growth (infancy, adolescence) does not necessarily mean that there is iron deficient erythropoiesis

A

true

47
Q

why does ferritin give falsely high values in infections and patients with long term inflammatory conditions such as rheumatoid arthritis

A

ferritin is an acute reactant protein

48
Q

name some causes of B12 deficiency

A

nutritional: vegan, poor diet, pregnancy
Malabsorption: gastro causes are surgery or pernicious anaemia (IF and gastric parietal cell antibodies). Intestinal causes are iliac resection,
Get malabsorption but not deficient in chrons, coeliac and CF

49
Q

Name some common causes of folate deficiency

A

nutritional: poor diet, goat milk only drinkers (this has iron but no folate)
coeliac disease or jejunal resection
excessive requirement during pregnancy, prematurity
increased turnover: in chronic Haemolysis, severe skin conditions
Drugs: methotrexate, anticonvulsants
Excess loss during dialysis
alcohol (although beer is a good source of folate)

50
Q

What are some of the main signs in someone with B12 deficiency

A

Incidious onset (comes on slowly at first and doesn’t have obvious symptoms at first)
neuropathy
mild jaundice and anaemia
glossitis (inflammation of the tongue)
angular cheilitis (inflammation of the corners of the mouth)

51
Q

what is one of the main symptoms of folate deficiency

A

similar to b12 deficiency but more often a sensory peripheral neuropathy only

52
Q

Name some other causes of macrocytosis (large red blood cells) that isn’t Vitamin B12 and folate deficiency

A 
alcohol
pregnancy 
chemotherapy, anti-HIV drugs 
liver disease
raised reticulocyte count 
hypothyroidism 
aplastic anaemia (fails tp produce red blood cells in sufficient quantities)
hypoxia 
Myeloma
53
Q

When you tell a patient to take iron supplements, what advice should you give them

A

take it on an empty stomach with orange juice (ascorbic acid), don’t take it with tea, coffee, eggs or milk products and be aware that your stools may turn black

54
Q

True or false: folate alone may exacerbate neuropathy symptoms

A

true

55
Q

what is pernicious anaemia

A

autoimmune condition where antibodies form against the parietal cells or intrinsic factor
a lack of IF prevents the absorption of B12

56
Q

What neurological symptoms can B12 deficiency cause

A

peripheral neuropathy with numbness or paraesthesia (pins and needles)
loss of vibration sense or proprioception
visual changes
mood or cognitive changes

57
Q

TOM TIP:
in exams you should remember to test for what if someone presents with peripheral neuropathy, particularly with pins and needles

A

vitamin b12 deficiency and pernicious anaemia

58
Q

If there is a folate deficiency as well as a B12 deficiency, why is it important to treat the B12 deficiency first. I.E why should you not give someone folic acid when they have a b12 Deficiency

A

can lead to subacute combined degeneration of the cord

59
Q

what is haemolytic anaemia

A

anaemia as a result of increase in destruction of red blood cells (Haemolysis)

60
Q

in haemolytic anaemia what is the main thing on the FBC that would be raised

A

increased reticulocyte

61
Q

Name some inherited haemolytic anaemias

A
  • Hereditary Spherocytosis
  • Hereditary Elliptocytosis
  • Thalassaemia
  • Sickle Cell Anaemia
  • G6PD Deficiency
62
Q

Name some acquired haemolytic anaemias

A
  • Autoimmune haemolytic anaemia
  • Alloimmune haemolytic anaemia (transfusions reactions and haemolytic disease of newborn)
  • Paroxysmal nocturnal haemoglobinuria
  • Microangiopathic haemolytic anaemia
  • Prosthetic valve related haemolysis
  • Copper deficiency (Wilson’s disease)
63
Q

AS a result of the destruction of red blood cells, what symptoms would you expect to see in someone with haemolytic anaemia

A

anaemia due too reduction in circulating red blood cells
splenomegaly as the spleen becomes filled with destroyed red blood cells
jaundice as bilirubin is released during the destruction of red blood cells

64
Q

What is hereditary spherocytosis

A

autosomal dominant condition which causes a share shaped red blood cell that are fragile and easily break down when passing through the spleen

65
Q

how does hereditary spherocytosis present

A

jaundice, gallstones, splenomegaly and notably aplastic crisis

66
Q

what is the treatment for hereditary spherocytosis

A

foliate supplementation and splenectomy

removal of gallbladder (cholecystectomy) may be required if gallstones are a problem

67
Q

TOM TIP: The key piece of knowledge for G6PD deficiency relates to triggers. In your exam look out for a patient that presents in what way

A

turns jaundice and becomes anaemia after eating broad beans, developing an infection or being treated with antimalarials.

68
Q

What is G6PD deficiency and what triggers a crisis

A

a condition where there is a defect in the red blood cell enzyme G6PD
more common in Mediterranean and African patients ad is X linked recessive
Causes crisis that are triggered by infections, medications or lava beans

69
Q

what is autoimmune haemolytic anaemia (AIHI)

A

occurs when antibodies are created against the patients red blood cells

70
Q

what is the usual cause of warm type autoimmune haemolytic anaemia

A

it is idiopathic

71
Q

what is the usual cause of cold type autoimmune haemolytic anaemia

A

often secondary to other conditions such as lymphoma, leukaemia, systemic lupus erythematous and infections such as mycoplasma, EBV, CMV and HIV

72
Q

what is the management of autoimmune haemolytic anaemia

A

blood transfusion
prednisolone steroid
rituximab (a monoclonal antibody against B cells)
Splenectomy

73
Q

What is the haemoatocrit

A

the percentage of red blood cells in blood

74
Q

what is mean cell volume

A

MCV is the size of the red blood cells

75
Q

What does the reticulocyte count tell you

A

measures the number of new red blood cells being produced (high reticulocyte count may mean that they are being destroyed prematurely and low reticulocyte means not enough is being produced

76
Q

Around 6 weeks of age what is fetal Hb replaced with

A

Hb A

77
Q

patients with sickle cell disease have an abnormal variant of Hb known as

A

HbS which causes the red blood cells to be an abnormal sickle shape

78
Q

what kind of genetic inheritance is sickle cell disease

A

autosomal recessive

79
Q

why is there no need for sickle cell patients to receive constant blood transfusion

A

the oxygen dissociation curve of sickle Hb is shifted to the right and oxygen is more readily. released to the tissues which makes the anaemia well tolerated

80
Q

what do anti globulin tests look for

A

antibodies to red blood cells

81
Q

what medication is used in sickle cell patients which switches back on the production of fetal Hb

A

hydroxyurea

Medicine Y3 TCD 1-12 (30 decks)

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