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Priority 1 > Haematology > Flashcards

Haematology Flashcards

1
Q

Definition of anaemia

A

Low Hb concentration
Low red cell mass or increased plasma volume

<135g/L for men
<115g/L for women

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2
Q

Symptoms of anaemia

A

Triad: Pallor, SOB, fatigue/lethargy

Hb<80: 
Tachycardia/flow murmurs (ESM)
Splenomegaly
Jaundice
Cardiac enlargement
Retinal haemorrhage
Iron deficiency anaemia:
Abdominal discomfort 
Epigastric/central pain
Angular stomatitis
Atrophic glossitis
Koilonychia
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3
Q

Where does red cell production occur?

A

Marrow of skull, ribs, sternum, vertebral column, pelvis and proximal ends of femurs

Maturation occurs in BM

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4
Q

What is required for red blood cell production?

A

Vitamin B12 and folic acid for DNA synthesis

Iron for haemoglobin synthesis

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5
Q

Where does absorption of iron occur?

Where is iron stored?

A

Duodenum via ferroportin receptors on enterocytes

Absorption controls iron metabolism

Storage:
2/3 incorporated into haemoglobin
1/3 in hepatocytes

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6
Q

How is iron regulated?

A

Hepcidin is the iron regulatory hormone

Its receptor ferroportin controls absorption/storage/diet

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7
Q

Diagnosis of anaemia

A

FBC:
Number and size of cells in blood
Hb, Hct, MCV, MCH, MCHC, RDW, reticulocyte count

Blood film:
Microscopy
Size, shape, colour, inclusions, Howell-jolly bodies

Additional tests:
WBC, platelet count, iron studies (ferritin, serum Fe, TIBC), haematinic levels (B12/folate)

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8
Q

What is included in iron studies?

A 
Ferritin
Transferrin saturation
Serum Fe
Transferrin/ferrin receptors
Total iron binding capacity
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9
Q

Classification of anaemias

A

Size of RBCs:
Microcytic
Normocytic
Macrocytic

Cause:
Decreased production
Increased production
Blood loss

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10
Q

Examples of microcytic anaemia

A

Thalassaemia
Anaemia of chronic disease/iron deficiency anaemia
Lead poisoning/sideroblastic anaemia

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11
Q

What does high/low ferritin mean in microcytic anaemia?

A

High: acute/chronic illness

Low: iron deficiency, GI or gynae blood loss

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12
Q

Examples of normocytic anaemia

A

Acute blood loss
Anaemia of chronic disease
Chronic renal failure/low EPO
Bone marrow hypo/aplasia

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13
Q

Examples of macrocytic anaemia

A 
Reticulocytosis
Megaloblastic
Others/multifactorial: 
Liver disease/alcoholism
Drugs (HIV treatment, anticonvulsants)
Folate antagonists
Chemotherapeutics
Antibiotics
NO
Hypothyroidism
Myelodysplastic syndrome
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14
Q

Anaemia and B12

A

High B12 - myeloproliferative disorders

Normal B12 - alcohol/liver

Low B12 - Pernicious anaemia

Low B12 and low folate - dietary deficiency, malabsorption

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15
Q

Do patients with anaemia require blood transfusion?

A

No:
Treat cause and manage e.g. iron supplementation

Yes:
If severe acute anaemia with Hb <70g/L
Severe chronic anaemia with HF

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16
Q

Define anaemia of chronic disease

A

Low levels of red blood cells as a result of autoimmune disease

17
Q

Pathophysiology of anaemia of chronic disease

A

Poor use of iron in erythropoiesis (decreased absorption in gut, decreased feroportin, stops iron released from Kupffer cells)

Cytokine induced shortening of RBC survival

Decreased production of and response to EPO

18
Q

Causes of anaemia of chronic disease

A 
Chronic infection
Vasculitis
Rheumatoid
Malignancy
Renal failure
19
Q

Investigations for anaemia of chronic disease

A

Mild, normocytic anaemia

Blood film, ferritin, B12, folate, TSH, test for haemolysis

20
Q

Management of anaemia of chronic disease

A

Treat underlying cause
EPO
Parenteral iron can overcome functional iron deficiency

21
Q

Causes of iron deficiency (microcytic)

A

Too much out:
Blood loss, menstruation, GI tract loss, parasites

Not enough in:
Poor diet, malabsorption, increased physiological need

Dilution:
Pregnancy

22
Q

Signs of iron deficiency

A

Koilonychia
Atrophic glossitis
Angular cheilitis
Post-cricoid webs

23
Q

Investigations for iron deficiency

A 
FBC
History
Ix GI loss - OGD, sigmoidoscopy/colonoscopy, stool microscopy for hookworm ova
Coeliac disease screening
H. pylori testing
24
Q

Management of iron deficiency

A

Treat cause
Oral iron
IV iron if oral is impossible or ineffective
Eradicate H. pylori - omeprazole, amoxicillin, clarithromycin or metronidazole

Priority 1 (17 decks)

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