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Anaemia Flashcards

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1
Q

Define Anaemia

A

Low Hb concentration

Due to low red cell mass or increased plasma volume

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2
Q

What are low values in males and females?

A

Low Hb in males: <135g/L

Low Hb in females: <115g/L

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3
Q

What are some general symptoms of anaemia?

A

Fatigue

Dyspnoea

Faintness

Palpitations

Headache

Tinnitus

Anorexia

Angina if pre-existing CAD

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4
Q

What are some general signs of anaemia?

A

May be absent

Pallor e.g. conjunctival

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5
Q

What are signs of severe anaemia?

A

Signs of hyper-dynamic circulation

  • Tachycardia
  • Flow murmurs
  • Cardiomegaly
  • Retinal haemorrhages

Later heart failure may occur

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6
Q

What is a normal MCV?

A

Normal: 76-96fL

First thing that should be checked

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7
Q

Define microcytic anaemia?

A

Anaemia associated with a low MCV (< 80 fl)

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8
Q

What is the aetiology of microcytic anaemia?

A

Defects of haem synthseis:
Iron deficiency
Anaemia of Chronic disease
Sideroblastic anaemia

Defects in globin synthesis:
Thalasaemia
Sickle cell (haemolytic)

Lead poisoning

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9
Q

What causes iron deficiency?

A 
blood loss (e.g. GI – in 
Tropics, hookworm is the most common cause of GI blood loss, menorrhea)

Reduced absorption (e.g. small bowel disease, coeliac, cystic fibrosis, gastectomy)

Increased demands (e.g. growth/pregnancy)

Reduced intakes (e.g. vegans)

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10
Q

What causes anaemia of chronic disease?

A

Due to poor use of iron in erythropoiesis, cytokine-induced shortening of RBC survival, and reduced production of and response to erythropoietin

Hepcidin plays a key role - hormone that regulates iron metabolism

Can occur in many chronic diseases e.g. chronic infection, vasculitis, rheumatoid arthritis, malignancy, renal failure

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11
Q

What is sideroblastic anaemia?

A

Abnormality of haem synthesis

Can be inherited or secondary (e.g. to alcohol/drugs)

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12
Q

Epidemiology of microcytic anaemia?

A

Iron deficiency anaemia is the MOST COMMON form of anaemia worldwide

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13
Q

Presenting symptoms of microcytic anaemia?

A
  • Tiredness

o Lethargy

o Malaise

o Dyspnoea

o Pallor

o Palpitations

o Exacerbation of ischaemic conditions

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14
Q

What can lead poisoning cause?

A

Microcytic anaemia

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15
Q

What are the symptoms of lead posioning?

A
  • Anorexia

o Nausea/Vomiting

o Abdominal pain

o Constipation

o Peripheral nerve lesions

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16
Q

What are the signs of microcytic anaemia on examination?

A
  • Pallor

o Brittle nails and hair

o Koilonychia (if severe)

Glossitis

· Angular stomatitis

· Signs of thalassemia

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17
Q

What are the signs of lead poisoning?

A
  • Blue gumline

o Peripheral nerve lesions (causing wrist or foot drop)

o Encephalopathy

o Convulsions

o Reduced consciousness

*basophilic stippling on blood film

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18
Q

What are the appropriate investigations for microcytic anaemia?

A 
FBC
Serum iron
Total iron binding capacity
Serum ferritin (high in ACD)
Serum lead
CRP/ESR for ACD
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19
Q

What is seen on a blood film in microcytic anaemia?

A

Microcytic
Hypochromic
Anisocytosis
Poikilocytosis

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20
Q

What is seen on a blood film in sideroblastic anaemia?

A

Dimorphic blood flim

Hypochromic microcytic celles

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21
Q

What is the treatment for iron deficiency anaemia?

A

Oral iron supplements

OCP for menorrhagia

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22
Q

What is the treatment for sideroblastic anaemia?

A

o Treat the cause

o Pyridoxine used in inherited forms

o Blood transfusion and iron chelation can be considered if there is no response to other treatments

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23
Q

What is the treatment for lead poisoning?

A

o Remove the source

o Dimercaprol

o D-penicillinamine

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24
Q

Define normocytic anaemia?

A

Anaemia with a normal MCV (80-100).

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25
Aetiology of normocytic anaemia?
``` Acute blood loss Failure of RBC production Haemolysis Uncompensated increase in plasma volume Pooling of red cells in spleen ```
26
What can cause failure in RBC production?
Bone marrow failure or suppression e.g. aplastic anaemia, chemotherapy Bone marrow infiltration e.g. malignancy Renal failure – abnormal erythropoietic drive Early stages of iron deficiency or anaemia of chronic disease Hypothyroidism (can be macrocytic) Vitamin B2 deficiency Vitamin B6 deficiency
27
What can cause an increase in plasma?
Pregnancy Fluid overload
28
Presenting symptoms of normocytic anaemia?
Breathlessness Fatigue Conjunctival pallor
29
Investigations for normocytic anaemia?
FBC - check Hb and MCV Check history for haemorrhage If WCC low or platelets low, suspect marrow failure
30
Define macrocytic anaemia?
Anaemia associated with a high MCV of erythrocytes (>100 fl in adults) Usually results from abnormal haemopoiesis so that red cell precursors continue to synthesis haemoglobin and other cellular proteins but fail to divide normally.
31
What is megaloblastic anaemia?
specifically refers to a delay in maturation of the nucleus while the cytoplasm continues to mature and the cell continues to grow - unusually large, structurally abnormal, immature red cell
32
What are the main features of megaloblastic anaemia?
Oval macrocyctes o Caused by deficiency of B12 or folate required for the conversion of deoxyuridate to thymidylate, DNA synthesis and nuclear maturation
33
What are the causes of B12 deficiency?
Reduced absorption (e.g. post-gastrectomy, pernicious anaemia – autoimmune condition causing severe lack of IF, terminal ileal/small bowel resection or disease) · Reduced intake (vegans) · Abnormal metabolism (congenital transcobalamin II deficiency)
34
What are causes of folate deficency?
- Reduced intake (alcoholics, elderly, anorexia) · Increased demand (pregnancy, lactation, malignancy, chronic inflammation) · Reduced absorption (coeliac, tropical sprue) · Jejunal disease (e.g. coeliac disease) · Drugs (e.g. phenytoin)
35
What can cause non-megaloblastic macrocytic anaemia?
Alcohol excess or Liver disease – ROUND macrocytes o Myelodysplasia o Multiple myeloma o Hypothyroidism o Aplastic anaemia o Haemolysis (shift to immature red cell form - reticulocytosis) o Drugs (e.g. tyrosine kinase inhibitor) o Pregnancy
36
Summarise the epidemiology of macrocytic anaemia
More common in ELDERLY FEMALES · Pernicious anaemia is the MOST COMMON cause of B12 deficiency in the West
37
Recognise the presenting symptoms of macrocytic anaemia
Tiredness o Lethargy o Dyspnoea · Family history of autoimmune disease · Previous GI surgery · Symptoms of the CAUSE (e.g. weight loss, diarrhoea)
38
Signs of Pernicious Anaemia
- Mild jaundice o Glossitis o Angular stomatitis o Weight loss
39
Signs of B12 Deficiency
- Peripheral neuropathy o Ataxia o Subacute combined degeneration of the spinal cord o Optic atrophy o Dementia o Positive Babinski’s, absent ankle reflex, increase knee reflex
40
Bloods for macrocytic anaemia?
FBC · High MCV · Pancytopaenia in megaloblastic anaemia · Different degrees of cytopaenia in myelodysplasia · Exclude reticulocytosis o LFT · High bilirubin (due to ineffective erythropoiesis or haemolysis) o ESR o TFT o Serum vitamin B12 o Red cell folate o Anti-parietal cell (90%) and anti-intrinsic factor antibodies (40-60%) o Serum protein electrophoresis - looking for a dense band in myeloma
41
What does megaloblastic anaemia look like on a blood film?
Megaloblasts · Hypersegmented neutrophil nuclei · Target cells if liver disease
42
How can you test for pernicious anaemia?
schilling Test o Method of testing for pernicious anaemia o B12 will only be absorbed when given with intrinsic factor
43
What is treatment for pernicious anaemia?
IM hydroxycobalamin for life o If no neurological defect IM hydroxycobalamin 1mg 3x/week for 2 weeks then 1mg/3 months o If neurological defect present 1mg every other day until no further improvement then 1mg/2 month
44
What is treatment for folate deficiency?
Oral folic acid o If B12 deficiency is present, it must be treated before the folic acid deficiency as B12 is needed for folate to enter cells · In pregnancy, prophylactic folate is given from conception until 12 weeks to prevent spina bifida
45
What are some complications of macrocytic anaemia?
Pernicious anaemia --> increased risk of gastric cancer · Pregnancy - folate deficiency increases the risk of neural tube defects
46
Define haemolytic anaemia?
Premature erythrocyte breakdown causing shortened erythrocyte life span (< 120 days) with anaemia
47
What are some presenting symptoms of haemolytic anaemia?
- Jaundice · Haematuria · Dark urine · Anaemia · Can often be asymptomatic · Family history · Race · Recent travel
48
What are the signs of haemolytic anaemia on examination?
- Pallor · Jaundice · Hepatosplenomegaly · Leg ulcers, due to poor blood flow - Pigementuria
49
What is seen on a FBC in haemolytic anaemia?
- Low Hb · High reticulocytes (polychromasia) · High MCV · High unconjugated bilirubin · Low haptoglobin (a protein that binds to free Hb released by red blood cells) o U&Es o Folate
50
What is seen on a blood film in haemolytic anaemia?
- Leucoerythroblastic picture o Macrocytosis o Nucleated erythrocytes or reticulocytes o Polychromasia
51
How can you test for auto-immune haemolytic anaemia?
Coomb's test positive (direct antiglobulin test) | Antibody to RBC antibody leads to clumping of RBC
52
What are the acute complications of sick cell disease?
``` Vaso-occlusive crisis Acute chest syndrome Stroke Infection Fat embolism Splenic sequestration ```
53
What is Sickle cell disease?
``` disease of red blood cells Caused by an autosomal recessive single gene defect in the beta chain of haemoglobin Sickle cell Hb production fragile and haemolyse occlude small vessles ```
54
What are presenting features of sickle cell disease?
FH Persistent pain in skeleton, chest, abdomen Dactylitis Pallor Jaundice Febrile illness Tachycardia/Tachypnoea
55
How would you investigate cause of iron deficiency anaemia?
History and exam | e.g. menhorragia in pre-menopausal woman
56
What are causes of iron deficiency anaemia?
Decreased intake - dietary - malabsorption Increased blood loss - GI bleed - GI cancer - Menorrhagia Increased requirements - Pregnancy - CKD
57
What would iron studies show in anaemia of chronic disease?
Ferritin high | Transferrin low
58
What investigation is done for sickle cell anaemia?
Haemoglobin electrophoresis
59
What is the treatment for a vaso-oclusive sickle cell crisis?
Analgesia Supportive care +/- blood transfusion
60
What preventive measures are taken in sickle cell?
Reduce infection risk - Pneumococcal immunisation - AB prophylaxis - Good nutrition
61
What are causes of megaloblastic anaemia?
B12/Folate deficency
62
What are features of megaloblastic anaemia on blood film?
Hypersegmented neutrophils | Impaired DNA synthesis produces abnormal cell production
63
What are signs OE for iron deficency anaemia?
Angular stomitis Atrophic glossitis Koilonychia
64
What are some metabolic causes of haemolytic anaemia?
Pyruvate kinase deficiency | G6PD deficiency
65
What is MAHA? What causes it?
Microangiopathic haemolytic anaemia | Causes: haemolytic-uraemic syndrome, TTP, DIC, pre-eclampsia
66
How might MAHA, G6PD and AI Haemolytic anaemia's present on blood film?
Schistocytes - MAHA Heinz bodies - G6PD Spherocytes - autoimmune haemolytic
67
What can cause intravascular haemolytic anaemia?
Malaria G6PD Deficency Mismatched blood transfusions (ABO) Cold antibody haemolytic syndromes Drugs MAHA (e.g. HUS, TTP) Paroxysmal nocturnal haemoglobinuria
68
How can we classify hereditary haemolytic anaemia's?
Membrane Red cell Metabolism Hb
69
What are the consequences of haemolysis?
Anaemia (not always, there is compensation with increased erythropoiesis) Increased reticulocytes Increased folate demand for production of RBCs Increases susceptibility to parvovirus B19
70
What are the clinical effects of G6PD deficiency?
Neonatal jaundice Acute Haemolysis Rarely chronic haemolytic anaemia X-linked Positively selected for in areas with endemic malaria
71
What can precipitate acute haemolysis in G6PD deficiency?
Drugs Infection Fava Beans
72
What are the principles of management for haemolytic anaemia?
Folic acid suppplementation Avoidance of precipiating factors Red cell transfusion Immunisation against blood born virus Splenectomy
73
What are indications for splenectomy in haemolytic anaemia?
PK deficiency Hereditary spherocytosis Severe elliptocytosis/pyropoilikocytosis Thalassaemia syndromes Immune haemolytic anaemia
74
What are the risks with splenectomy?
Risk of sepsis Esp capsulated bacteria e.g. pneumoccocus

Year 3 Haem (7 decks)

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