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Y2 Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Define anaemia?

A

Low Hb or low RBCs for perons sex and age

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2
Q

Three main categories of anaemia?

A

1) erthropoiesis (can’t make RBC)
2) losing RBC
3) RBC being destroyed (haemolytic anaemia)

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3
Q

Primary and secondary erthropoiesis anaemia causes?

A

primary - Fancoi’s anaemia/phenytoin
seconary - malgignancy (lymphoma, leukaemia), infection (EBV/ Hep C/ TB/ HIV/ CMV/ parovirus B19)

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4
Q

Causes of losing RBC anaemia?

A

Menstruation, blood loss

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5
Q

Inherited causes of chronic haemolytic anaemia?

A

Hereditary spherocytosis
Hereditary elliptocytosis
G6Pd deficiency
Sickle cell anaemia
Thalassaemia

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6
Q

Acquired causes of chronic haemolytic anaemia?

A

Autoimmune haemolytic anaemia
Alloimmune haemolytic anaemia (e.g., transfusions reactions and haemolytic disease of newborn)
Paroxysmal nocturnal haemoglobinuria
Microangiopathic haemolytic anaemia
Prosthetic valve-related haemolysis

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7
Q

Features of haemloytic anaemia?

A

Anaemia
Splenomegaly (the spleen becomes filled with destroyed red blood cells)
Jaundice (bilirubin is released during the destruction of red blood cells)

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8
Q

What are key investigations for haemolytic anaemia?

A

Full blood count shows a normocytic anaemia
Blood film shows schistocytes (fragments of red blood cells)
Direct Coombs test is positive in autoimmune haemolytic anaemia (not in other types)

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9
Q

Describe hereditary spherocytosis, presentation, key findings and treatment?

A

fragile, sphere-shaped red blood cells, break down easily in spleen. autosomal dominant

presentation: anaemia, jaundice, gallstones and splenomegaly. Aplastic crisis in parovirus presence. Likely pos FH.

key findings: raised MCH, raised reticulocytes, spherocytes on blood film.

treatment: folate supplements, blood transfusion and splenectomy. cholecystectomy if gallstones are issue.

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10
Q

Describe hereditary elliptocytosis, presentation, key findings and treatment?

A

similar to spherocytosis but RBCs = elipse shaped. autosomal dominant

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11
Q

Describe G6PD deficency, presentation, its triggers, key findings and treatment?

A

defect in G6PD enzyme which protects RBCs from oxidative damage. X-linked recessive. Mediterranean, asian, afriican pts.

presentation: jaundice, gallstones, anaemia, splenomgely, Heinz bodies on blood film.

triggers: infection, drugs (ciprofloxacin, sulfonylureas (e.g., gliclazide) and sulfasalazine), fava beans

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12
Q

Describe autoimmune haemolytic anaemia (warm and cold), presentation, key findings and treatment?

A

antibodies created against RBCs

warm AIHA: occurs at warm temps. idiopathic. IgG antibodies.
cold AIHA: occurs <10 degrees. cause RBC agglutination. Causes secondary to lymphoma, leukaemia, SLE, infections (mycoplamsa, EBV, CMV, HIV)

treatment: blood transfusion, pred, rituximab, splenectomy

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13
Q

Describe two types of Alloimmune Haemolytic Anaemia

A

antibodies produced due to foreign RBCs.

causes: blood transfusion reactions and haemolytic disease of the newborn

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14
Q

what is haemolytic disease of the newborn?

A

When maternal antibodies destory foetal RBCs
Mother = rhesus D neg; foetus = rhesus D pos

Mother can become exposed to foetus blood (sensitisation event) = mother produces anti-D antibodies against rhesus D antigen. Antibodies can cross to baby = haemolysis.

Sensitisation event prevented with anti-D prohylaxis in rhD neg women.

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15
Q

Describe Prosthetic valve-related haemolysis, presentation, key findings and treatment

A

Complication of bioprosthetic and metallic valvue replacement.

Cause: turnbulent flow of valvues and shearing of RBCs. They break down.

mangement: monitor, oral iron and folate, blood transfusions, revision surgery

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16
Q

Describe sickle cell anaemia, pathophys, relation of malaria and treatment?

A

abnormal Hb (HbS) = sickle cell shaped RBCs. Autosomal recessive of beta-globin on chr-11 (x2 = disease, x1 = trait)

relation to malaria: less severe malaria if have sickle cell trait

17
Q

Causes of microcytic anaemia?

A

TAILS
Thalassemia
Anaemia of chronic disease
iron deffiency
Lead poisoning
Sideroblastic anaemia

18
Q

Causes of normocytic anaemia?

A

3As and 2Hs

aplastic anaemia (abnormal bone marrow)
anaeamia of chronic disease (renal failure, low EPO)
acute blood loss

haemolytic anaemia
hypothyroidism

19
Q

Causes of macrocytic anaemia?

A

Megablastic: B12/folate defficency

Normoblastic: HARD L

Hypothyroidism
alcohol
Reticulocytosis
drugs
liver disease

20
Q

What factors could hinder anaemia treatment?

A

decreased absoprtion in stomach/intestine due to:

decreased stomach acid
loss of intrinsic factor (pernicious anaemia)
coeliac disease

21
Q

Presentation of anaemia, signs and symptoms?

A

tiredness
SOB
headaches
dizziness

pale skin
conjunctival pallor
tachycardia
raised resp rate

22
Q

Specific signs and symptoms for iron deficiency?

A

Pica
hair loss

koilonychia
angular cheilitis
atrophic glossitis
brittle hair and nails

23
Q

Types of cells seen on blood film for iron deficency?

A

Target and pencil cells

24
Q

Specific and non specific signs of haemolytic anaemia?

A

Pallor of conjunctive/Palmar Crease
Tachy + Flow Murmurs
Cardiac Failure
Venous Thromboembolism

Pre-Hepatic Jaundice - Unconjugated hyperbilirubinaemia (due to increased breakdown of RBC)
Splenomegaly - Extramedullary Haematopoiesis
Dark Urine - Haematopoiesis (intravasular Hameolysis)
Gallstones - Right Upper Quadrant Pain

25
Q

In haemolytic anaemia, reticulocytes unconjugated bilirubin and serum lactate dehydrogenase (LDH) is all high. why?

A

Reticylocytes - attempt to replace broken down RBCs
UC B - break down of RBC released bilirubin
LDH - non specific marker of cell turnover

26
Q

What is direct coombs test?

A

Identifies cells coated with antibody/complement components, suggesting autoimmune cause of haemolysis

27
Q

What are haptoglobins and their presence in haemolytic anaemia?

A

bind free Hb, will be low/absent in haemolysis as lots of free Hb in circulation

28
Q

What is hemosiderin and its relevance in haemolytic anaemia?

A

free Hb in kidney tubules. detected by prussian blue staining

29
Q

Treatment for haemolytic anaemia?

A

Autoimmune = steroids (and IV Ig)
Sickle cell = hydroxycarbamide
RC transfusions

30
Q

What is thalassaemia?

A

autosomal recessive
loss in alpha or beta chains of Hb

31
Q

Types of thalassaemia and presentation?

A

β Major:
- Severe Anemia
- Jaundice
- Hepatosplenomegaly
- Bone deformities

⍺ Major:
- Fetalis Hydrops [In utero heart
failure :’( ]

β & ⍺ Trait:
- mild microcytic anaemia (maybe
more severe in ⍺)
- asymptomatic

32
Q

Investigations for thalassaemia?

A

low MCV
low MCH
high reticylocytes

  • Haemoglobin electrophoresis reveals partial or complete absence of HbA.

Cannot detect ⍺ trait
Genetic analysis required for ⍺ trait

33
Q

Treatment for thalassaemia?

A

Major = lifelong transfusions
splenectomy
allogenic bone marrow transplant

trait = give iron if deficient
genetic counselling

34
Q

What is sickle cell disease?

A

autosomal recessive
defect beta chains for Hb (2 beta and 2 alpha chains needed for normal Hb)

35
Q

Presentation of sickle cell disease?

A
  • Chronic haemolytic
    anaemia
  • Haemolytic crises
  • Painful infarctive crises
  • Aplastic crises
  • Splenic complications
  • Infection susceptibility
  • Acute chest syndrome
  • Cerebrovascular
    ischaemia
  • skin ulceration
  • proliferative retinopathy

Hb forms crystals in low O2 so agglutinates banana-shaped RBCs

36
Q

Investigations of sickle cell?

A

normocytic anaemia
reticuloysis

blood film:
sickle cells, target cells, Howell-Jolly bodies

Hb electrophoresis: HbS, some HbF and no HbA

37
Q

Treatment for Sickle cell anaemia?

A

prophylaxis:
* avoid precipitating
factors
* folic acid
* pneumococcal
vaccine; regular oral
penicillin
* hydroxycarbamide

  • crises:
  • analgesia (opiates),
    rest, rehydration,
    oxygen +/- antibiotics
  • blood transfusion/
    exchange transfusion
  • stem cell
    transplantation

Y2 Haematology (23 decks)

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