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Week 19 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

“Tired all the time bloods”?

A
  • Full blood count- check haemoglobin levels to exclude anaemia
  • Vit D levels- shows deficiency which can make you feel tired
  • Renal function- underlying chronic kidney disease can cause anemia
  • Coeliac disease autoantibodies IgA tissue tranaglutaminase- coeliac disease can cause fatigue
  • Thyroid function test- hypothyrodism can cause fatigue
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2
Q

A must not miss diagnosis that presents similar to anemia?

A

Acute myeloid lymphoma- can present with tiredness and breathlessness

Often presents with recurrent infetions and abnormal bleeding (from gums or nosebleeds) and weight loss

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3
Q

Micro, normo and macrocytic anaemia- ranges?

A

Micro- less than 80 MCV
Normo- 80-100 MCV
Macro- greater than 100 MCV

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4
Q

Causes of microcytic anaemia?

A

Thalasaemia
Anaemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia

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5
Q

Usual cause of anameia of chronic disease and treatment?

A

Often occurs with chronic kidney disease due to reduced production of erythropoietin by the kidneys

Treatment- erythropoietin

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6
Q

Causes of normocytic anaemia?

A

Acute blood loss
Anaemia of chronic disease
Aplastic anaemia- deficiency of all blood cell caused by failure of bone marrow development
Haemolytic anaemia
Hypothyroidism

Sickle cell disease
Malaria
Renal disease

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7
Q

2 types of macrocytic anameia and their causes?

A

V
Megablastic anaemia- from impaired DNA synthesis- preventing cells from dividing normally so they grow into large abnormal cells- causes:
* Vit B12 (cobalamin) deficiency
* Folate (vit B9) deficiency

Normoblastic deficiency caused by:
* Alcohol
* Reticulocytosis- increased conc of reticulocytes (immature RBCs)
* Hypothyroidism
* Liver disease
* Drugs e.g. azathioprine

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8
Q

Common causes of iron deficiency anaemia?

A
  • Diet
  • GI blood loss
  • Menstruation
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9
Q

Signs and symptoms of iron deficiency anaemia?

A
  • Koilonychia- spoon shaped nails
  • Angular chelitis- red corner of mouth
  • Atrophic glossitis (smooth tongue)
  • Brittle hair and nails
  • Pica- cravings of abnormal thinsg such as dirt/soil
  • Hair loss
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10
Q

Sign of haemolytic anaemia?

A

Jaundice

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11
Q

Sign of thalassaemia?

A

Bone deformaties

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12
Q

Generic symptoms of anaemia?

A
  • Tiredness
  • SOB
  • Headaches
  • Dizziness
  • Palpitations
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13
Q

Blood test for pernicious anaemia?

A

Intrinsic factor antibodies

anameia caused by the deficiency on the production of RBCs through lack

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14
Q

Blood test to rule out thalassaemia and sickle cell disease as a cause of anaemia?

A

Haemoglobin electrophoresis

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15
Q

What is an FBC looking for to diagnose anaemia?

A

Haemoglobin levels
Mean cell volume
Reticulocyte count

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16
Q

Which vitamins would we look for in a blood test to diagnose anaemia?

A

B12, folate and ferritin

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17
Q

Main site of iron absorption?

A

Duodenum and jejunum

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18
Q

How are Total iron binding capacity and transferrin leevls effected in iron deficiency?

A

Increased

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19
Q

Transferrin saturation gives a good indication of? and normal % in body?

A

Total iron in the body- around 30%

20
Q

What can iron be supplemented with in diet?

A

Ferrous sulphate or ferrous fumarate

21
Q

Thalassaemia and sickle cell anaemia are types of what type of anaemia?

A

Chronic haemolytic anaemia

22
Q

3 key features of heamolytic anaemia?

A
  • Anaemia
  • Splenomegaly- spleen is filled with destroyed RBCs
  • Jaundice- bilirubin is released during the destruction of RBCs
23
Q

Hereditary spherocytosis- what is it, presentation, findings and treatment?

A

Most common inherited haemolytic anaemia in europeans
* Autosomal dominant- causes fragile sphere shaped RBCs

Presents with:
* Anaemia
* Jaundice
* Gallstones
* Splenomegaly
* Aplastic crisis in the presence of parovirus

Key findings:
* Raised MCHC
* Raised reticulocyte count due to rapid turnover of RBCs
* Spherocytes on a blood film

Treatment:
* Folate supplementation
* Blood transfucsions when required
* Splenectomy

24
Q

G6PD deficiency- what is it, presentation, findings and treatment?

A

Caused be defect in the gene coding for G6PD- an enzyme that protects cells from oxidative damage
* x-linked recessive- males more afected

Results in acute episodes of haemolytic anameia triggered by:
* infections
* drugs- antimalarials
* fava beans- broad beans

Presents:
* Jaundice
* Gallstones
* Aanemia
* Splenomegaly
* Heinz bodies on blood film

Diagnosis- do a G6PD enzyme assay

“Male patient that turns jaundice and becomes anameic after eating broad beans, developing an infection or taking antimalarials”= G6PD deficiecy

25
Q

Autoimmune haemolytic anameia- what is it, presentation, findings and treatment?

A

Antibodies attack patients RBCs- 2 types- warm and cold depending on the temp at which the destroy the RBCs.

Warm- idopathic
Cold- at temps less than 10 degrees- secondary to- lymphoma, leukemia, systemic lupus erythematosus and infections

Management:
* Blood transfusions
* Prednisolone
* Rituximab
* Splenectomy

26
Q

Alloimmune haemolytic anameia- what is it and cause?

A

Caused by transfusion reactions or

Haemolytic disease of the newborn- when the fetus is rhesus D positive and the mother is rhesus D negative

27
Q

Paroxysmal nocturnal haemoglobinuria- what is it, presentation, findings and treatment?

A

Caused by a genetic mutation in the haematopoietic stem cells in the bone marrow- occurs during the patients lifetime (not inherited)
* Results in a loss of inhbiton of the complement cascade on the RBCs so they get destroyed

Presentation:
* Red urine in the morning- contains haemoglobin and haemosiderin
* Anaemi a
* Thrombosis
* Smooth muscle dystonia- oesophageal spasm/ erectile dysfunction

Management:
* Eculizumab
* Bone marrow transplantation

28
Q

Microangiopathic haemolytic anaemia- what is it, presentation, findings and treatment?

A

Caused by abnormal activation of the clotting system- thrombi block small blood vessels- thrombotic microangiopathy = churn RBCs and = haemolysis

Usually secondary to:
* Haemolytic uraemic syndrome (HUS)
* Disseminated intravascular coagulation (DIC)
* Thrombotic thrombocytopenic purpura (TTP)
* Systemic lupus erythematosus (SLE)
* Cancer

Key finding:
* Schistocytes on blood film

29
Q

Prosthetic valve haemolysis- what is it, presentation, findings and treatment?

A

Key complication of prosthetic heart valves- both bioprosthetic and metallic

Valve churns up the RBCs and breaks them down

Management:
* Monitoring
* ORal iron and folic acid supplementation
* Blood transfusion if severe
* Revision of surgery if severe

30
Q

4 most common side efects of oral iron supplemenation?

A
  • Nausea
  • GI discomfort
  • Constipation
  • Diarrhoea
31
Q

How is sickle cell anaemia screened?

A

Newborn blood spot

32
Q

Triggers of sickle cell crisis?

A
  • Spontaneously
  • Dehydration
  • Infection
  • Stress
  • Cold weather
33
Q

Presentation and cause of vaso-occlusive crisis?

A

Also known as painful crisis
Caused by the RBC clogging capillaries causing distal ischemia

Associated with fever and pain and swellig in hands and feet and penis- aspiration of the blood is needed

34
Q

Presentation, cause and treatment of splenic sequestration crisis?

A

Caused by sickle cell RBCs blocking blood flow within the spleen = enarged painful spleen= severe anaemia anf hypovolaemic shock

Splenectomy treats or blood transfusion and fluid resuscitation

35
Q

Presentation and cause of aplastic crisis?

A

Temporary abscence of teh creation of new RBCs- usually truggered by infection with parovirus B19

= sig anameia- management is uspportive and ususally resolves spontaneously after a week

36
Q

Presentation, cause and treatment of acute chest syndrome?

A

Occurs when the vessesls supplying the lungs become clogged with sickle cell RBCs- vaso-occlusive crisis, fat embolism or infection can trigger it

Presents with:
* Fever
* SOB
* Chets pain
* Cough
* Hypoxia

Chest x ray will show pulmonary infiltrates

Treatment- medical emergency- treatment of underlying cause

37
Q

General medication management of sickle cell disease?

A
  • Phenoxymethylpenicillin
  • Hydroxycarbamide- stimulates production of fetal haemoglobin
  • Crizanlizumab- monoclonal antibody that targets p-selecton- prevents RBCs from sticking to blood vessel walls and reduces frequency of vaso-occlusive crises
38
Q

Cause, presentation and management of pernicious anaemia?

A

Autoimmune condition in which antibodies attack prietal cells in the stomach whoch produce intrinisic factor.

Intrinsic factor is essential for absoprotion of B12 in the distal ileum

Presents with neurological symptoms:
* Peripheral neruopathy- numbness or parasthesia
* Loss of vibration and proprioception
* Visual changes
* Mood changes

Remember to test for B12 deficiency/ pernicious anaemia in patients presenting with peripheral neuropathy

Management:
* Intramuscular hydroxocobalamin
* no neuro symps- 3 times weekly for 2 weeks
* Neuro symps- alternate days until there is no further improvement in symps

Maintenance:
* Pernicious anameia- 2-3 monthly injections for life
* Diet related- oral cyanocobalamin or twice yearly injections

39
Q

Features of hyposplenism?

A

Howell- Jolly bodies
Siderocytes
= typical blood film findings

Reduction of splenic function

40
Q

Causes of relative, primary and secondary polycythaemia? How to differntiate?

A

Relative- dehydration and stress
Primary (true)- rubra vera (leukemia)
Secondary (true)- COPD, altitude, Obstructive sleep aponea

Differentiate:
In true- total red cel mass in males>35 women>32

41
Q

What is it and features of polycythaemia?

A

Myeloproliferative disorder caused by clonal proliferation of marrow stem cell= increased in RBC volume- often accompanied with overproduction of neutrophils and platelets

Caused by a mutation of JAK2

Features:
* Pruritus
* Splenomegaly
* Hypertension
* Hyperviscosity
* Haemorrhage
* Low ESR

42
Q

Tests for polycythaemia?

A
  • Full blood count/film= raised haematocrit, neutrophils, basophils and platelets
  • Jak2 mutation
  • Serum ferritin
  • Renal and liver function tests
43
Q

Criteria for JAK2-positive polycythaemia vera diagnosis?

A

A1- high haematocrit or raised RBC mass
A2- mutation in JAK2

Requires both to present

44
Q

Management of polycythaemia vera?

A
  • Aspirin- reduces the risk of thrombotic events
  • Venesection- 1st line treatment to keep the haemoglobin in teh normal range
  • Chemotherapy
45
Q

Prognosis of polycthaemia?

A

Thrombotic events= sig cause of morbidity and mortality
5-15% of patients progress to acute leukemia
5-15% of patients progress to myelofibrosis

46
Q

2 types of Coomb’s test?

A

Both look for antibodies to RBCs

Indirect antiglobulin test- tests the antibody in the patients serum- test used to cross match blood for suitability for transfusion
* Positive test= the tested donors RBCs are incompatible and should not be given as a transfusion

Direct antiglobulin test (DAT)- doen much less- detects antibodies to a patitnes own serum causing an autoimmune haemolytic anaemia

Week 19 (5 decks)

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