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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Anaemia associated with decreased production =

A

Low reticulocyte count

Hypoproliferative anaemia (reduced amount of erythropoiesis)
Maturation defect (erythropoiesis is active but ineffective)
Failure to produce Hb (a cytoplasmic defect)
Failure of cell division (a nuclear defect)

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2
Q

Anaemia associated with increased loss/destruction =

A

High reticulocyte count

Bleeding
Haemolysis

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3
Q

Mean cell volume is low (microcytic) =

A

Haemoglobin cause

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4
Q

Mean cell volume is high (macrocytic) =

A

Problems with cell division i.e. maturation

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5
Q

Causes of microcytic anaemias

A

TAILS

Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemias (congenital)

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6
Q

What does circulating iron bind to ?

A

Transferrin

(transports iron from donor tissues [macrophages, intestinal cells and hepatocytes] to tissues expressing transferrin receptors - especially erythroid marrow)

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7
Q

How to measure iron supply

A

% saturation of transferrin with iron

  • reduced in iron deficiency
  • reduced in anaemia of chronic disease
  • increased in genetic haemochromatosis
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8
Q

Why is serum ferritin measured ?

A

Indirect measure of storage iron

Low ferritin = low iron

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9
Q

How iron is stored:

A
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10
Q

Iron supplement given to children ?

A

Sodium feredetate (sytron) - liquid prep with lower elemental iron concentration

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11
Q

Low Hb, low RBC, high MCV

A
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12
Q

What happens as normoblasts (red cell precursors) develop?

A
  • Accumulate Hb
  • Reduce in cell and nuclear size as the nucleus matures
  • Stop dividing and lose nucleus (Hb content triggers this)
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13
Q

What happens in megaloblastic anaemia?

A

Larger precursor cells with an immature nucleus

They accumulate Hb - but there is a smaller number of macrocytes - therefore ANAEMIA

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14
Q

Causes of megaloblastic anaemia ?

A

B12 deficiency
Folate deficiency
Drugs
Rare inherited abnormalities

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15
Q

What causes pernicious anaemia ?

A

Autoimmune condition with resulting destruction of gastric parietal cells

  • results in intrinsic factor deficiency with B12 malabsorption and deficiency
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16
Q

B12/Folate deficiency symptoms

A

Symptoms/signs of anaemia
weight loss, diarrhoea, infertility
Sore tongue, jaundice
Developmental problems

+ B12 only: Neurological problems

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17
Q

Pernicious anaemia treatment

A

Vitamin B12 (hydroxycobalamin) injections for life

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18
Q

Causes of non-megaloblastic anaemia

A
  • Alcohol
  • Liver disease
  • Hypothyroidism
  • Marrow failure: Myelodysplasia, Myeloma, Aplastic anaemia
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19
Q

Why are people with pernicious anaemia mildly jaundiced ?

A
  • Red cells die prematurely in the marrow
  • Haemoglobin and lactate dehydrogenase (LDH) are released from dead red cells
  • Haemoglobin converted to bilirubin
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20
Q
  • High reticulocyte count
  • Increased unconjugated serum bilirubin
  • Increased urinary urobilinogen
  • Splenomegaly
A

Haemolysis

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21
Q

Microcytic anaemia differential diagnosis

A

TAILS

Thalassaemia
Anaemia of chronic disease
Iron defiency
Lead poisoning
Sideroblastic anaemia

22
Q

Physiology of EPO

A

Kidneys detect reduced O2
EPO secreted into blood
EPO stimulates erythropoiesis by bone marrow
Additional circulating erythrocytes improve O2 carrying

23
Q

Role of hepcidin

A

Regulates ferroportin (the iron exporter)

Binds to ferroportin - breaks down ferroportin - therefore iron can’t be exported from iron storage

24
Q

Where is hepcidin synthesised?

A

Primarily hepatocytes (liver)

25
Q

Ferritin levels in anaemia of chronic disease ?

A

Normal or increased

26
Q

Ferritin levels in iron deficiency ?

A

Low

27
Q

Excess alcohol = micro/macrocytosis?

A

Mild macrocytosis

28
Q

MCV > 120fl = (usually)

A

B12 or Folate deficiency

29
Q

Hypersegmented neutrophils + oval macrocytes on blood film =

A

Megaloblastic

30
Q

Dysplastic neutrophils on blood film =

A

Myelodysplasia

31
Q

Uniform macrocytosis on blood film =

A

Alcohol

32
Q

Malabsorption of iron is primarily in ______

A

Jejunum

33
Q

Iron deficiency over 50 y.o. - what investigations must be done ?

A

GI investigations for malignancy even with negative FOBs (foetal occult blood tests)

34
Q

Macrocytic anaemia causes =

A

FAT RBC

Foetus
Alcohol
Thyroid

Reticulocytosis - acute blood loss OR haemolysis
B12 + Folate deficiencies
Cirrhosis/chronic liver disease

35
Q

Explain why TAILS conditions cause reduced MCV

A

T = Globin (imbalanced ratio of globin chains, Unbound globin chains precipitate, leading to the destruction of erythroid precursors)
A = depends
I = iron
L = inhibits ferrochelatase (used in haem synthesis)
S = inhibits mitochondrial proteins which regulate protoporphyrin (and therefore haem) synthesis

36
Q

When is IV iron prescribed?

A

When rapid iron replacement is needed e.g. 3rd trimester of pregnancy, before surgery
Malabsorption

37
Q

Reticulocytosis could be due to either…

A
  1. Acute blood loss
    or
  2. Haemolysis
38
Q

Blood film for B12/Folate deficiency =

A

Macroovalocytes + hypersegmented neutrophils in megaloblastic anaemia

39
Q

Why does reticulocytosis cause increased MCV?

A

Reticulocytes are immature and therefore larger

So this is a “pseudomacrocytosis” as the RBCs haven’t actually increased MCV

40
Q

Reticulocytosis appearance on blood film

A

Polychromasia !!

41
Q

What do the red arrows indicate?

A

Spherocytes

  • indicate haemolysis
  • indicated by raised MCHC (mean corpuscular haemoglobin concentration)
42
Q

Spherocytes are…

A

Red blood cells with no central pallor due to membrane damage

seen in haemolysis

43
Q

LFT which shows liver synthesis levels ?

A

Albumin

44
Q

LFT which shows haemoglobin breakdown (haemolysis)

A

Bilirubins

45
Q

What does raised lactate dehydrogenase indicate?

A

Non-specific cell damage/necrosis

46
Q

What does reduced haptoglobulin indicate?

A

Haemolytic anaemia

(protein which binds to free haemoglobin released from lysed red cells)

47
Q

When to suspect haemolytic anaemia?

A

Reticulocytosis (high ret count, anaemia with polychromasia) = either haemolysis or acute blood loss

Chronic blood loss = microcytosis, iron deficiency, no reticulocytosis

Spherocytes - cells with no central pallor due to membrane damage in haemolysis

48
Q

Other name for DAT (Direct Antibody Test)

A

Coombs test

49
Q

Management of autoimmune haemolysis =

A

Steroids + folic acid

50
Q
A

Haematology (12 decks)

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