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Flashcards in Anaemia Deck (24):
1

Fanconi Anaemia

aplastic anaemia
increased risk of acute myeloid leukaemia
neurological
skeletal abnormalities: short stature
cafe au lait spots

2

Microcytic Anaemia

iron-deficiency anaemia
thalassaemia*
congenital sideroblastic anaemia
anaemia of chronic disease (more commonly a normocytic, normochromic picture)
lead poisoning

3

Normocytic Anaemia

anaemia of chronic disease
chronic kidney disease
aplastic anaemia
haemolytic anaemia

4

Macrocytic anaemia

Megaloblastic causes
vitamin B12 deficiency
folate deficiency

Normoblastic causes
alcohol
liver disease
hypothyroidism
pregnancy
reticulocytosis
myelodysplasia
drugs: cytotoxics

5

Anaemia in regnancy

Booking visit < 11 g/dl
28 weeks < 10.5 g/dl

6

Pernicious Anaemia

Epidemiology
more common in females (F:M = 1.6:1)
typically develops in middle to old age
more common if blood group A

Pathophysiology
autoimmune disease caused by antibodies to gastric parietal cells or intrinsic factor
results in vitamin B12 deficiency
associated with thyroid disease, diabetes, Addison's, rheumatoid and vitiligo
predisposes to gastric carcinoma

Features
lethargy, weakness
dyspnoea
paraesthesia
also: mild jaundice, diarrhoea, sore tongue
possible signs: retinal haemorrhages, mild splenomegaly, retrobulbar neuritis

Treatment of the disorder is with 3 monthly treatment of vitamin B12 injections. Folic acid supplementation may also be required.

7

Sickle Cell Anaemia

Autosomal recessive
Single base mutation
Deoxygenated cells become sickle in shape
Causes: short red cell survival, obstruction of microvessels and infarction
Sickling is precipitated by: dehydration, infection, hypoxia
Manifest at 6 months age
Africans, Middle East, Indian
Diagnosis: Hb electrophoresis

8

Sickle cell crises

Bone pain
Pleuritic chest pain: acute sickle chest syndrome commonest cause of death
CVA, seizures
Papillary necrosis
Splenic infarcts
Priapism
Hepatic pain

9

Causes of decreased Hb in sickle cell crises

Aplasia: parvovirus
Acute sequestration
Haemolysis

10

Long Term complications of sickle cell

Infections: Streptococcus pnemoniae
Chronic leg ulcers
Gallstones: haemolysis
Aseptic necrosis of bone
Chronic renal disease
Retinal detachment, proliferative retinopathy

11

Management sickle cell disease

Supportive
Hydroxyurea
Repeated transfusions pre operatively
Exchange transfusion in emergencies

12

Sideroblastic anaemia

Sideroblastic anaemia is a condition where red cells fail to completely form haem, whose biosynthesis takes place partly in the mitochondrion. This leads to deposits of iron in the mitochondria that form a ring around the nucleus called a ring sideroblast. It may be congenital or acquired

Congenital cause: delta-aminolevulinate synthase-2 deficiency

Acquired causes
myelodysplasia
alcohol
lead
anti-TB medications

Investigations
hypochromic microcytic anaemia (more so in congenital)
bone marrow: sideroblasts and increased iron stores

Management
supportive
treat any underlying cause
pyridoxine may help

13

Iron deficiecy anaemia

Blood film
target cells
'pencil' poikilocytes

if combined with B12/folate deficiency a 'dimorphic' film occurs with mixed microcytic and macrocytic cells

14

AIHA

Warm AIHA

In warm AIHA the antibody (usually IgG) causes haemolysis best at body temperature and haemolysis tends to occur in extravascular sites, for example the spleen. Management options include steroids, immunosuppression and splenectomy

Causes of warm AIHA
autoimmune disease: e.g. systemic lupus erythematosus*
neoplasia: e.g. lymphoma, CLL
drugs: e.g. methyldopa

Cold AIHA

The antibody in cold AIHA is usually IgM and causes haemolysis best at 4 deg C. Haemolysis is mediated by complement and is more commonly intravascular. Features may include symptoms of Raynaud's and acrocynaosis. Patients respond less well to steroids

Causes of cold AIHA
neoplasia: e.g. lymphoma
infections: e.g. mycoplasma, EBV

15

Target Cells

Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease

16

'Tear-drop' poikilocytes

Myelofibrosis

17

Spherocytes

Hereditary spherocytosis
Autoimmune hemolytic anaemia

18

Basophilic Stipling

Lead poisoning
Thalassaemia
Sideroblastic anemia
Myelodysplasia

19

Howell Jolly Bodies

Hyposplenism

20

Heinz Bodies

G6PD deficiency
Alpha-thalassaemia

21

Schistocytes

Intravascular haemolysis
Mechanical heart valve
Disseminated intravascular coagulation

22

Burr Cells

Uraemia
Pyruvate kinase deficiency

23

Acanthocytes

Abetalipoproteinemia

24

Beta Thalassaemia Trait

mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia
HbA2 raised (> 3.5%)