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Anaemia Flashcards

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1
Q

What are the general causes of anaemia?

A

Not enough red blood cells

Not enough haemaglobin within red blood cells

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2
Q

What are the causes of anaemia to do with erythropoiesis in the bone marrow?

A

Reduced erythropoiesis

Dyserythropoiesis

Haemaglobin synthesis

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3
Q

What are the causes of reduced erythropoiesis?

A

Chronic kidney disease

Empty bone marrow

Infiltration of bone marrow

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4
Q

Why does chronic kidney disease lead to reduced erythropoiesis?

A

Kidneys don’t produce erythropoietin

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5
Q

Why does empty bone marrow lead to reduced erythropoiesis?

A

Lack of cells in bone marrow

lack of precursors of red blood cells

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6
Q

What can cause bone marrow to be empty?

A

Chemotherapy

Parvovirus infection

Aplastic anaemia

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7
Q

Why does infiltration of bone marrow lead to reduced erythropoiesis?

A

Lack of normal haematopoietic cells

lack of precursors of red blood cells

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8
Q

What can bone marrow be infiltrated with?

A

Cancer cells

Fibrous tissue

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9
Q

What is the term for bone marrow infiltrated by fibrous tissue?

A

Myelofibrosis

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10
Q

How is reduced erythropoiesis by chronic kidney disease treated?

A

Give patient erythropoietin hormone

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11
Q

What are the causes of dyserythropoiesis?

A

Anaemia of chronic disease

Myelodysplastic syndromes

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12
Q

Which chronic conditions might anaemia be a symptom of?

A

Chronic inflammatory conditions

  • inflammatory bowel disease e.g. crohn’s, ulcerative colitis
  • rheumatoid arthritis

Chronic infection
-TB

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13
Q

How do some chronic conditions cause anaemia?

A

Bone marrow doesn’t respond to erythropoietin

Increased activity of macrophages
-circulating red cells have reduced lifespan

Inflammatory cytokines increase production of hepcidin

  • less iron absorption in gut
  • less iron release from macrophages
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14
Q

How does anaemia of chronic disease appear on a blood film?

A

Anaemia can be

  • microcytic
  • normocytic
  • macrocytic
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15
Q

What are the levels of inflammatory markers in anaemia of chronic disease? Give examples

A

E.g. ferritin
CRP

both raised

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16
Q

How is anaemia of chronic disease treated?

A

Treat the underlying cause of the anaemia

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17
Q

What is the pathophysiology of myelodysplastic syndromes?

A

Mutations in cells of bone marrow

As a result

  • do not mature
  • produce clones of themselves
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18
Q

How do myelodysplastic syndromes cause anaemia?

A

Proper red blood cells not produced

Red blood cells prematurely destroyed by reticuloendothelial system

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19
Q

How does anaemia caused by myelodysplastic syndromes appear on a blood film?

A

Macrocytic - red blood cells are large

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20
Q

How is myelodysplastic syndrome diagnosed?

A

Look at chromosomal changes in bone marrow cells

Look at bone marrow cells and blood film under microscope

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21
Q

How is anaemia caused by myelodysplastic syndromes treated?

A

Chronic transfusions of red blood cells

Chemotherapy followed by stem cell transplantation in younger patients

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22
Q

What can myelodysplastic syndromes develop into?

A

Acute leukaemia

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23
Q

What are the causes of anaemia to do with haemaglobin synthesis in the bone marrow?

A

Lack of iron

Lack of vitamin B12, folate

Genetic disorders

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24
Q

What are vitamin B12 and folate required for?

A

Nuclear maturation
nuclear division

Cell division

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25
What is seen on a blood film with vitamin B12 and folate deficiency?
Macrocytic - red blood cells are large
26
What causes macrocytic anaemia with vitamin B12 and folate deficiency?
Cytoplasm develops faster than nuclear maturation, nuclear division and cell division red blood cell precursors have large nuclei, are large themselves
27
What do neutrophils look like with vitamin B12 and folate deficiency?
Hypersegmented nuclei
28
What can prolonged vitamin B12 and folate deficiency lead to?
Pancytopenia - low neutrophils and platelets as well as low red blood cells
29
What is the term for anaemia caused by vitamin B12 and folate deficiency?
Megaloblastic anaemia
30
What are the genetic disorders of haemaglobin synthesis?
Sickle cell Thalassaemia
31
What is the inhertiance pattern of sickle cell anaemia?
Autosomal recessive
32
What is the genotype of sickle cell anaemia?
HbS HbS
33
What is the cause of sickle cell anaemia?
Point mutation in B-globin gene | Valine replaced by glutamate
34
What are the symptoms of sickle cell anaemia?
Anaemia Haemolytic crises Vaso-occlusive crises Aplastic crises
35
How severe is the anaemia in sickle cell anaemia? Why?
Mild | because HbS gives up oxygen more readily than HbA
36
What happens to HbS with oxygen gas exchange?
Deoxygenated HbS | forms polymers of HbS
37
How do the polymers of HbS affect red blood cells?
Cause red blood cells to sickle - form crescent shape Damage red blood cell membrane
38
How do vaso-occlusive crises present?
Pain in ischaemic area
39
Which tissues and organs are usually involved in vaso-occlusive crises? How?
Brain - infarct Lung - infarct Spleen - infarct, atrophy Kidney - infarct Femur - avascular necrosis of head Skin - ulcers
40
What can trigger a sickle cell crisis?
Temperature change e.g. cold Stress e.g. infection
41
How do sickled red blood cells affect blood flow?
Form thromboses in small blood vessels block blood flow give ischaemia
42
HbS is common in which ethnic group? Why?
African people | because it confers protection against malaria
43
What are the two types of thalassaemias?
Alpha Beta
44
What are the types of alpha thalassaemia?
Carrier state A-thalassaemia trait HbH disease Hydrops fetalis
45
What is the genetic defect in the carrier state of alpha thalassaemia?
Deletion of a single a-globin gene
46
What are the symptoms of the carrier state of alpha thalassaemia?
Asymptomatic
47
What is the genetic defect in the a-thalassaemia trait?
Deletion of two a-globin genes | maybe two on same chromosome, or one on each chromosome
48
What are the symptoms of a-thalassaemia trait?
Mild anaemia
49
What is the genetic defect of HbH disease?
Deletion of three a-globin genes
50
What is produced in HbH disease?
Tetramers of b-globin chains | called HbH
51
What are the symptoms of HbH disease?
Severe anaemia
52
What appears on a blood film with HbH disease?
Target cells Heinz bodies
53
What is the genetic defect in hydrops fetalis?
Deletion of all four a-globin genes
54
What is produced in hydrops fetalis?
In the foetus Gamma-globin tetramers produced Called HbBart
55
Does a foetus with hydrops fetalis usually survive? Why?
No intrauterine death HbBart is unable to deliver oxygen to tissues
56
What are the types of B-thalassaemia?
B-thalassaemia trait B-thalassaemia major
57
What is the genetic defect in B-thalassaemia trait?
Deletion of one b-globin genes
58
What are the symptoms of B-thalassaemia trait?
Mild anaemia
59
What is the genetic defect in B-thalassaemia major?
Deletion of both b-globin genes
60
What are the symptoms of B-thalassaemia major?
Severe anaemia
61
When do the symptoms of B-thalassaemia major manifest? Why?
6-9 months after birth when HbF switches to HbA b-globin chains only produced for HbA
62
How is B-thalassaemia major treated?
Transfusions
63
What does a blood film with thalassaemia look like? Why?
Hypochromic due to lack of Hb Microcytic
64
How are red blood cells affected by thalassaemia?
Other globin chain produced in excess precipitates in red blood cell Developing red blood cells destroyed within bone marrow Mature red blood cells destroyed within spleen
65
How are organs affected by thalassaemia? Why?
Extramedullary haemopoiesis in liver and spleen giving hepatomegaly, splenomegaly Expansion of haemopoiesis into bone cortex gives skeletal abnormalities Stimulation of erythropoietin production in kidneys
66
How is iron affected by thalassaemia?
Iron overload - excess absorption of iron in diet, stimulated by ineffective erythropoiesis - repeated blood transfusions
67
How is thalassaemia treated?
Transfusions with iron chelation Folate
68
What do target cells look like and why?
Darker region in centre of red blood cell | because Hb has precipitated there
69
What are the causes of anaemia to do with red blood cells?
Defects in red blood cell - structure - metabolism Loss of red blood cells
70
What is the most common inherited condition to do with a defective red blood cell membrane leading to anaemia?
Hereditary spherocytosis
71
What are spherocytes?
Abnormal red blood cells | are spherical in shape
72
What are elliptocytes?
Abnormal red blood cells | rod-like shape
73
What are acanthocytes?
Abnormal red blood cells | irregular shape
74
What are the causes of acquired defective red blood cell membranes?
Mechanical damage Heat damage - burns
75
What are some causes of mechanical damage to red blood cells?
Heart valves Vasculitis Microangiopathy DIC
76
What is a shistocyte?
Fragment of red blood cell
77
What are some defects in metabolism that lead to anaemia?
G6PDH deficiency Pyruvate kinase deficiency
78
What are some causes of loss of red blood cells?
Acute - haemorrage Chronic - ulceration, cancer, excessive menstruation
79
How might chronic blood loss present? Why?
Hypochromic microcytic anaemia | due to development of iron deficiency
80
What are the causes of anaemia to do with the reticuloendothelial system?
Haemolytic anaemia
81
What is haemolytic anaemia?
Anaemia caused by increased red blood cell destruction
82
Where does the extra red blood cell destruction occur in haemolytic anaemia?
Intravascular - within blood vessels Extravascular - reticulendothelial system in spleen, bone marrow, liver
83
What are the causes of haemolytic anaemia?
Defective red blood cells as with many of the causes of anaemia Autoimmune haemolytic anaemia
84
What is the pathophysiology of autoimmune haemolytic anaemia?
Autoantibodies against bind to red blood cell membrane proteins spleen destroys those red blood cells
85
What are the types of autoimmune haemolytic anaemia?
Warm, IgG Cold, IgM
86
What are the key lab features of autoimmune haemolytic anaemia?
Increased reticulocytes Increased bilirubin Increased LDH
87
Why are reticulocytes increased with autoimmune haemolytic anaemia?
Bone marrow is producing more red blood cell | to compensate for the increased destruction
88
Why is bilirubin increased with autoimmune haemolytic anaemia?
Increased breakdown of red blood cells, haemaglobin, haem | haem is broken down into bilirubin
89
Why is LDH increased with autoimmune haemolytic anaemia?
Red blood cells are rich in this enzyme
90
How is a shistocyte produced?
Mechanical damage to red blood cells
91
What is seen in a blood film with myelofibrosis? Why?
Red blood cells are tear-drop shaped | because were squeezed through fibrotic tissue in bone marrow

Haematology (12 decks)

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