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Y3 HAEMATOLOGY > Anaemia > Flashcards

Anaemia Flashcards

(61 cards)

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1
Q

What is anaemia?

A

“without blood”

Reduced red blood cells

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2
Q

State the parameters for defining anaemia in an adult male

A

Hb less than 130g/L

Hct 0.38-0.52

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3
Q

State the parameters for defining anaemia in an adult female

A

Hb less than 120g/L

Hct 0.37-0.47

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4
Q

What is haematocrit?

A

Ratio/percentage of whole blood that is made up of red cells if the sample was left to settle

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5
Q

What cells represent circulatory red cells that have just left the bone marrow?

A

Reticulocytes

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6
Q

How does the blood film of reticulocytes appear?

A

Polychromatic
Purple/deep red stain (contain some leftover RNA)
Larger than average red cell

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7
Q

How is anaemia classified by pathophysiology?

A

Decreased production of red cells (reduced or ineffective erythropoiesis) [low reticulocyte count]

Increased destruction of red cells (haemolysis, bleeding) [high reticulocyte count)

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8
Q

What morphological characteristic can be used to classify anaemia?

A

Mean cell volume

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9
Q

How can mean cell volume be used to distinguish between cytoplasmic and nuclear defects in erythropoiesis?

A

Low MCV suggests problems with haemoglobinisation in the cytoplasm
High MCV suggests problems with red cell maturation

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10
Q

Deficiency in haemoglobin production results in what type of anaemia? This suggests a defect in what part of the cell?

A

Microcytic anaemia - cells are small (low MCV) and hypochromic (lack colour)
Cytoplasm

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11
Q

List some causes of microcytic anaemia

A 
CYTOPLASMIC MATURATION DEFECTS
Haem deficiency (low body iron (deficiency), low available iron (chronic disease), problem with porphyrin synthesis)
Globin deficiency (thalassaemia)
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12
Q

Circulating iron is bound to what?

A

Transferrin

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13
Q

Iron is stored as ferritin where in the body?

A

Liver

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14
Q

How can iron deficiency be confirmed?

A 
Anaemia (less functional iron)
Low ferritin (less stored iron)
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15
Q

List some causes of iron deficiency

A

Dietary insufficiency
(Relative in woman of child bearing age or children) (Absolute in vegetarians)
Blood loss (GI, malignancy, menorrhagia, haematuria)
Malabsorption (coeliac disease)
Pregnancy

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16
Q

High mean cell volume is associated with which type of anaemia?

A

Macrocytic anaemia - cells are big

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17
Q

What is the difference between macrocytosis and macrocytic anaemia?

A

Macrocytosis: raised MCV, normal RBC count

Macrocytic anaemia: raised MCV, low RBC count

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18
Q

List causes of macrocytosis

A

GENUINE (TRUE)
Megaloblastic
Non-megaloblastic
SPURIOUS (FALSE)

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19
Q

What unit is MCV measured in?

A

Femtolitres (fl)

1 femtolitre = 10^-15 litres

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20
Q

What is the range for a normal MCV?

A

80-100 fl

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21
Q

What is a megaloblast? What is a macrocyte?

A

Abnormally large red cell precursor with an immature nucleus - nucleus looks hypersegmented on film
Large red cell but has no nucleus

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22
Q

What biochemical defect is megaloblastic anaemia characterised by?

A

Defect in DNA synthesis and nuclear maturation but RNA and haemoglobin synthesis preserved

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23
Q

What is the consequence of a megaloblastic cell?

A

Cytoplasm and haem synthesis is fully developed even though nucleus is immature; cell senses it has enough Hb and doesn’t divide anymore, leading to macrocytosis (BIGGER CELLS) and anaemia (LESS CELLS)

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24
Q

List some causes of megaloblastic anaemia

A 
NUCLEAR MATURATION DEFECTS
B12 deficiency
Folate deficiency
Drugs
Inherited conditions
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25
Why does lack of B12 and folate cause megaloblastic anaemia?
B12 and folate are essential cofactors for nuclear maturation - enable reactions for DNA synthesis and gene activity Thus deficiency leads to DNA defects
26
Which 2 biochemical cycles involving folate and B12 are involved in DNA synthesis?
Methionine cycle | Folate cycle
27
Where in the body does B12 bind to intrinsic factor?
Ileum
28
List some causes of B12 deficiency
``` Dietary insufficiency (vegans) Pernicious anaemia Atrophic gastritis Gastrectomy Pancreatitis Small bowel resection Crohn's disease Malabsorption (Coeliac, IBD) ```
29
Where in the body is dietary folate absorbed?
Duodenum and jejunum
30
How long does the body store B12 and folate respectively?
B12: 2-4 years Folate: 4 months
31
State the daily requirements of B12 and folate
B12: 1-3 micrograms/day Folate: 100 micrograms/day
32
List some causes of folate deficiency
Dietary insufficiency (esp. alcoholics) Malabsorption (coeliac, crohns) Excess utilisation (haemolysis, pregnancy, malignancy) Drugs (anticonvulsants)
33
List clinical features of B12 and folate deficiency
``` Signs of anaemia Weight loss Diarrhoea Infertility Sore tongue Jaundice Developmental problems ```
34
B12 deficiency can cause issues with the myelin sheath. What neurological problems may result?
``` Dorsal column abnormality Lateral tract degeneration Neuropathy Dementia Psychiatric manifestations ```
35
What is pernicious anaemia?
Autoimmune condition where gastric parietal cells are destroyed, causing decreased intrinsic factor and thus B12 deficiency Common in women who have an autoimmune history
36
How is macrocytic anaemia diagnosed in the lab?
Blood count (RBC low) Blood film: macrovalocytes and hypersegmented neutrophils (more than 5 segments) Reticulocyte count (rule out reticulocytosis) B12 and folate serum assay Antibodies: parietal-cell, intrinsic factor
37
List treatment for megaloblastic anaemia
Treat cause B12 injections every 3 months Folic acid tablets (5mg daily) Red cell transfusion if life-threatening
38
List some causes of non-megaloblastic anaemia
Alcoholism Liver disease Hypothyroidism Marrow failure (myelodysplasia, myeloma, aplastic anaemia)
39
What is spurious macrocytosis?
The size of the red cell is normal but the MCV is high
40
What causes a spurious macrocytosis?
1. Reticulocytosis | 2. Cold-agglutins
41
How does reticulocytosis result in spurious macrocytosis?
Acute blood loss/haemolysis response: increase in reticulocytes, which are bigger than red cells, which are analysed as part of MCV
42
What are cold agglutins?
Abnormal proteins which cause clumping of red blood cells
43
What condition can complicate severe megalobastic anaemia?
Pancytopaenia (red blood cells, white blood cells and platelets are low)
44
List treatment options for anaemia
Iron supplements three times a day Modified diet IV iron if severe
45
Reticulocytosis is a marker of what?
Red cell production
46
List tools used in the diagnosis of anaemia
``` History/exam Full blood count Reticulocyte count Blood film features Haematinics (ferritin/B12/folate) Bone marrow biopsy Special tests (Hb electrophoresis, HLPC) ```
47
An increased reticulocyte response or reticulocytosis in anaemia is typically suggestive of...
``` Haemolysis (increased red cell turnover) Blood loss (red cells gone) ```
48
A reduced reticulocyte response in anaemia is typically suggestive of...
``` Maturation abnormality (ineffective erythropoesis) Hypoproliferative (reduced erythropoeisis) ```
49
A patient has an anaemia with a high reticulocyte count. How do you differentiate between the differentials?
Haemolysis would present with increased products of red cell destruction (increaed unconjugated serum billirubin, increased urinary urobilinogen)
50
What compound is a product of red cell breakdown that causes pale urine?
Urobilinogen
51
What is the commonest cause of hypochromic microcytic anaemia?
Iron deficiency
52
List aetiology of anaemia
``` Iron deficiency Heme defects (lead poisoning, sideroblastic anaemia) Globin defects (thalasaemia) Nuclear maturation (megaloblastic anaemia, MDP) Apparent (agglutination in reticulocytosis) ```
53
List aetiology of macrocytosis without anaemia. What do the cells look like on film?
Alcohol Liver disease Hypothyroidism UNIFORM MACROCYTOSIS
54
Normochromic normocytic cells is typically indicative of...
Hypoproliferative anaemia | Marrow fails to appropriately respond to anaemia, but cells produced are usually normal
55
List causes of hypoproliferative anaemia
``` Marrow failure (drugs, aplastic anaemia) Hypometabolic Marrow infiltration (mets, fibrosis) Renal impairment Chronic disease (infective, inflammatory, malignant) ```
56
What is renal anaemia?
Anaemia of chronic disease due to failure of epo production
57
Anaemia of chronic disease is common. True/ False?
True | Second most common cause of anaemia after iron deficiency
58
There is always a low MCV in microcytosis. True/ False?
False | Microcytic anaemia is relative to the individual, not always absolute
59
What is the best blood test to differentiate between iron deficiency and anaemia of chronic disease?
Serum ferritin Reduced in iron deficiency Normal or increased in chronic disease
60
What is the main mechanism behind anaemia of chronic disease?
Inflammation produces an elevation of IL-6 which stimulates hepcidin production and release from the liver, reducing the iron carrier protein ferroportin so that access of iron to the circulation is reduced
61
What is the first and second line investigation for an older person who is anaemic?
Sigmoid colonoscopy | Endoscopy for chronic bleed

Y3 HAEMATOLOGY (16 decks)

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