Anaemia Flashcards
(41 cards)
What are the causes of iron deficiency anaemia?
Blood loss: Menorrhagia, GI, NSAID, Colonic/gastric Ca
Poor diet: Kids
Malabsorption: Coeliac, IBD, PPI, H.Pylori, ↓Vit C
Excess iron requirement: Pregnancy, kids
Where is iron absorbed?
Duodenum
What are the causes of microcytic anaemia?
Iron deficiency Lead poisoning Chronic disease Sideroblastic Thalassaemia
What are the causes of normocytic anaemia?
Haemolytic anaemia BM disorder Hypersplenism Acute blood loss Chronic disease
What are the causes of macrocytic anaemia?
Vit B12 & folate deficiency Liver disease (OH-) Hypothyroidism Reticulocytosis Myelodysplasia
What are the early & late Sx of iron deficiency anaemia?
EARLY: Dyspnoea on exertion Fatigue LATE: Koilonychia Atrophic glossitis Angular cheilosis Pale conjunctiva
What are worrying signs in iron deficiency anaemia?
Acute dyspnoea Dizzy/syncope Palpitations Chest pain ↑HR, ↓BP
How is iron deficiency anaemia investigated?
Bloods: ↓MCH ↓MCV ↓Hb ↑TIBC
↓Ferritin = DIAGNOSTIC
Blood Film: Microcytic, hypo chromic, target cells, poikilocytes
In iron deficiency anaemia what investigations can be done to look for specific causes?
Coeliac Screen: TTG, endoscopy & biopsy Urine Dip: Bladder Ca Endoscopy: Upper/Lower GI H.Pylori Test: Urea breath test DRE: Malaena/fresh blood
How is iron deficiency anaemia managed?
Iron rich foods
Ferrous Sulphate: 200mg TDS, start before results of Ix, expect ↑ >10g/L/week, continue for 3m after Fe levels are normal, check FBC 2-4w post Tx then 2-4m
Blood transfusion
When in iron deficiency anaemia should a blood transfusion be considered?
Hb <80
Where is folate & B12 absorbed?
Folate = Jejunum B12 = Ileum
What does B12 require to be absorbed?
Intrinsic factor
Produced by gastric parietal cells
What are the 2 types of macrocytic anaemia? What are the causes?
Megaloblastic: B12 (CD, Addison’s), Folate (Hep, leukaemia, diet), Cytotoxic (Azathiprine)
Non-megaloblastic: OH- liver disease, hypoThy, Pregnancy, Myelodysplasia, reticulocytosis
How are megaloblastic cells produced?
Abnormal erythroblasts in BM
Delayed maturation of nucleus relative to cytoplasm
Defective DNA synthesis
LARGE cells
How are non-megaloblastic cells produced?
Issues relating to outside of the BM
What are the initial sign of macrocytic anaemia
Dyspnoea on exertion
Fatigue
What are the late signs of macrocytic anaemia?
Angular stomatitis Glossitis Pale conjunctiva Lemon tinge Peripheral neuropathy
How is macrocytic anaemia investigated?
Bloods: ↓Hb, ↑MCV, ↑Ferritin, TIBC n
Blood Film: Hypersegmented polymorphs = B12/FOLATE, Target cells = LIVER DISEASE
PERNICIOUS anaemia: Parietal cell Abx, IF auto-Abx
↓B12,↓Folate
BM Biopsy: If no obvious cause- EXCLUDE leukaemia
What should be done before prescribing folic acid? Why?
CHECK B12 LEVELS
Folic acid can exacerbate subacute combined degeneration of the spinal cord
If BOTH B12 & Folate deficient- start B12 FIRST then once B12 normalises start Folic acid
How is a folate deficiency treated?
Diet: Green veg, nuts, liver
Folic acid: 5mg OD for 4m, look for Hb ↑10g/L/week
How is B12 deficiency treated?
B12 injections: Hydroxocobalamin
Initially - 1mg IM alt days for 2w
Maintenance- 1mg IM/3m for life
How is B12 absorbed?
B12 binds to IF in stomach → absorbed in terminal ileum
B12 def = ↓Thymidine synthesis → ↓DNA synthesis rate
↓RBC production
What is a major complication of untreated B12 deficiency?
Subacute combined degeneration of the spinal cord
Insidious onset
Symmetrical loss of dorsal column & corticospinal tracts
