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Flashcards in Anaemia Deck (36)
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1
Q

What is anaemia defined as?

A

Decrease in number of RBC, or decrease in oxygen-carrying capacity of blood cells

2
Q

What are the mechanisms that can lead to anaemia?

A
  • Decreased RBC production
  • Increased RBC lysis
  • Loss of blood
3
Q

What is MCV?

A

Measurement of average volume of RBCs

4
Q

What is a normal MCV?

A

80-100fl

5
Q

What are the most common causes of microcytic anaemias?

A
  • Iron deficiency anaemia

- Thalassaemia

6
Q

What kind of anaemia is sideroblastic anaemia?

A

Generally microcytic, but may be normocytic

7
Q

What are the causes of macrocytic anaemia?

A
B12 or folate deficiency.
Alcohol excess or liver disease.
Reticulocytosis eg with haemolysis
Cytotoxics, eg hydroxycarbamide.
Myelodysplastic syndromes.
Marrow infiltration.
Hypothyroidism.
Antifolate drugs (eg phenytoin).
8
Q

What are the causes of normocytic anaemia?

A
Acute blood loss.
Anaemia of chronic disease (or ↓mcv).
Bone marrow failure.
Renal failure.
Hypothyroidism (or ↑mcv).
Haemolysis (or ↑mcv).
Pregnancy.
9
Q

In general, how might patients with anaemia present?

A
  • Fatigue
  • Dyspnoea
  • Headaches
10
Q

What is iron deficiency anaemia?

A

Anaemia caused by inadequate iron intake, which leads to decreased RBC production

11
Q

Who is at the highest risk of iron deficiency anaemia?

A

Pre-menopausal women (due to menstrual loss)

12
Q

What is the most common cause of iron deficiency anaemia in men and post-meno women?

A

GI bleeding

13
Q

What are the main mechanisms of development of iron deficiency anaemia?

A
  • Insufficient dietary intake or malabsorption of iron
  • Increased loss of iron
  • Increased demand for iron
14
Q

When might there be malabsorption of iron?

A

Coeliac disease

15
Q

When might there be increased loss of iron?

A
  • GI bleeding
  • Cancer
  • UC
  • Endemic infectious diseases, e.g. hookwork, schisto
16
Q

When might there be increased demand for iron?

A

During pregnancy

17
Q

What is Plummer-Vinson syndrome?

A

Triad of;

  • Iron deficiency anaemia
  • Oesophageal webs
  • Dysphagia
18
Q

What does treatment of Plummer-Vinson syndrome involve?

A
  • Iron replacement

- Endoscopic dilatation of oesophagus

19
Q

Why is careful assessment required in Plummer-Vinson syndrome?

A

Patients at higher risk of developing oesophageal carcinomas

20
Q

What initial investigations are done in iron deficiency anaemia?

A
  • FBC
  • Peripheral smear
  • Iron studies
21
Q

What will be found on peripheral smear in iron deficiency anaemia?

A

Hypochromic (central pallor of RBC), microcytic anaemia

22
Q

What is found on iron studies in iron deficiency anaemia?

A

Low iron levels, but increased total iron binding capacity

23
Q

What other investigations may be done in iron deficiency anaemia?

A
  • Endoscopy

- Coeliac screen

24
Q

When should patients with iron deficiency anaemia be referred for urgent 2 week wait endoscopy?

A
  • Over 60

- Under 50 with rectal bleeding

25
Q

When should coeliac screen be done in iron deficiency anaemia?

A

If indicated clinically

26
Q

What is the first line management for iron deficiency anaemia?

A

Oral ferrous sulphate/fumurate

27
Q

How long might it take for Hb to normalise with oral iron replacement?

A

2 months

28
Q

What should be considered for patients who do not respond to oral iron with iron deficiency anaemia?

A

Consider for IV iron replacement

29
Q

What is it important to warn patients taking iron supplementation of?

A

Side effects of treatment, including black stools, constipation, and nausea

30
Q

What are the main forms of thalassaemia?

A
  • Alpha

- Beta

31
Q

What causes thalassaemia?

A

Gene deletions in alpha and point mutations in beta which lead to improper synthesis of adult haemoglobin

32
Q

What is adult haemoglobin comprised of?

A

2 alpha and 2 beta chain

33
Q

What does the variation in presentation of thalassaemia depend on?

A

Type and extent of involvement

34
Q

What can thalassaemia be classified as?

A
  • Minor
  • Major
  • Intermedia
35
Q

Who is more likely to be affected by beta thalassaemia?

A

People of Mediterranean origin

36
Q

Who is more likely to be affected by alpha thalassaemia?

A

Asians