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Y3 MedEd > Anaemia > Flashcards

Anaemia Flashcards

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1
Q

Main signs of anaemia (5)

A

Skin and mucosal pallor
Pale conjunctiva
Fatigue
RR and HR increased

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2
Q

4 causes of microcytic anaemia

A

Sickle cell
Anaemia of chronic disease (but can be normocytic often too)
Thalassaemias
IDA

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3
Q

What does anisopoikilocytosis mean

A

Anisocytosis - unequal size

PoiKILOcytosis - unequal shape

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4
Q

What disease are pencil cells seen in

A

IDA

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5
Q

What is seen on the blood film of IDA (5)

A 
Anisocytosis
Poikilocytosis
Pencil cells
Hypochromic
Microcytic cells
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6
Q

Three main ways you can get IDA

A

Reduced uptake
Increased loss
Increased requirement

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7
Q

What can cause reduced uptake IDA (4)

A

Malnutrition
Coeliac
IBD
Achlorhydria

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8
Q

What can cause increased loss IDA (4)

A

GI Malignancy
Peptic ulcer
IBD
Menstruation

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9
Q

What can cause increased requirement IDA (2)

A

Pregnancy

Breastfeeding

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10
Q

What is the triad for colon cancer

A

Unexplained IDA
PR bleeding
Weight loss

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11
Q

Which is increased in Anaemia of Chronic Disease?

Intrinsic factor
Hepcidin
TIBC
Transferrin 
Ferroportin
A

Hepcidin

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12
Q

Changes to level of ferritin and TIBC in IDA?

A

Ferritin - down

TIBC - up

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13
Q

Changes to level of ferritin and TIBC in ACD?

A

Ferritin - up

TIBC - down

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14
Q

What causes anaemia of chronic disease

A

Increased hepcidin which reduces iron uptake, storage and release

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15
Q

Why does ferritin increase in ACD

A

It is an acute phase protein and so increases in infections

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16
Q

The chipmunk facies/skull abnormalities seen in thalassaemia are due to what

A

Extramedullary haematopoiesis

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17
Q

What are the 7 different types of thalassaemia

A 
Alpha defect:
Alpha+ 
Alpha°
Hb H
Hb Barts

Beta defect:
Beta minor
Beta intermedia
Beta major

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18
Q

Which type of thalassaemia is rarer - alpha or beta

A

Alpha

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19
Q

Which chromosome is affected to cause alpha thalassaemia

A

Chr 16

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20
Q

Which chromosome is affected to cause beta thalassaemia

A

11

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21
Q

Which thalassaemia does a defect in chromosome 16 cause

A

Alpha

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22
Q

Which thalassaemia does a defect in chromosome 11 cause

A

Beta

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23
Q

Describe the alpha thalassaemias and their severities

A

Alpha+ and Alpha° cause very mild anaemias (where you lack 1 or 2 alpha genes)

Hb H causes a significant anaemia (where you lack 3 alpha genes)

Hb Barts causes death in utero (no alpha genes)

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24
Q

Describe the beta thalassaemias and their severities

A

Beta minor often presents with a mild anaemia but a disproportionately low MCV
Beta intermedia is a variant condition – be aware it exists nothing more
Beta major – severe anaemia presenting in the first few months of life

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25
Ix for thalassaemias
Microcytic anaemia | Normal Iron studies
26
When does alpha thalassaemia present
From birth
27
When does beta thalassaemia present
From early infancy
28
What is seen on the blood film of a sickle cell patient (2)
Howell-Jolly bodies | Sickled cells
29
Mx of an acute painful sickle cell crisis (4)
Saturate (supportive Oxygen) Antibiotics (if needed) Pain relief Cannula (IV fluids)
30
Mx of a stroke with sickle cell disease
Exchange Blood Transfusion
31
Mx of a sequestration crisis with sickle cell disease
Splenectomy
32
Mx of a chronic cholecystitis with sickle cell disease
Cholecystectomy
33
How to diagnose SCA (2)
Hb electrophoresis + Blood film
34
Medical Mx of SCA
Vaccinations Hydroxyurea Prophylactic ABx
35
How does hydroxyurea work in SCA
Hydroxyurea increases production of HbF (which does not contain the defective beta globin S chain) which inadvertently reduces the total level of sickle-able cells.
36
Surgical Mx of SCA
Bone Marrow Transplant (curative)
37
What causes megaloblastic anaemia
Folate or B12 deficiency
38
What is seen in the blood film of megaloblastic anaemia
Hypersegmented neutrophils and macrocytic cells
39
Causes of vitamin B12 related megaloblastic anaemia (5)
``` Alcohol IBD/Coeliac Bariatric surgery Malnutrition Pernicious anaemia ```
40
Causes of folate related megaloblastic anaemia (5)
Alcohol IBD/coeliac Anti-folate drugs Pregnancy
41
S/s of B12 deficiency (4)
Glove & stocking parasthesiae Hyporeflexia Romberg’s +ve Subacute combined degeneration of the cord
42
Does B12 deficiency cause hypo or hyperreflexia
Hyporeflexia
43
In the subacute combined degeneration of the cord what does lateral corticospinal tract lesion result in:
Myopathy
44
In the subacute combined degeneration of the cord what does dorsal column tract lesion result in:
pressure, vibration and touch sense diminished
45
How long do your B12 reserves last for
3-4 years
46
Average onset of pernicious anaemia?
60 years old
47
RF for pernicious anaemia
AI PMHx
48
Which auto-antibodies are involved in pernicious anaemia (2)
Anti-Parietal cells | Anti-Intrinsic factor
49
Diagnostic criteria of pernicious anaemia (4)
Macrocytosis Megaloblastic film Neuro signs as seen in B12 deficiency anaemia Low B12
50
Diagnostic criteria of folate deficiency (3)
Macrocytosis Megaloblastic film Low Folate
51
How long do our folate reserves last for
Around 6 months
52
Non-megaloblastic causes of macrocytic anaemia
Alcoholics May Have Liver Failure Alcohol Myelodysplasia Hypothyroidism Liver disease
53
Features of haemolytic anaemia (3)
Scleral icterus Pallor Pale conjuctiva
54
Bloods tests for haemolytic anaemia (4)
Hb low Haptoglobin low Unconjugated bilirubin raised LDH raised
55
What are hereditary haemolytic anaemias and what are they a defect in (4)
Membrane - hereditary spherocytosis Enzymes - G6PD deficiency Haemoglobin - SC and thalassaemia
56
What is the direct anti globulin test also known as
Coombs test
57
What is the Coombs test also known as
Direct antiglobulin test
58
What does the Coombs test test for
Presence of antibody on the red cell surface - e.g. in AI haemolytic anaemia
59
What should be avoided if you have G6PD deficiency and why (2)
Beans and antimalarials - quinines due to oxidative stress
60
What is seen on blood film in G6PD deficiency anaemia (2)
Heinz bodies and Bite cells
61
What is the inheritance pattern of G6PD deficiency
X linked recessive
62
What is the inheritance pattern hereditary spherocytosis
Autosomal dominant
63
Diagnostic criteria for hereditary spherocytosis
Osmotic fragility test and Coombs' test negative
64
Complications of hereditary spherocytosis
Aplastic crisis
65
What can trigger aplastic crisis in hereditary spherocytosis
Parvovirus B19
66
What is the 'triad' seen in HUS
Haemolysis Urinary problems Shits
67
What are the GI features of HUS (2)
Abdominal Pain | Bloody Diarrhoea
68
What population gets HUS
Early childhood - usually through infection of EHEC O157 that produces Shiga-like toxin
69
What are the renal features of HUS (2)
Oliguria | Creatinine
70
What are the haemolytic features of HUS (2)
Jaundice | Conjunctival pallor
71
How does AKI manifest in HUS
a child is infected with E. coli and develops the classical bloody diarrhoea associated with that. It produces a Shiga-like toxin (like shigella’s toxin) which is capable of binding to endothelial cells within the kidney. It enters these cells and damages them. This damaged endothelium attracts widespread platelet plug formation. This leads to microthrombi which shear red blood cells. The end result is an acutely dysfunctional kidney – AKI – alongside a haemolytic anaemia.
72
How does HUS cause uraemia
The endothelial damage to make a dysfunctional kidney reduces kidney function which means compounds such as urea are not excreted leading to uraemia
73
Causes of DIC (6)
``` Pancreatitis Sepsis Obstetric complications Cancers Trauma ABO reaction ```
74
Blood results of DIC (4)
Platelets↓ Fibrinogen ↓ FDPs ↑ D-dimer ↑
75
Clotting features of DIC (2)
Prolonged APTT | Prolonged PT
76
What is the pathology behind TTP
Defunct ADAMTS-13 enzyme
77
What is the 6 things in TTP
ADAMTS ``` Antiglobulin (Coombs) negative Decreased platelets AKI MAHA Temperature Swinging CNS signs ```
78
Neurological manifestations of TTP? (6)
Neurologic manifestations include alteration in mental status, seizures, hemiplegia, paresthesias, visual disturbance, and aphasia
79
What happens in TTP
Defunct ADAMTS-13 enzyme fails to break down clots forming through vWF leading to blood clots forming in smaller vessels
80
Which drug can cause haemolytic anaemia
Dapsone | Anti-leprosy ABx
81
Which infection can cause haemolytic anaemia
Plasmodium falciparum
82
What cause of anaemia would result in a positive Coombs test
AI
83
What are the 2 types of a positive Coombs test and what do they indicate
Warm - above 37 IgG antibodies Cold - below 37 IgM antibodies
84
What causes +ve warm Coombs' test (3) and what antibody
IgG antibodies Idiopathic SLE CLL
85
What causes +ve cold Coombs' test (3) and what antibody
IgM Antibodies Idiopathic Mycoplasma Mononucleosis
86
Which thrombosis often manifests during pregnancy
Anti-phospholipid syndrome
87
Clinical features of APL syndrome (5)
Recurrent miscarriages (3+) VTE Stroke/MIs, HTN (arterial problems) Livedo reticularis (mottled)
88
Ix for APL syndrome (2)
Anti-cardolipin +ve | Lupus anti-coagulant test +ve
89
Clinical features of PRV (4)
Older (~60) Asymptomatic Aquagenic pruritis Hyperviscosity syndrome
90
Ix for PRV (4)
Elevated Hb & haematocrit | +/- Thrombocytosis
91
What is PRV and what happens in it
A Philadelphia chromosome negative myeloproliferative disorder which involves JAK2 leading to RBC proliferation independent of EPO
92
Which gene is affected in PRV
JAK2 V617F +ve
93
What happens in myelofibrosis
Fibrosis in response to a BM malignancy
94
What is associated with myelofibrosis
Moderate JAK2 mutation association
95
Age of myelofibrosis
Over 65
96
RF for myelofibrosis
Radiation
97
Ix for myelofibrosis
BM aspirate showing dry tap fibrosis | Blood film shows tear drop cells
98
What do tear drop cells on a blood film suggest
Myelofibrosis
99
What does aplastic crisis occur in
SCA and hereditary spherocytosis
100
What happens in aplastic anaemia
Aplastic anaemia typically arises from an autoimmune reaction to the haematopoietic stem cells of the BM. This leads to complete BM failure as all cell lines are affected
101
RFs of aplastic anaemia
Radiation and some infections (including EBV, HIV
102
Ix for aplastic anaemia (3)
FBC showing pancytopenia EPO raised BM aspirate hypocellular
103
Features of aplastic anaemia
Anaemia features: + EPO raised Thrombocytopaenia: Bleeding Petechiae Leucopoenia: Sepsis Recurrent infections

Y3 MedEd (34 decks)

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