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Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What is anaemia?

A

Anaemia is a low Hb or RBC count more than 2 SD from the mean whereby usual Hb is 135-175 for males or 120-155g/L in females

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2
Q

List 5 Sx of Anaemia

A
  • Tired (caution as a common symptom)
  • SOB
  • Myalgia
  • Dizziness
  • Angina
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3
Q

List 3 signs of Anaemia

A

Palor: skin + conjunctiva
Tachycardia
Rapid breathing
Peripheral oedema (if severe anaemia)

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4
Q

What are the adaptations involved in anaemia?

A

CO increases: heart rate and stroke volume

Blood flow distribution changes

Change in oxygen dissociation curve - 2,3-BPG

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5
Q

How may anaemia be classified?

A

RBC change: Under-production or increased loss of RBC

Onset: Congenital or Acquired

Duration: Acute or Chronic

Mean cell volume (MCV): microcytic, normocytic, macrocytic

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6
Q

What is MCV?

A

MCV = mean cell volume = derived from RBC histogram

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7
Q

What is MCH?

A

MCH = mean cell Hb = 

Hb / RBC

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8
Q

What is MCHC?

A

MCHC = mean cell Hb concentration = 

Hb / Hct

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9
Q

List the three classifications by MCV.

A

Microcytic (60-80fl)

Normocytic (80-100fl)

Macrocytic (100-120fl)

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10
Q

Give an example of a Microcytic Anaemia

A

iron deficiency

thalassaemia 


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11
Q

Give an example of a Normocytic Anaemia

A

blood loss

anaemia of chronic disease

renal impairment

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12
Q

Give an example of a Macrocytic Anaemia

A

megaloblastic anaemia

B12/folate deficiency

myelodysplasia 


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13
Q

What is the most common cause of anaemia?

A

Iron deficiency anaemia

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14
Q

What are the haematological changes observed in iron-deficiency anaemia?

A

MCV reduced (65-80) ≈ microcytic

Reduced Hb

Low ferritin

Low transferrin saturation with iron

Rest of FBC normal (h/e raised platelets if bleeding)

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15
Q

What are the causes of iron deficiency anaemia?

A

Poor intake

Menstruation

GI track blood loss: haematemesis, cancer, peptic ulcer, angiodysplasia, hookworm

Malabsorption - coeliac disease, CD etc

Increased need e.g. growth spurt/pregnancy

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16
Q

List 5 clinical features of iron deficiency anaemia

A

Pallor

Tachycardia

Koilonychia

Pica

Hair loss

Glossitis

Angular stomatitis

17
Q

Give two tests that can show iron-deficiency anaemia.

A

FBC: Hb low, MCV low, RBC low

RBC Histogram: Normocytic and Microcytic

Blood film: Hypochromic + Poikilocytosis + Anisocytosis

18
Q

Give the treatment for Iron-deficiency anaemia

A

1) Oral replacement: Ferrous Sulphate 200mg BDS-TDS
2) IM iron
3) IV Iron: Ferric carboxymaltose over 15-30 mins (ferinject) or Iron dextran (4-6 hours after test dose)
4) Treat underlying cause

19
Q

Give 3 side effects of ferrous sulphate

A

Nausea
Abdominal Pain
Constipation

20
Q

A 24 year old woman presents with fatigue and tiredness. Her PMHx is unremarkable and DHx is only paracetamol for headaches and Vitamin D supplements. She does not drink alcohol and has a balanced, Vegan diet.

O/E you identify angular stomatitis, koilonychia and tachycardia.

What is your differential?

Give 3 reasons for her condition.

Outline the possible treatment options for her.

A

Iron-deficiency anaemia

Causes:

  • Poor intake
  • Menstruation
  • Malabsorption
  • GI tract loss
  • Increased need

Rx:
- Ferrous sulphate 200mg BDS or TDS

  • IM
  • IV: Iron dextran
  • Treat underlying causes
21
Q

A 28 year old woman presents with tiredness and fatigue. She also mentions she has numbness in her left arm. She is a non-smoker and does not drink alcohol. She has a balanced vegan diet and exercises for 5 hours per week.

O/E you notice palor, tachycardia and peripheral neuropathy.

What investigations might you order?

The investigations show low B12. What is your differential?

Outline your management.

A

Investigations:

  • FBC
  • Iron
  • TFTs
  • CT/MRI

Differential: B12 deficiency anaemia

Rx:

  • Oral cyanocobalamin
  • Hydroxycobalamin 1mg IM alternate days for loading dose then 3 months if needed
22
Q

List 3 causes of B12 deficiency anaemia

A

Poor intake
Terminal ileal disease
Pernicious anaemia

23
Q

A 28 year old Pregnant woman presents with tiredness and fatigue. She also mentions she has numbness in her left arm. Her PMHx shows she has history of autoimmune hepatitis. She is a non-smoker and does not drink alcohol. She has a balanced vegan diet and exercises for 5 hours per week.

O/E you notice palor, tachycardia and peripheral neuropathy.

What investigations would you order?

Her investigations show low Folate and large RBCs. What is your Differential?

Give 3 causes of this differential.

Outline her management.

A

Investigations:

  • FBC
  • TFTs
  • ßcHG
  • CT/MRI
  • Serology
  • LFTs

Differential: Folate deficiency anaemia

Causes:

  • Poor intake
  • Pregnancy
  • Haemolysis
  • Malabsorption
  • Drugs (anti-epileptics etc)

Rx:
- Folic Acid 5mg per day PO OD

24
Q

A 19 year old woman presents with pallor and fatigue. Recently she has noticed her periods have been much heavier (menorrhagia) and she has experienced post-coital bleeding.

O/E you notice she is tachycardia, has angular stomatitis, koilonychia however you cannot see any O+G causes.

What investigations might you order?

Your investigations show low Rb, Hb and a radiographic find in the myometrium reproductive tract.

What is your haematological and reproductive (O + G) differential?

Give 3 causes of the haematological condition.

Outline the Rx

A

Investigations:

  • FBC
  • TFTs
  • LFTs
  • U+E
  • TV-US

Differential:

  • Blood loss-related anaemia
  • Uterine fibroids

Causes:

  • Injury
  • Blood sampling
  • GI bleed
  • Severe internal bleeding
  • Pregnancy delivery

Rx:
- IV infusion

25
Q

A 34 year old Caucasian male patient presents with fatigue and tiredness. He has a long history of IBD for which he is on medication. Other than that, he has no remarkable PMHx.

O/E you identify pallor, angular stomatitis and koilonychia.

What investigations might you order?

The investigations show raised CRP and low ferritin

What is your diagnosis?

Outline your treatment

A

Investigations:

  • FBC
  • Iron tests
  • TFTs
  • U+E
  • LFTs
  • Serology

DDx: Anaemia of chronic disease

Rx:

  • Treat underlying disease
  • Iron supplements: Ferrous sulphate 200mg BDS
26
Q

A 56 year old Male patient presents with pallor. They have a PMHx of CKD Stage 3, RPGN, Autoimmune Hepatitis and MI.

O/E you notice pallor and angular stomatitis.

Outline the Differential for this patient regarding their haematology.

What is your Management plan?

A

Ddx: Anaemia of Renal Failure

Management:

  • IV EPO
  • SC EPO
27
Q

A 27 year old female presents with pallor and fatigue. She has a relatively unremarkable PMHx however she has a FHx of Autoimmune conditions. She has had childhood asthma and eczema. She recently had an infection with Haemophilus causing Tonsillitis which she experienced a systemic reaction to her penicillin Rx.

O/E you notice diffuse bruising, pallor, tachycardia, and hair loss on the scalp.

The investigations come back showing low Hb, low RBCs, a low MCHC and MCH with schistocytes present on peripheral blood smear.

What is your DDx?

Outline your Management plan.

A

DDx: Haemolytic anaemia

Management:

  • Find and remove causative agent
  • Iron supplements: Ferrous Sulphate 200mg PO BDS

OR

  • Steroids
  • Splenectomy
  • Monoclonal Ab - Ritixumab
28
Q

A 34 year old Ghanian male presents with pallor and fatigue. He says he has noticed it more so recently due to a new job which is more taxing. He says he has a vegan diet and does not drink alcohol however this problem has run in his family for a long time and no one knew why.

O/E you confirm signs of anaemia (pallor, tachycardia, poikylonychia and hair loss).

His bloods show low Fe, low RBCs, low Hb. Peripheral blood smear shows distinct poikilocytosis.

What is your differential?

What investigation may be useful to obtain a precise DDx?

Outline his management.

A

Ddx: Haemoglobinopathy - Sickle Cell Disease

Genotype/Genetic Tests: Sickle Cell Disease

Management:

  • Supportive
  • Hydroxycarbamide (increase HbF production)
  • Stem cell transplant
29
Q

How does Hydroxycarbamide treat anaemia?

A

Increase HbF production

30
Q

A 34 year old Sri Lankan male presents with pallor and fatigue. He says he has noticed it more so recently due to a new job which is more taxing. He says he has a vegan diet and does not drink alcohol however this problem has run in his family for a long time and no one knew why.

O/E you confirm signs of anaemia (pallor, tachycardia, poikylonychia and hair loss).

His bloods show low Fe, low RBCs, low Hb. Peripheral blood smear shows distinct poikilocytosis.

What is your differential?

What investigation may be useful to obtain a precise DDx?

Outline his management.

A

DDx: Thalassaemia (likely ß-thalassemia as progressive anaemia due to declining HbF after birth)

Investigation(s):
- Genotype analysis to determine alpha or ß-thalassemia

Treatment:

  • Supportive
  • Transfusion
  • Stem cell transplant
31
Q

A patient with known cancer of the breast presents with pallor and fatigue. She has had Breast Ca for 3 years and has been receiving Rx.

O/E you confirm pallor, koilonychia and hair loss.

Bloods show reduced Rb, Hb reduced and cell size increased. MRI scan shows numerous lesions (possible metastasis) in the bone.

Give your haematological DDx.

Outline the management.

A

Marrow infiltration anaemia e.g. Metastases

Management:

  • Cancer referral
  • Chemotherapy
  • Radiotherapy
  • Immunotherapy
32
Q

A patient with known cancer of the breast presents with pallor and fatigue. She has had Breast Ca for 1 year and has been receiving Rx recently.

O/E you confirm pallor, koilonychia and hair loss.

Bloods show pancytopenia, reduced Rb, Hb reduced and cell size increased. MRI scan shows numerous lesions (possible metastasis) in the bone.

Give your haematological DDx.

Outline the management.

A

Aplastic Anaemia - pancytopenia due to chemotherapy

Rx:

  • Supportive care
  • Chemotherapy
  • SC transplant
  • Supportive care
  • Anti-thymocyte globulin

Haematology (2 decks)

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