anaemia Flashcards
(34 cards)
What is anaemia in men and women?
Female - Haemoglobin levels below 11.5 g/dl
Male - Haemoglobin below 13.5 g/dl
What are the normal ranges for Hb?
female - 11.5 - 16.0 g/ dl
Male - 13.5 -18.0 g/dl
What can influence Hb levels apart from anaemia
Blood volume
- Giving IV fluids - increase BV - diluting blood - low Hb reading than expected
- Dehydrated - not been drinking Hb may be higher than expected
Signs of anaemia ?
- Tired
- Breathless/SOBOE (short of breath on exertion )
0 - Headaches
- Feeling faint
- Palpitations
0 not enough Hb to deliver enough 02 body compensates increasing heart rate and respiratory rate) - Exacerbates/can precipitate angina or - intermittent claudication (calf pain when walking - sign of osteosclerosis )
- Pale
- Tachycardia
- Cardiac signs
Important note about diagnosing iron deficiency anaemia’s ?
Have to exclude malignancy when dealing with iron deficiency anaemia.
- e.g bowel cancer - bleeding into the bowel so Hb dropping.
how is neutropenic sepsis diagnosed?
Neutropenia - Decreased neutrophils - below 0.5 x 10^9/L
+ one of these :
- Fever - > 38 degrees C
any symptoms and/or signs of sepsis,
What is neutropenic Sepsis ?
medical emergency - Neutropenia
- Less neutrophils , more vulnerable to infection. Patients gets an infection —.> body cant fight it off —–> become septic
Side effect of Chemotherapy almost over treatments. Can destroy bone marrow affecting neutrophil production.
G - CSF - Granulocyte colony stimulating factor can given —– stimulate the production of white blood cells from precursors.
Treatment
SEPSIS 6 pathway
-
erythropoiesis
- Bone marrow -Pluripotent stem cell
- proerythroblast / pronormoblast
- eythroblast / normoblast
( start to lose organelles , nuclues) - reticulocyte - ( Should be about 2% of circulating red calls - if haemorrhage - should expect higher proportion of reticulocyte due to blood loss) - loss of red cells so bone marrow compensating
- Erthyrocyte ( 120 day lifespan
What is Polycthemia ? Types ?
polycythaemia / erythrocytosis - Higher levels of red blood cells (than normal)
Can cause Blood clots.
Apparent polycythaemia - reduced plasma, normal red blood cell conc - blood thicker due to reduced plasma
Relative polycythaemia - sim to apparent but cause by dehydration
Absolute polycythaemia - production of too many red cells.
0 primary polycythaemia - Bone
marrow produce too much RBC
e. g . polycythaemia vera (PV) - mutation in JAK2 gene - can also effect platelets and WBC - levels abnormally high.
0 secondary polycythaemia - too
much RBC production but caused
by underlying condition.
(Respiratory conditions e.g COPD stimulates liver to release more erythropoietin in response to hypoxia - causes high levels of Hb and RBC.
What causes low release of erythropoietin ?
Kidney disease- leads to lower release and not enough —-> not enough RBC produced.
Can give recombinant erythropoietin.
What is needed for RBC production ?
- Hormones
- Metal
- iron
- Vitamins - Folic acid , B12
- other vitamins.
Classify the different anaemias according to MCV
Microcytic - < 80 FL
- iron defieciency
- Thalassaemia
Macrocytic - > 96 / 100 fl
- Megaloblastic - Vitamin B12 , folate deficiency
- Normoblastic - Haemolytic anaemia , Haemorrhage , increased reticulocytes.
Megaloblast are have hyper segmented nucleus , normoblast - don't) - Normal sized cells - normal MCV -
What is Anaemia of chronic disease?
anaemia of inflammation - anaemia that affects people who have conditions which cause inflammation.
very common is hospital patients
- Kidney disease -reduced erythropoietin
- Chronic inflammation - Crohns , Rheumatoid arthritis , malignancy , Systemic lupus erythematosus
- inflammation states - increased hepcidin
Hepcidin binds to transpoiten in enterocyte membrane. Causes internalisation of hepcidin and degradation. Stop transport of ferritin outside the cell into blood. ) - Unwell - RBC might survive for full 120 days
What is iron deficiency anaemia ?
Reduce iron levels in blood
Causes
0 Increased loss -
heavy periods , colon
cancer , gastric ulcers
0 Reduced absorption -
IBD , Celiac disease -
( destruction of
duodenal cells. ) ,
reduced gastrc acid - non -
activation of ferri -reductase
(reduces fe3 to fe2)
0 reduced intake - diet
- vege/ vegans - high in fe3+
instead of fe2+ - fe3 harder to
absorb has to be converted
first.
- infant - breast milk low in iron
0 increased demand
- pregnancy
- child & adolescence
(periods of rapid growth)
How is iron absorbed from diet?
Duodenal cell
- FE3+ , FE2+ diffuse into cell .
- HCL activates ferri - reductase which converts fe3+ into fe2+.
- ferritin stores FE 2 + until ready for use.
- FE2+ diffuses into blood.
- Hephaestin converts Fe2+ to FE3+.
- FE3+ transported to target tissues by transferrin.
Characteristics of Iron deficiency A ?
Microcytic Hypochromic RBC
- Reduced MCV (below 80 fl)
- pale colour RBC
- Poikilocytosis - wrong
shape
0 Spherocytes
0 elliptocytes - Anisocytosis - wrong size - lots of different sizes.
What you expect blood test and blood smears to show - Iron deficiency Anaemia ?
REDUCED
0 haemoglobin
0 MCV
0 serum iron
0 serum ferritin - (below 15 mg/ l - confirms diagnosis )
INCREASED
0 total iron binding
capacity (unbound
transferrin in blood)
0 Red cell distribution width - different sizes
Blood smear - microcytic and hypochromic
NICE classifications of anaemia ?
Anaemia is defined as a haemoglobin (Hb) level two standard deviations below the normal for age and sex:
• In men aged over 15years — Hbbelow 130 g/L.
• In non-pregnant women aged over 15years —Hb below 120 g/L.
• In children aged12–14years—Hb below 120 g/L.
• In pregnant women—Hb below 110 g/L throughout pregnancy. An Hb level of 110 g/L or more appears adequate in the first trimester, and a level of 105g/L appears adequate in the second and third trimesters.
• Postpartum — below 100 g/L
Treatments of iron deficiency ?
Iron deficiency anaemia should be treated with oralferrous sulfate 200mg tabletstwo or three times a day and continuedfor 3 months after iron deficiencyis corrected.
• Haemoglobin levels (full blood count) should be checked after 2–4 weeks to assess the person’s response to iron treatment.
• People should undergo specialist assessment if there is a lack of response (increase of less than 20 g/L in the Hb level) after 2–4 weeks.
(oral ferrous sulfate + orange juice - helps increase absorption. )
0 IV iron - if oral not tolerated
Signs of iron Deficiency A ?
Fatigue
headaches
pallor - pale
Atrophic glossitis - absence of filiform papillae. - bald tounge.
koilonychia - spoon shaped nails
Tachycardia
angular cheilitis - inflammation of corners of mouth (oral commissures)
dyspnoea
iron deficiency A and general bleeding ? - cancer pathway referral ,
○ People aged over 60 years with iron deficiency anaemia.
○ Women aged over 55 years withpostmenopausal bleeding.
Urgent referral should be considered for peopleaged under 50 yearswith rectal bleeding.
What is Aplastic anaemia and consequences ?
Pancytopenia - reduction in all blood cell lines
0 RBC , WBC , platelets
Autoimmune destruction of Hemopoietic stem cells.
reduced RBC -
0 consequence - less
oxygenation to
tissues - heart pumps
faster - chest pain,
shortness of breath
-Leukocytopenia - low WBC
0 consequence -
increased risk of
infection (sepsis)
-Thrombocytopenia - low platelets
0 Consequence -
- increased risk of
bleeding
Causes of Aplastic A?
Most often idiopathic
- can be cause by :
0 radiation / toxins
0 Drugs
- anti- seizure
- anti -thyroid
- chemo drugs/
agents
- anti- thryoid
drugs -
propylthiouracil ,
methimazole
- Antibiotics -
chloramphenicol
, sulfonamides.
0 Clonal or genetic
mutations
0 Infectious agents -
HIV, Epstein - barr
virus (part of
herpes family )
What is Falconi’s anaemia ?
Most common form of Aplastic anaemia
- Genetically inherited - caused my inheritance of an abnormal gene which results in reduced production of blood cells by bone marrow.
