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Anaemia Flashcards

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1
Q

In terms of red cells, what does a high unconjugated bilirubin suggest? Why?

A

It indicates haemolysis as when red cells breakdown one of the products is unconjugated bilirubin

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2
Q

In terms of red cells, what does a high conjugated bilirubin suggest? Why?

A

A problem in the liver, if it was to do with red cells the bilirubin would be unconjugated, conjugation of bilirubin occurs in the liver

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3
Q

Is LDH intra or extra cellular?

A

Intracellular

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4
Q

In relation to reticulocytes, what is the normal response in anaemia?

A

Increase the production of reticulocytes, those with anaemia should have a high reticulocyte count

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5
Q

What does anaemia with low reticulocytes indicate?

A

There is a problem with RBC production

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6
Q

What are indicators of haemolysis when looking at bloods?

A

High unconjugated bilirubin
Raised LDH
Reduced haptoglobulins

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7
Q

What are the 4 mechanisms of anaemia?

A

Reduced production of RBCs
Increased clearance of RBCs in circulation
Blood loss
Pooling of cells in the spleen

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8
Q

What are some causes of reduced red cell survival?

A

Hereditary spherocytosis
G6PD deficiency
Autoimmune haemolytic anaemia

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9
Q

What are some causes of reduced red cell production?

A

Anaemia of chronic disease
Iron deficiency anaemia
Megaloblastic anaemia

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10
Q

How does chromia of red cells differ when cells are macrocytic vs normocytic vs microcytic

A

Microcytic: hypochromia
Normocytic: normochromia
Macrocytic: normochromia

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11
Q

What are the common causes of microcytic anaemia?

A

Deficiency in haem synthesis (iron deficiency anaemia or anaemia of chronic disease)
Deficiency in globin synthesis (alpha or beta thalassaemia)

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12
Q

How can we differ between anaemia of chronic disease and iron deficiency anaemia?

A

Ferritin will be high in chronic but low in iron deficiency, transferrin will be normal/low in chronic but high in iron deficiency

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13
Q

How does electrophoresis allow us to differentiate between alpha and beta thalassaemia?

A

In alpha thalassaemia, the HbA2 will be normal but in beta it will be raised

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14
Q

How do we differentiate between iron deficiency anaemia and thalassaemia?

A

Haemoglobin will be low in iron deficiency but normal an thalassaemia, RBC will be low in iron deficiency but raised in thalassaemia

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15
Q

What are common causes of macrocytic anaemia?

A

Vitamin B12 and folic acid deficiency
Drugs that interfere with DNA synthesis
Liver disease and ethanol toxicity
Haemolytic anaemia

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16
Q

What are some common causes of normocytic anaemia?

A

Recent blood loss
Failure of production red cells
Pooling of red cells in the spleen

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17
Q

Define haemolysis

A

Destruction of red cells

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18
Q

What is the lifespan of a normal red cell?

A

150 days

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19
Q

What pathway provides energy to red cells?

A

The glycolytic pathway

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20
Q

What enzyme is involved in the glycolytic pathway? How is it significant?

A

G6PD enzyme, it is rate limiting

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21
Q

How is G6PD deficiency inherited?

A

X linked recessive (mainly present in men)

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22
Q

What occurs relating red cells when there is G6PD deficiency?

A

Haemolysis

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23
Q

How will MCV be affected if there are lots of reticulocytes?

A

It will increase as reticulocytes are larger than RBCs

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24
Q

How do RBCs and reticulocytes compare in terms of size?

A

Reticulocytes are larger

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25
What will you see on a blood film of someone with G6PD deficiency?
Hyperchromatic cells Abnormally shaped cells Heinz bodies Ghost cells
26
What are heinz bodies and how do they form?
Haemoglobin is subject to oxidative damage and becomes precipitated and oxidised, causing it to clump together
27
What are ghost cells?
Smaller and more condensed cells
28
What type of cells are a feature of intravascular haemolysis?
Ghost cells
29
What type of cells are a feature of extravascular haemolysis?
Spherocytes
30
What advice is given to patients with G6PD deficiency?
Avoid oxidant drugs Dont eat broad beans/fava beans Avoid naphthalene Be aware haemolysis can result from infection
31
Is LDH intracellular or extracellular?
Intracellular
32
What are some non immune ways haemolytic anaemia can be acquired?
Malaria Snake venom Drugs Haemolytic uraemic syndrome
33
What is the test to determine if haemolytic anaemia is autoimmune or not?
Direct antiglobulin test (DAT)
34
What does the DAT stand for? How does the DAT work?
Direct antiglobulin test RBCs are suspended in saline Rabbit antibodies are added to the sample, they bind to autoimmune antibodies on the RBC surface if present This causes agglutination and confirms a positive result
35
What is allo-immune anaemia?
Anaemia that occurs after a blood transfusion
36
What does allo imune mean?
Post blood transfusion
37
What type of anaemia can cause gallstones?
Haemolytic anaemia
38
What is hereditary spherocytosis?
An inherited disorder where RBCs become sphere shaped due to bits of the membrane breaking off
39
How do spherocytes look on a blood film?
Reduced diameter Lack central pallor Very round
40
How are RBCs lost in hereditary spherocytosis?
They pool in the spleen and are removed
41
What should reticulocyte count be in someone with hereditary spherocytosis?
High
42
How is hereditary spherocytosis treated?
Giving folic acid if need is increased | Splenectomy if its severe (this increases the lifespan of the red cells)
43
Why does megaloblastic anaemia arise?
Due to B12 or folate deficiency
44
What is different about the organelles in megaloblastic anaemia?
The nucleus isnt maturing and developing but the cytoplasm is
45
What is B12 needed for?
DNA synthesis and integrity of the nervous system
46
What molecule is needed to allow absorption of B12? Where is it found?
Intrinsic factor | Made in the parietal cells of the stomach
47
What is a common cause of destruction of stomach parietal cells?
Pernicious anaemia
48
What is transferrin used for?
Transporting iron from the gut
49
What is ferritin for?
Iron storage
50
What are transferrin and ferritin levels in someone with anaemia of chronic disease?
Transferrin is low | Ferritin is high
51
What happens to reticulocyte count in anaemia of chronic disease?
It remains low as theres no compensatory response
52
What is the usual cause of anaemia of chronic disease?
Low iron levels due to conditions like TB, HIV, rheumatoid arthritis, autoimmune disorders, malignancy etc
53
What is ESR and what does it indicate?
Erythrocyte sedimentation rate, it indicates inflammation levels, if inflammation is high ESR will also be raised
54
What will patients with iron deficiency anaemia present with?
Fatigue Breathlessness when resting and worse on exertion Ankle swelling at the end of the day
55
What levels will show on the blood film of someone with iron deficiency anaemia?
Low haemoglobin, MCV, MCH, RBC | High platelets
56
What happens to MCV in megaloblastic anaemia?
It is high
57
Describe serum iron, ferritin and transferrin levels in iron deficiency anaemia
Ferritin and serum iron is low | Transferrin is high
58
What questions can you ask if you suspect iron deficiency anaemia?
Are the vegetarian/vegan? Do they have any GI symptoms eg dysphagia, dyspepsia, change in bowel habits What medications are they on? (NSAIDs/aspirin?)
59
What are the 3 main causes of iron deficiency anaemia?
Blood loss- hookworm most commonly, also menorrhagia Insufficient iron intake- eg vegetarian/vegan diet Increased requirement- pregnant, in infancy
60
What will you see on a blood film of someone with iron deficiency anaemia?
Microcytosis Hypochromia Occasional target cells Pencil cells (elliptocytes)
61
What investigations can be undertaken when iron deficiency anaemia is suspected?
Faecal immunochemical test to investigate blood in the stool GI investigations eg endoscopy, duodenal biopsy, colonoscopy Coeliac antibody testing
62
How does excretion of iron work?
Iron is not physiologically excreted yet absorption is tightly controlled
63
How much iron is absorbed daily?
1-2mg from the diet
64
Why is excess iron dangerous?
It is toxic to the body
65
What molecule regulates iron absorbtion?
Hepcidin

BRS Y2 (85 decks)

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