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MedEd > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Basic features of anaemia?

A

Pale conjunctivae and skin, fatigue and high RR and HR if severe

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2
Q

IDA on blood film features?

A

Aniso-poiliocytosis
Pencil Cells
Hypochromic and microcytic

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3
Q

Causes of IDA?

A

Reduced uptake: malnutrition, coeliac, IBD

Increased Loss: GI malignancy, peptic ulcer, IBD, menstruation

Increased requirement: pregnancy and breastfeeding

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4
Q

High plant based foods for iron?

A

Spinach, broccoli, lentils

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5
Q

Pathology of ACD?

A

Chronic disease causes cytokine release so increased Hepcidin to reduce iron to infection normally. Therefore decreased ferroportin and transferrin activity and increased storage in Ferritin

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6
Q

IDA vs ACD bloods?

A

Both Iron low
IDA = low ferritin and high TIBC
ACD = High or normal ferritin and decreased TIBC

TIBC = transferrin iron binding capacity

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7
Q

What is thalassaemia?

A

Globin chain quantitative defcts. Autosomnal recessive and high in Mediterranean and CYPRUS
Resistant to Malaria

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8
Q

Thalassaemia types?

A

Chr 16 = alpha and alpha O is mild anaemia, HbH is significant and needs transfusion.HbBarts is death in utero

Chr 11 = beta major needing transfusions

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9
Q

Investigations for thalassaemia?

A

Microcytic anaemia + film
Normal iron studies
Gel electrophoresis

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10
Q

Haemoglobin types?

A 
HBA1 = 2alpha + 2beta
HBA2 = 2 alpha and 2 delta
HbF = 2 alphga and 2 gamma
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11
Q

What predisposes sickling in SCD?

A

hypoxia, dehydration, acidosis and infection

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12
Q

SCD features?

A

Point mutation on beta globin gene on CHR 11. autosomnal recessive and resistant to malaria

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13
Q

SCD on blood films?

A

Howell-Jolly bodies in RBC and sickled cells (10-20 day lifespan)

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14
Q

Acute Management of various SCD crises?

A

Sickle Acute Painful Crises: Saturate (O2), Abx, Pain Relief, Cannula (IV fluids)

Stroke: Exchange blood transfusion

Sequestration = splenectomy

Chronic cholecystitis = cholecystectomy

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15
Q

SCD presentation and diagnosis?

A

Dactylitis, acute chest syndrome, haemolytic anaemia, aplastic crisis, priapism

Hb electrophoresis + blood film

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16
Q

SCD chronic management?

A

Conservative: avoid triggers, vaccination.

Medical: Vaccinations, hydroxyurea, prophylactic Abx

Surgical: bone marrow transplant

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17
Q

Features of folate + B12 deficiency Blood film?

A

Megaloblastic anaemia from hypersegmented neutrophils and macrocytic cells

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18
Q

Causes of megaloblastic anaemia types?

A

Vit B12 = alcohol, IBD and coeliac, malnutrition and pernicious anaemia

Folate: alcohol, IBD and coeliac, anti-folate drugs and pregnancy

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19
Q

B12 Deficiency ?

A

Megaloblastic + Neuro changes +/- pernicious anaemia (either parietal or IF)

Neuro: glove and stocking parasthesiae, hyporeflexia, Rombergs +ve, Subactue combined degeneration of the spinal cord

20
Q

Non-megaloblastic macrocytic anaemia causes?

A

Alcoholics may have liver failure

Alcohol, Myelodysplasia, Hypothyroidism, liver disease

21
Q

What must be avoided in patients with G6PD deficiency?

A

Beans e.g. fava or broad

22
Q

General features of haemolytic anaemia?

A

Scleral ictus and jaundice, pale conjunctivae and skin.

Blood tests = Hb low, haptoglobin low, unconjucated bilirubin raised and LDH raised

23
Q

Hereditary haemolytic anaemias?

A 
Membrane = hereditary spherocytosis
Enzymes = G6PD deficiency
Hb = SCD and thalassaemia
24
Q

Pathology of G6PD?

A

Vulnerable to oxidative stress as decreased NAPDH so less glutathione.
Beans means HEINZ bodies

25
Q

G6PD on blood film?

A

Heinz bodies and Bite cells (previous haemolysis)

26
Q

Pathology of hereditary spherocytosis?

A

Beta spectrin or ankyrin deficiency so weak cytoskeleton so no biconcave shape

27
Q

Investigations and complications of hereditary spherocytosis?

A

Osmotic fragility test by giving hypotonic saline which causes lysis

Coombs test Negative

Complication is aplastic crises due to Parvovirus B19

28
Q

HUS classic grouping?

A

Child
AKI and MAHA features (jaundice, conjunctival pallor, schistocytes), thrombocytopenia

GI: abdo pain and bloody diarrhoea

Typically E.Coli producing SHiga

29
Q

Pathology Microangiopathic Haemolytic Anaemia?

A

Microthrombi causing schistocyte formation

Can be due to DIC

30
Q

Causes of DIC?

A

Pancreatitis, sepsis, obstetric complication, ABO reaction, trauma and cancers e.g. MM

31
Q

DIC Features?

A

Bleeding: petechiae, ecchymoses, haematuria all due to decreased platelets and fibrinogen, increased FDPs and D-dimer

Clotting: Prolonged APTT and PT

Haemolytic: jaundice and conjunctival pallor + underlying pathology

32
Q

Thrombotic thrombocytopaenic Purpura (TTP) pathology?

A

Dysfunctional ADAMTS-13 that cannot cleave VWF

33
Q

TTP features?

A

COOMBS NEGATIVE
Defunct ADAMTS

Antiglobulin negative, Decreased platelets, AKI, MAHA, Temperature and Swinging CNS signs

Form Pentad with HUS triangle

34
Q

MAHA components?

A

DIC, HUS, TTP

35
Q

What is the Coombs test?

A

Direct antiglobulin test (DAT)

Detects presence of Ab attached to RBC surface e.g. autoimmune haemolytic anaemia

36
Q

What are the other acquired haemolytic anaemias?

A

Autoimmune: so anti-RBC Abs

Drugs e.g. Dapsone (anti-leprosy Abx)

Infections e.g. Malaria

37
Q

Describe agglutination in Coombs?

A

Warm >37: IgG Abs so idiopathic, SLE or CLL

Cold <37: IgM so idiopathic, mycoplasma or mononucleosis

38
Q

Presentation of MM, AML, Essential thrombocytosis and Myelodysplasia?

A

MM has increase in WCCs, AML does not have splenomgealy but CML does, ET does not cause splenomegaly and common in 35-55YO, and myelodysplasia does not have elevated platelets or splenomgealy

39
Q

Myelofibrosis presentation?

A

In response to BM malignancy

Myelofibrosis has characteristic dry tap of bone, in older patients with radiation exposure, low RBC< Hb and WCC with poikilocytosis and high platelets

Tear drop cells on blood film

40
Q

Causes of polycythaemia?

A

Primary: Rubra Vera
Secondary: Appropriate (hypoxic response from altitude, COPD, heart disease) or Inappropriate (EPO-secreting tumour) e.g. lung cancer

41
Q

Whats the classic mutation for PCV?

A

JAK2 V617F activates itself instead of needing EPO so high Hb and primary polycythaemia
Nearly 100% of PCV

42
Q

Features of polycythaemia rubra vera

A

Philadelphia Chr negative myeloproliferative disorder.

Older>60, asymptomatic aquagenic pruritis, hyper-viscosity syndrome

Elevated Hb and haematocrit +/- thrombocytosis

43
Q

Symptoms of hyperviscosity?

A

headaches and ligh headedness, visual disturbances and strokes

44
Q

What is anti-phospholipid syndrome?

A

autoimmune mediated thrombosis. Often in pregnancy.

CausesL recurrent miscarriages 3+, VTE, Stoke/MIs, HTN, livedo reticularis (mottled)

By anti-cardiolipin +ve and lupus anti-coagulant test +ve

45
Q

What is aplastic anamia?

A

Bone marrow failure causing pancytopaenia

Caused by fanconis (congential, infections e.g. parvovirus and radiation

Anaemia features + raised EPO

Thrombocytopaenia: bleeding + petechiae

Leucopoenia: sepsi + recurrent infections

BM aspirate in hypocellular

46
Q

When do you get aplastic crisis?

A

In SCD and hereditary spherocytosis - restricted due to RBC

MedEd (32 decks)

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