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HLB > Anaemia: Causes, Symptoms, Investigations and Management > Flashcards

Anaemia: Causes, Symptoms, Investigations and Management Flashcards

1
Q

What are the key components of DNA synthesis necessary for erythropoiesis?

A

B12 and folate.

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2
Q

What type of anemia results from deficiency of B12 or folate?

A

Megaloblastic anemia.

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3
Q

Which hormone, produced in the kidney, acts on proerythroblasts and early erythroblasts to prevent apoptosis and increase RBC production?

A

Erythropoietin.

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4
Q

What is the effect of androgens and thyroxine on erythropoiesis?

A

They exert a stimulatory effect on erythropoiesis, potentially leading to erythrocytosis (elevated red cell count).

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5
Q

What are the key components necessary for iron incorporation into heme during erythropoiesis?

A

Copper and pyridoxine.

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6
Q

What is the usual level of reticulocytes in the blood?

A

Around 1%.

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7
Q

What does an increased level of reticulocytes indicate?

A

Chronic bleeding or hemolysis.

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8
Q

What does a low level of reticulocytes indicate in the presence of anemia?

A

Precursor deficiency (e.g., iron) or bone marrow failure.

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9
Q

How can reticulocyte levels be used to monitor treatment progress?

A

An increase in reticulocyte count demonstrates that more RBCs are being produced in response to replacement therapy.

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10
Q

What parameters are checked in a full blood count for anemia?

A

Haemoglobin, platelet count, haematocrit, MCV, MCH, neutrophils.

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11
Q

What is the diameter of red blood cells?

A

6-8 μm.

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12
Q

Do red blood cells have a nucleus?

A

No, red blood cells are anucleate.

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13
Q

How many molecules of haem does each red blood cell carry?

A

Each red blood cell carries 640 million molecules of haem.

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14
Q

What is the shape of red blood cells?

A

Biconcave.

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15
Q

What factors contribute to maintaining the normal shape of red blood cells?

A

Specific cytoskeletal proteins (e.g., spectrin/ankyrin), normal enzymes (e.g., Glucose 6 phosphate dehydrogenase and Pyruvate Kinase), and normal type and amount of hemoglobin.

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16
Q

What is the average lifespan of red blood cells?

A

120 days.

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17
Q

How many globin proteins are present in each hemoglobin molecule?

A

Each hemoglobin molecule has 4 globin proteins - 2 alpha and 2 beta.

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18
Q

How is hemoglobin measured?

A

Hemoglobin is measured in g/L.

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19
Q

What does the hematocrit represent?

A

The hematocrit gives an idea of the proportion of the mass of red blood cells that make up the whole blood pool.

20
Q

How is hematocrit calculated?

A

Hematocrit is calculated by multiplying RBCC (red blood cell count) by MCV (mean cell volume) and dividing by 1000.

21
Q

How can hematocrit be expressed?

A

Hematocrit can also be expressed as a percentage.

22
Q

What does Mean Cell Hemoglobin (MCH) represent?

A

Mean Cell Hemoglobin represents the average amount (mass) of hemoglobin in the average cell.

23
Q

What does Mean Corpuscular Volume (MCV) measure?

A

Mean Corpuscular Volume measures the volume of the average red blood cell.

24
Q

How can the size variation of red blood cells be assessed?

A

The red cell distribution width (RDW) can be used to assess the size variation of red blood cells.

25
Q

What is the purpose of a blood film?

A

A blood film allows for direct inspection of the morphology, size, and shape of blood cells.

26
Q

How is a blood film prepared?

A

A drop of blood is smeared onto a glass slide and a stain is applied.

27
Q

What can be assessed from a blood film?

A

RBC size variations, RBC color, RBC shape, the presence of spherocytes, and other abnormalities including white cells and platelets.

28
Q

How is anemia defined in clinical practice?

A

Anemia is defined as a condition that arises when there is a deficiency in the number of red blood cells and/or hemoglobin in the circulation.

29
Q

What are the WHO-defined thresholds for anemia?

A

According to the World Health Organization (WHO), anemia is defined as hemoglobin levels below 130g/L in men, below 120g/L in women, and below 110g/L in pregnant women.

30
Q

What are some symptoms of anemia?

A

Lethargy, shortness of breath, palpitations, headache, non-specifically unwell.

31
Q

What are some signs of anemia?

A

Pallor, pale conjunctivae, tachypnea, tachycardia, changes to nails and hair.

32
Q

What is the worldwide impact of anemia?

A

Anemia contributes to 20% of all maternal deaths, poor pregnancy outcomes, increased risk of morbidity in children, impaired physical and cognitive development. Prevalence is widespread, but severity is worse in developing countries. It also leads to reduced work productivity in adults.

33
Q

What are the main reasons for developing anemia?

A

Not making enough red blood cells, spending too much (excessive destruction or loss), or it being lost/hidden.

34
Q

What are some causes of anemia related to problems with synthesis?

A

Deficiency of building blocks of RBCs/haemoglobin such as iron, B12, folate, or thyroid hormone. Bone marrow failure conditions like myelodysplasia, leukemia, and aplastic anemia can also cause problems with synthesis.

35
Q

What are some causes of anemia related to consumption?

A

Premature destruction of RBCs (haemolysis) due to inherited problems with hemoglobin (e.g., thalassemia, sickle cell), red cell membrane (e.g., spherocytosis), red cell enzymes (e.g., G6PD deficiency), or acquired causes such as autoimmune or mechanical factors (e.g., metallic heart valve).

36
Q

What are some causes of anemia related to bleeding or sequestration?

A

Anemia can occur due to bleeding from somewhere in the body (e.g., bowel, heavy periods) or sequestration in conditions like spleen or liver sequestration crisis in patients with sickle cell disease or anemia of chronic disease where iron is trapped in macrophages due to chronic inflammation.

37
Q

How can the cause of anemia be established?

A

The cause of anemia can be established by evaluating the mean corpuscular volume (MCV) and considering different categories based on it.

38
Q

What MCV range indicates microcytic anemia?

A

MCV < 80fL indicates microcytic anemia.

39
Q

What MCV range indicates normocytic anemia?

A

MCV between 80-96fL indicates normocytic anemia.

40
Q

What MCV range indicates macrocytic anemia?

A

MCV > 95fL indicates macrocytic anemia.

41
Q

What are some potential causes of microcytic anemia?

A

Iron deficiency (history of bleeding or dietary deficiency), anemia of chronic disease (chronic condition or chronic inflammation), thalassemia (family origin or family history).

42
Q

What are some potential causes of normocytic anemia?

A

Anemia of chronic disease (chronic condition or chronic inflammation), acute bleeding, renal failure.

43
Q

What are some potential causes of macrocytic anemia?

A

B12 deficiency (dietary deficiency or history of autoimmune conditions), folate deficiency (dietary deficiency or increased requirements), myelodysplasia (problems with other components of the FBC), thyroid dysfunction (any other thyroid symptoms), haemolysis (elevated reticulocytes, known haemolytic disorder).

44
Q

What tests can be conducted to evaluate consumption-related causes of anemia?

A

Haemolysis screen including bilirubin, reticulocytes, LDH, and haptoglobin. Direct antiglobulin test (DAT) can also be done to identify an immune cause.

45
Q

What tests can be conducted to evaluate problems with synthesis in anemia?

A

Iron studies, B12, folate levels, and bone marrow biopsy can be conducted to evaluate problems with synthesis.

46
Q

What tests or procedures can be conducted to investigate bleeding or sequestration causes of anemia?

A

CT scan or “oscopies” can be performed to examine internal organs (e.g., bowel, bladder) for signs of bleeding.

HLB (40 decks)

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