Anaemia Overview Flashcards
Anaemic pt has a low reticulocyte count and a low MCV, what are the three potential causes?
Iron deficiency anaemia
Thalassaemia
Chronic disease
Anaemic pt has a high reticulocyte count - where especially would you check for haemorrhage?
GI (PR)
Genitourinary (catheter)
On the floor and four more (head, thorax, abdo, pelvis) ?long bones
Anaemic pt has a low reticulocyte count and a high MCV, what are the 3 potential causes?
Alcohol
Myelodysplasia
B12/folate deficiency
Anaemic pt has a normal reticulocyte count and a normal MCV, what could be causing their anaemia?
Chronic disease
Renal disease
Marrow suppression
Pt has a high reticulocyte count and they are showing no evidence of bleeding/haemorrhage, what categories of disease could be causing their anaemia?
Immune (non-acquired/hereditary)
Non-immune (acquired)
What is a microcytic hypochromic anaemia?
Iron deficiency anaemia
What are the 6 main symptoms of anaemia?
Fatigue Dyspnoea Palpitations Faitness Headache Tinnitus
What are the 3 main signs of anaemia?
Pallor
Hyperdynamic circulation (fast HR, flow murmer: apical ESM, cardiac enlargement)
Ankle swelling with heart failure
What does apical ESM stand for?
Apical end-systolic murmer
As MCV is an average, what do you use to make sure there aren’t two pathologies going on, one raising MCV and the other one lowering?
RDW - red call distribution width
Gives the range of sizes seen - so a large figure = two populations present
What are haematinics?
Iron, Vit B12, Folate
Where is iron absorbed?
Duodenum and jejunum
Where is B12 absorbed?
Terminal ileum
Where is folate absorbed?
Small bowel
What is ferritin indicative of?
Iron stores
What can make a ferritin level dubious?
It is an acute-phase reactant, so goes up during episodes of acute inflammation, similar to ESR and CRP
What is the single best test for iron deficiency anaemia
ferritin
What investigation can be taken if iron deficiency anaemia is suspected but there is diagnostic uncertainty from the blood tests?
Bone marrow biopsy
What conditions cause an iron overload?
Haemachromatosis
Diseases that require frequent blood transfusions
On iron studies, what value is usually low in diseases such as haemachromatosis and having lots of tranfusions?
Total iron-binding capacity
What is the iron studies picture in iron-deficiency anaemia?
Serum iron, Serum total iron-binding capacity, Serum ferritin, Transferrin saturation, Serum sTfR’s
Serum iron - Reduced
Serum total iron-binding capacity - Increased (the body tries hard to bind any iron around the system)
Serum ferritin - Reduced
Transferrin saturation - Reduced
Serum sTfR’s (soluble transferrin receptors) - Increased (since red cells attempt to absorb any iron in the system)
What is the iron studies picture in anaemia of chronic disease?
(Serum iron, Serum total iron-binding capacity, Serum ferritin, Transferrin saturation, Serum sTfR’s)
Serum iron - Normal or slightly reduced
Serum total iron-binding capacity - Reduced
Serum ferritin - May be raised as acute phase reactant
Transferrin saturation - Reduced
Serum sTfR’s (soluble transferrin receptors) - Normal - reflecting the true state of body iron levels
Why do most cases of B12 deficiency occur?
Poor absorption
What test is used to distinguish between the various causes of Vit B12 deficiency?
Schilling Test
