anaemia Pt 1 Flashcards
(79 cards)
1
Q
anaemia definition =
A
reduction in quantity of O2 carrying Hb in blood
2
Q
normal variants in Hb
A
- women have lower
- gradual reduction in elderly
3
Q
symptoms of anaemia (7)
A
fatigue headache light-head palpitations breathlessness angina intermittent claudication
4
Q
signs of anaemia (3)
A
pallor
tachycardia
cardiac failure
5
Q
investigations for anaemia
A
FBC
blood film
bone marrow investigations
6
Q
where is bone marrow aspiration usually done
A
iliac crest
7
Q
trephine=
A
provides a core of bone which is processed as a histological specimen for examination
8
Q
when is trephine indicated
A
due to dry tap aspiration
more detailed assessment
9
Q
where is trephine done
A
posterior iliac crest +local anaesthetic
10
Q
needle for trephine =
A
jamshidi
11
Q
definition of microcytic anaemia
A
anaemia that is microcytic and hypochromic
12
Q
causes of microcytic anaemia (5)
A
- iron deficiency
- thalassemia (suspect if microcytic in children)
- anaemia of chronic disease
- sideroblastic anaemia
- lead poisoning
13
Q
common cause of anaemia=
A
iron deficiency
14
Q
where is Fe2+ iron found
A
cereals
green veg
15
Q
what type of bioavailability does Fe2+ have
A
poor = non-haem iron
16
Q
haem Fe3+ iron found in
A
red meat - good bioavailability
17
Q
how is iron tranferred
A
transferrin
18
Q
how is iron stored
A
as ferritin - in blood and liver muscle
19
Q
where is most iron absorbed
A
proximal small intestine -duodenum and proximal jejunum
20
Q
what can help iron absorption
A
gastric acid
21
Q
what happens to non-haem Fe2+
A
reduced to haem Fe2+ by brush border ferrireductase
22
Q
what channel transports iron
A
ferroportin 1 channel
23
Q
what regulates the bodies iron
A
hepatic hepcidin -regulates activity of ferroportin (binds to it reducing its activity)
24
Q
in what condition may hepatic hepcidin be missing
A
hemochromatosis
25
what system breaks down RBCs
reticuloendothelial system
26
how is iron recycled
by macrophages
27
iron loss from the body
low -only occurs through shedding of mucosal cells containing ferritin (negligible renal loss)
28
causes of iron deficiency (6)
- menstruation
- GI tract tumour
- parasitic hook worm (commonest worldwide)
- gastric bypass
- coeliac
- poor diet intake
29
clinical features of iron deficiency
- brittle nails and hair
- spoon shaped nails- koilonychia
- plummer-vinson syndrome
30
plummer-vinson syndrome= (4)
- dysphagia
- glossitis
- oesophageal webs
- angular stomatitis -inflammation in corners of mouth
31
iron studies in iron deficiency
- ferritin low
- serum Fe low
- transferring receptors and total iron binding capacity high
- transferrin saturation low
32
what does transferring receptors and total iron binding capacity differentiate
high in iron deficiency
| low in anaemia of chronic disease
33
types of iron tablet
ferrous sulfate
ferrous fumarate
ferrous gluconate
34
what vitamin promotes iron absorption and can therefore be prescribed alongside iron
vit C
35
how long is iron replacement therapy for
3+ months
36
if a patient has iron overload prescribe
chelator desferryoxamine
37
SE of iron tablets
GI disturbance common (diarrhoea/ constipaiton, nausea, epigastric pain)
black stool
38
parental iron indication
- if patient can't tolerate oral iron
- malabsorption
- recurrent blood loss
39
interactions of iron tablets
levothyroxine
calcium/ bisphosphonates
quinolone antibiotics
tetracycline antibiotics
40
why does anaemia of chronic disease occur
inflammatory induced activation of hepicidin
41
anaemia of chronic disease investigation results
- microcytic or normocytic
- never profound -doesn't progress
- low serum iron
- ferritin can be raised
- TIBC/ transferrin receptors normal
42
what can raise ferritin
acute phase protein
43
what is the main differentiation between anaemia of chronic disease and iron deficiency anaemia
chronic disease has normal TIBC/ transferring receptors
| iron def has high
44
treatment of anaemia of chronic disease
no need for iron therapy if severe treat with EPO
45
conditions causing anaemia of chronic disease 5
```
hypopituitarism
hypoadrenalism
CKD
hypothyroidism
RA (and other inflammatory conditions)
```
46
sideroblastic anaemia aetiology
hereditary or acquired
47
characteristic of sideroblastic anaemia
refractory anaemia--> hypochromic cells and excess iron
48
what is sideroblastic anaemia
where red cells fail to completely form haem - so that a ring of iron forms around the nucleus called a sideroblast
49
congenital cause of sideroblastic anaemia=
delta-aminolevulinate synthase-2 deficiency
50
findings in the bone marrow in sideroblastic anaemia
sideroblasts and iron deposits
51
acquired causes of sideroblastic anaemia
leukaemia
lead toxicity
alcohol misuse
drugs (isonazid)
52
macrocytic anaemia=
macrocytic hypochromic anaemia
53
2 categories of macrocytic anaemia
megaloblastic and non-megaloblastic
54
causes of non-megaloblastic macrocytic anaemia (6)
```
haemolysis
pregnancy
liver-disease
hypothyroidism
myelodysplastic syndrome
drugs- hydroxycarbamide, azathioprine
```
55
megaloblastic anaemia caused by (3)
B12 deficiency
folic acid deficiency
myelodysplasia
56
megaloblastic anaemia characterised by
erythroblasts within bone marrow that are large with immature nucleus
57
B12 storage=
in liver -may take 2 years to develop deficiency as lost very slowly
58
how is B12 absorbed
bound by intrinsic factor in duodenum and absorbed in ileum
59
causes of B12 deficiency (6)
- low intake (alcoholics)
- pernicious anaemia
- gastrectomy
- ileal disease (IBD/Coeliac)
- small bowel resection
- bacterial overgrowth in small bowel
60
test for B12 absorption=
schilling test
61
pernicious anaemia due to
auto-Ig against parietal cells
62
pernicious anaemia most common in (4)
fair-haired
blue eyes
blood group A
other autoimmune conditions
63
disease pattern of pernicious anaemia
insidious onset progressing,
| can cause neurological defects
64
neurological defects of pernicious anaemia
polyneuropathy -can cause paralysis
| -wernicke's encephalopathy
65
body reserve of folate =
very low -runs out in week
66
folate deficiency in
- alcoholics
- crohns, gastrectomy, coeliac
- antifolate drugs
- increased cell turnover (cancer, IBD)
67
antifolate drugs (3)
phenytoin (anticonvulsant)
methotrexate
trimethoprim
68
FBC of megaloblastic anaemia
MCV raised
| low reticulocyte count
69
blood film of megaloblastic anaemia=
oval macrocytes with hypersegmented polymorphs (neutrophils) with six or more lobes in nucleus
70
haematics of megaloblastic anaemia
raised bilirubin and lactate dehydrogenase
71
what is diagnostic for B12 deficiency anaemia
low serum B12 (cobalamin)
72
what is diagnostic for folate deficiency anaemia
low RBC folate level (not low serum folate)
73
in which megaloblastic anaemia is methylmaloniv acid raised
B12 only
74
IMPORTANT rule for treatment of megaloblastic anaemia
never give folic acid before B12
75
what can happen in folic acid is given before B12
sub acute degeneration of the cord
76
treatment of B12 def
hydroxycobalamin 1000 nanograms IM -life long
77
SE of B12 treatment
hypokalaemia can occur
78
treatment of folate deficiency
5mg folic acid orally for 4 months
79
folate in pregnancy
400 micrograms daily for low risk
| 5mg daily for high risk
