Anaemia's Flashcards by Clair Haynes

What is the definition of anaemia

A low Hb concentration in the blood

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What are the 2 broad categories than can cause anaemia?

Low red cell mass or an increase in plasma volume

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What is the defined value for anaemia in men and women?

<135g/L for men

<115g/L for women

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What are the 3 morphological descriptions of anaemia?

Hypochromic Microcytic
Normochromic normocytic
Macrocytic

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What are the differentiating features of the different types of anaemia?

Whether it is bone marrow failure, the functionality of the RBCs is wrong or there are being destroyed too quickly

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What does MCV and MCH stand for?

Mean cell volume

Mean cell haemoglobin

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What is a red cell indices?

Measurement of the red cell size and haemoglobin content

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What are the general features of anaemia?

Fatigue
Pallor
SOB
Ankle swelling 
Dizziness
Tinnitius 
Chest pain if severe

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What features of anaemia point to an underlying cause?

Bleeding: Menorrhagia, dyspepsia and PR bleeding
Malabsorption: diarrhoea and weight loss
Jaundice, splenohepatomegaly

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If the MCV indicates Hypochromic Microcytic anaemia then what is your next test?

Serum Ferratin

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If the serum ferritin is LOW then what condition is this indicative of?

Iron deficiency anaemia

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If the serum ferritin is high then what is this indicative of?

Thalassaemia and secondary anaemia

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If the MCV indicates Normochromic Normocytic anaemia then what next diagnostic test will you do?

The reticulocyte count

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If the reticulocyte count is low/normal in NN then what conditions is this suggestive of?

Secondary anaemia, bone marrow infiltration and hypoplasia

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If the reticulocyte count is high then what is this indicative of?

Haemolytic anaemia or blood loss

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If you think the condition is haemolytic anaemia then what next test would you perform?

DAGT - Coomb’s test

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If Coomb’s is positive in NN anaemia then what does this indicate?

Immune mediated haemolytic disease

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What are the Auto-antibody tests and what conditions do they concur to?

Warm auto-AB: auto-immune, drugs and CLL
Cold auto-AB: CHAD, infection and lymphoma
Allo Auto-AB: Transuction reaction

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If the MCV indicates a Microcytic anaemia then what are your investigations?

B12/folate count

Bone marrow function and blood film

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If the B12/folate/ Bm test indicates a megoblastic anaemia what 2 conditions might be causing this?

b12( or folate deficiency(diet, haemolysis or coeliac)

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If the B12/folate/ Bm test indicates a megoblastic anaemia what 2 conditions might be causing this?

b12 (pernicious anaemia) or folate deficiency (diet, haemolysis or coeliac)

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If the test indicates non-megobastic then what is the cause of the anaemia?

Marrow infiltration, drug induced

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What is the MOST common cause of microcytic anaemia

Iron deficiency anaemia

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What are the normal Hb levels in a male 12-70 and then over 70?

140-180

116-143

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What are the normal Hb levels for a woman 12-70 and over 70?

120-160 | 108-143

Is iron deficiency a diagnosis?

No this is a syndrome that is caused by something else

Is this a common cause of anaemia?

Yes, the most common

What are the causes of Fe deficiency anaemia?

Blood loss ie menorrhagia, or GI blood loss | Poor diet, malabsorption ie coeliac or gastrectomy, worms

Where in the GI tract is iron absorbed?

The duodenum

What is Fe bound to in the bloodstream?

Transferrin

What us hepcadin and what is it made in repose to?

It controls iron metabolism by binding to feroportin and stopping Fe moving into the circulation, released in response to inflammation

What are the key history questions in anaemia?

heavy periods? | Melenea, PR bleeding, Diet, NSAIDs and pregnancy

What are the examination findings in anaemia?

``` Kolinychia Tongue pallor Atrophic glossitis(smooth painful tongue) angular stomatitis Lymphadenopathy Bimanual PV and smear if menorrhagia ```

What is the dignostic test for iron deficiency anaemia?

MCV = Hypochrmoic microcytic | Serum Ferritin = diagnostics in low

WHAT ARE THE INVESTIGATIONS TO DETERMINE THE CAUSE IF IDA?

Endoscopy and barium studies

What is the treatment of IDA?

Diet, oral iron, Sx if bleeding | Transfusion if severe

What is haemolytic anaemia?

This is the breakdown of RBC's before their normal 120 day lifespan causing reduced iron

Because there is increased cell degradation what happens to the action of the bone marrow?

The reticulocytes in the bone marrow increase to make more RBC's

What are the 2 spaces where the destruction of red blood cells can occur?

Intravascular ie within the circulation and extravascular ie within the spleen, liver and bone marrow

What are the 2 etiological groups in HA?

Congenital and aquired

What are the classical symptoms of HA?

Jaundice, dark urine, previous anaemia, fatigue, pallor etc

what are the examination findings in HA?

Hepatosplenomegaly Gallstones due to increased bilirubin Leg ulcers

What are the findings in the FBC in HA?

Low Hb = Normochromic normocytic, do a reticulocyte count, if it is high then this is HA Also: raised indirect bilirubin, LDH, heptoglobulin and urinary urobilinogen

If the reticulocyte count is high, what next test are you going to do?

DAGT and then the Autoantibody testing

If there is intravascular haemolyisis then what are the clinical findings

``` Schistocytes (red cell fragments) ↑ FREE PLASMA HAEMOGLOBIN METHAEMALBUMINAEMIA HAEMOGLOBINURIA HAEMOSIDERINURIA ```

What is the treatment of HA?

Support the bone marrow if folate and treat the underlying cause

What is a DAGT?

Detects antibody or complement on red cell membrane (reagent contains either anti-human IgG or anti-complement and binds to these on the red cell surface causing agglutination in vitro, providing an immune basis for haemolysis

What are the conditions underlying hereditary HA?

hereditary Spherocytosis Glucose-6-phosphate dehydrogenase deficiency Haemoglobinopathy

What are the conditions underling acquired HA?

``` Autoimmune haemolytic anaemia INTRAVASCULAR Mechanical e.g. heart valve Severe infection e.g. sepsis, cells burst due to toxin Drugs ```

What is secondary anaemia?

This is anaemia of chronic disease

What are the 2 types that make up secondary anaemia?

70% normochromic normocytic | 30% hypo chromic microcytic

What are the 3 main causes pathophysiologically of SecA?

Defective iron utilisation(due to increased hepatic in imflam), cytokine induced shortening of the RBC's lifespan and decreased production of RBC's

Name 5 Causes of SecA

``` Chronic Infection Vasculitis Rheumatoid Malignancy Renal failure ```

What are your diagnostic tests for SecA?

MCV = Normochromic Normocytic and then your reticulocyte count will either be normal or low

What is the management of Secondary anaemia?

Treat the underlying cause

What is B12 deficiency other wise known as?

Pernicious anaemia

What are the causes of PA?

Autoimmune disease Antibodies against Intrinsic factor and gastric parietal cells Malabsorption of B12 Gastric/ileal disease

What are the causes of folate deficiency?

Dietary Increased requirements it haemolysis GI pathology ie coeliac disease

What is the cardinal feature of megoblastic anaemias?

Lemon yellow tinge of the skin

What are the features of B12/Folate deficiency anaemia?

Irritability, depression, psychosis and dementia Parasthesia and peripheral neuropathy Degeneration fo the spinal cord Classic triad of Extensor planters/ absent ankle jerks and absent knee jerks

What are your diagnostic tests for megobalstic anaemia?

CV = Macrocytic and then fo a B12/folate level | LFT, bilirubin, LDH

What are the diagnostic investigations for Perncious anaemia(autoimmune atrophic gastritis)?

Intrinsic factor antibodies | Parietal cell antibodies

What is the management of Folate deficiency?

Adress the diet and malabsorption | Oral folic acid

What is the treatment of B12 deficiency?

B12 IM injection (loading dose then 3 monthly maintenance)

Where is B12 absorbed?

Distal ileum

What are some of the other causes of macrocytosis?

``` Alcohol Drugs: Methotrexate, anti-retrovirals, hydroxycarbamide Disordered LFT's Hypothyroidism Myelodysplasia ```

What is sideroblasic anaemia?

Microcytic anaemia due to defect in the mitochondrial steps of haem synthesis

Anaemia's Flashcards

(67 cards)