Anemia Flashcards by MA CARMELA CONCEPCION SALES

_______
is defined as a reduction in red blood cell numbers or
a haemoglobin (Hb) level below the normal reference
level for the age and sex of that individua

Anaemia

How well did you know this?

Not at all

Perfectly

The WHO defines anaemia as haemoglobin
_______ for men,_______ for women and______
in pregnant women and school-aged children.

<130 g/L
<120 g/L
<110 g/L

How well did you know this?

Not at all

Perfectly

In Australia, most people with anaemia will have
iron deficiency ranging from up to _______ for children
to ________ for menstruating females.

20%

How well did you know this?

Not at all

Perfectly

The incidence of haemoglobinopathy traits,
especially _________ is increasing in
multicultural Western societies

thalassaemia,

How well did you know this?

Not at all

Perfectly

If a patient presents with precipitation or
aggravation of myocardial ischaemia, heart failure
or intermittent claudication, consider the possibility
of _________

anaemia

How well did you know this?

Not at all

Perfectly

The serum ________level, which is low in cases of
iron-deficiency anaemia, is probably the best test to
monitor iron-deficiency anaemia as its level reflects
the amount of stored iron.

ferritin

How well did you know this?

Not at all

Perfectly

Give some unusual features of anemia:

• dyspnoea on exertion
• palpitations
• angina on effort
• intermittent claudication
• pica—usually brittle and crunchy food, e.g. ice
(iron-deficiency anaemia

How well did you know this?

Not at all

Perfectly

Non-specific of anemia signs include

pallor, tachycardia, systolic

flow murmur and angular cheilosis.

How well did you know this?

Not at all

Perfectly

Specific of anemia signs include

jaundice—haemolytic
anaemia, and koilonychias (spoon-shaped nails)—
iron-deficiency anaemia

How well did you know this?

Not at all

Perfectly

The history may indicate the nature of the problem

___________: inadequate diet, pregnancy, GIT
loss, menorrhagia, NSAID and anticoagulant
ingestion

iron deficiency

How well did you know this?

Not at all

Perfectly

The history may indicate the nature of the problem

___________inadequate diet especially
with pregnancy and alcoholism, small bowel
disease

folate deficiency:

How well did you know this?

Not at all

Perfectly

The history may indicate the nature of the problem

__________previous gastric surgery,
ileal disease or surgery, pernicious anaemia,
selective diets (e.g. vegetarian, fad)

vitamin B12 deficiency:

How well did you know this?

Not at all

Perfectly

________abrupt onset anaemia with mild

jaundice

haemolysis:

How well did you know this?

Not at all

Perfectly

The various types of anaemia are classified in terms

of the red cell size—the_______

mean corpuscular volume

(MCV):

How well did you know this?

Not at all

Perfectly

microcytic—MCV _____
macrocytic—MCV_____
normocytic—MCV _______

≤ 80 fL
>100 fL
80–100 fL

How well did you know this?

Not at all

Perfectly

the anaemia of
______ can be macrocytic in addition to the
more likely normocytic;

hypothyroidism

How well did you know this?

Not at all

Perfectly

_____ is the most common cause of anaemia
worldwide

It is the biggest cause of microcytic
anaemia,

Iron deficiency

How well did you know this?

Not at all

Perfectly

the main differential diagnosis of

microcytic anaemia being a _____ and ____

haemoglobinopathy such

as thalassaemia

How well did you know this?

Not at all

Perfectly

Lab features of IDA

• Microcytic anaemia
• Serum ____ level low (NR: F 15–200 mcg/L: M
30–300 mcg/L)
• Serum _____ level low

ferritin

iron

How well did you know this?

Not at all

Perfectly

Non-haematological effects

of chronic iron deficiency

Angular cheilosis/stomatitis
Glossitis
Oesophageal webs
Atrophic gastritis
Brittle nails and koilonychias

How well did you know this?

Not at all

Perfectly

Cause of IDA: physiological
1
2
3

Prematurity, infant growth
Adolescent growth
Pregnancy

How well did you know this?

Not at all

Perfectly

s.Fe ↓; s.ferr ↓; transferrin ↑

Investigations: Therapeutic trial of iron; GIT
evaluation for blood loss

Iron deficiency

How well did you know this?

Not at all

Perfectly

s.Fe N or ↑; s.ferr N or ↑

Investigations: Haemoglobin investigation,
e.g. electrophoresis

Haemoglobinopathy (e.g.

thalassaemia

How well did you know this?

Not at all

Perfectly

s.Fe N or ↑; s.ferr N or ↑

Investigations: Bone marrow examination

Sideroblastic anaemia (hereditary

How well did you know this?

Not at all

Perfectly

Occasionally microcytic s.Fe ↓; s.ferr N or ↑; transferrin ↓

Anaemia of chronic disease

Example of macrocytic With megaloblastic changes 1 2 3

Vitamin B12 deficiency Folate deficiency Cytotoxic drugs

s.B12 ↓; rc.Fol N or ↑ Investigations: IF antibody assay; Schilling test

Vitamin B12 deficiency

s.B12 N; rc.Fol ↓

Folate deficiency

Appropriate setting; s.B12 N; rc.Fol N

Cytotoxic drugs

Examples of macrocytic without megaloblastic

1. Liver 2. disease/alcoholism Myelodysplastic disorders (including sideroblastic anaemia)

Appropriate setting; uniform macrocytosis; s.B12 N; rc.Fol N Liver function tests

Liver disease/alcoholism

Specific peripheral blood findings; s.B12 N; rc.Fol N Bone marrow examination

``` Myelodysplastic disorders (including sideroblastic anaemia ```

Examples of normocytic

Myelodysplastic disorders (including sideroblastic anaemia Chronic kidney disease Endocrine disorders (e.g. hypothyroidism

Isolated anaemia; Retic ↑

Acute blood loss/occult

Specific red cell changes; Retic ↑ Investigations: s.Bil and s.LDH ↑; s.hapt ↓ specific tests for cause

Haemolysis

Isolated anaemia; Retic ↓

Chronic kidney disease

T or F, if GI bleeding is suspected, do FOBT

false. Do gastroscopy and colonoscopy

CBC of IDA * Microcytic, hypochromic red cells * ____________ (variation in size), _______(shape)—pencil-shaped rods

Anisocytosis poikilocytosis

IDA * Low serum iron level * Raised _________ * _________low (the most useful index

iron-binding capacity Serum ferritin level

__________is increased in iron deficiency, but not in chronic disease. It is very helpful therefore in differentiating iron deficiency from other forms. It is an indirect marker of what is happening in the bone marrow

Soluble transferrin receptor factor

in iron deficiency, the serum iron and ferritin levels are low and the transferrin high, but the serum iron level is also low in ___________

all infections—severe, mild and even subclinical—as well as in inflammatory states, malignancy and other chronic conditions

``` Serum ferritin estimations are spuriously raised in 1 2 3 ```

liver disease of all types, chronic inflammatory conditions and malignanc

______is normally raised in | pregnancy.

transferrin

How to give oral Iron

oral iron (ferrous sulphate 1–2 tablets daily between meals for 6 months) e.g. Ferro- Gradumet with orange juice or ascorbic acid until Hb is normal

How to give parenteral iron

parenteral iron preferably by IV infusion is probably best reserved for special circumstances (there is a risk of an allergic reaction). Avoid blood transfusions if possible

• Anaemia responds after about _____weeks and is usually corrected after _____months (if underlying cause addressed). 1 • Oral iron is continued for ______months to replenish stores. • Monitor progress with regular serum levels. • A serum ferritin level ______ generally indicates adequate stores.

2 2 3 to 6 ferritin >50 mcg/L

Things to consider in failure to tx

• poor compliance • continuing blood loss • malabsorption (e.g. severe coeliac disease) • incorrect diagnosis (e.g. thalassaemia minor, chronic disease) • bone marrow infiltration

This inherited condition is seen mainly (although not exclusively) in people from the Mediterranean basin, the Middle East, north and central India and South- East Asia, including south China

Thalassaemia

The ______form is a very severe congenital anaemia needing lifelong transfusional support but is comparatively rare, even among the populations prone to thalassaemia

homozygous

The key to the diagnosis of _______thalassaemia minor is significant microcytosis quite out of proportion to the normal Hb or slight anaemia, and confirmed by finding a raised HbA 2 on Hb electrophoresis.

heterozygous

Treatment of thalassaemia major is transfusion to a high normal Hb with packed cells plus ______

desferrioxamine.

This Hb variant is common throughout South-East Asia. 4 It has virtually no clinical effects in either the homozygous or heterozygous forms, but these people have microcytosis, which must be distinguished from iron deficiency

Haemoglobin E

if the HbE gene is combined with the thalassaemia gene, the child may have a lifelong anaemia almost as severe as ______

thalassaemia | major.

AED associated with Marcocytosis

Phenytoin Primidone Phenobarbitone

Abx associated with Marcocytosis

Cotrimoxazole Pyrimethamine (incl. Fansidar and Maloprim) Zidovudine

Cytotoxics associated with Macrocytosis

Azathioprine | Methotrexate 5-fluorouracil

These conditions have been recognised under a variety of names, such as ‘refractory anaemia’ and ‘preleukaemia’, for a long time, but only relatively recently have they been grouped together. They are quite common in the elderly but may be seen in any age group

Myelodysplastic syndromes

MDS: They are usually associated with progressive intractable _________ and ___________or both, and progress slowly but relentlessly to be eventually fatal, terminating with infection, haemorrhage or, less often, acute leukaemia

neutropaenia | or thrombocytopenia

Although well recognised, this is a much less common cause of macrocytosis than the foregoing conditions. It is usually caused by lack of intrinsic factor due to autoimmune atrophic changes and by gastrectomy

Vitamin B12 deficiency | (pernicious anaemia

Vitamin B12 deficiency may also be seen together with other deficiencies in some cases of ______ and _____

malabsorption and Crohn disease

causes of Vit B12 deficiency:

* atrophic gastritis * H. pylori infection * H 2 receptor blockers * PPI drugs * other drugs, e.g. OCP, metformin * chronic alcoholism * HIV * strict vegan diet

B12 deficiency: The clinical features are anaemia (macrocytic), weight loss and neurological symptoms, especially a _____. It can precipitate ________of the cord.

polyneuropathy subacute combined degeneration

Tx of B12 replacement therapy ``` • Vitamin B 12 (1000 mcg i.e. 1 mg) IM injection; body stores (3–5 mg) are replenished _______ • Maintenance with _____ ``` • Can use crystalline oral B12

after 10–15 injections given every 2 to 3 days 1000 mcg injections every third month

Folic acid deficiency: Diagnostic test: serum folate (normal range 7–45 nmol/L) and ______—best test (normal >630 nmol/L)

red cell folate

Folic Acid Def The main cause is poor intake associated with old age, poverty and malnutrition, usually associated with ____

alcoholism

Folic Acid Def It may be seen in malabsorption and regular medication with anti-epileptic drugs such as ______.

phenytoin

Folic Acid deficiency It is rarely, but very importantly, associated with pregnancy, when the demands of the developing fetus together with the needs of the mother outstrip the dietary intake—the so-called _______which, if not recognised and treated immediately, can still be a fatal condition.

‘pernicious anaemia of pregnancy’

Folic acid requirement per day

5–10 mcg/day.

Oral folate 5 mg/day to replenish body stores (5–10 mg). This takes ____________. Vitamin B 12 is usually given unless levels normal.

about 4 weeks but continue for 4 months

This is the most common cause of normocytic anaemia and is usually due to haematemesis and/or melaena

Acute haemorrhage

Intercellular iron transport within the marrow is suppressed in inflammation so that, despite normal iron stores, the developing red cells are deprived of iron and erythropoiesis is depressed

Anemia from chronic inflammation

This is often associated with anaemia due to failure of erythropoietin secretion and is unresponsive to treatment, other than by alleviating the insufficiency or until erythropoietin is administered

Anemia from CKD

Suspect_______if there is a reticulocytosis, mild macrocytosis, reduced haptoglobin, increased bilirubin and urobilinogen

haemolytic anaemia

Hemolytic anemia: The more common of the congenital ones are hereditary spherocytosis, sickle cell anaemia and deficiencies of the red cell enzymes, pyruvate kinase and G-6-PD, although most cases of G-6-PD deficiency haemolyse only when the patient takes oxidant drugs such as ______ and _______

sulphonamides or eats | broad beans—‘favism’.

_______include those of the newborn due to maternal haemolytic blood group antibodies passing back through the placenta to the fetus, and adult anaemias due to drug toxicity or to acquired auto-antibodies

Acquired haemolytic anaemias

Acquired antibodies resulting on hemolytic anemia include:

About half of the latter are idiopathic and half associated with non-Hodgkin lymphomas, and the anaemia may be the presenting sign of lymphoma

Acquired antibodies resulting on hemolytic anemia Some of these antibodies are active only at cool temperatures—__________; others act at body temperature and are the more potent cause of autoimmune haemolytic anaemia

cold agglutinin disease

This may be due to foreign tissue, such as carcinomatous metastases or fibrous tissue as in myelofibrosis; it may also be due to overgrowth by one or other normal elements of the bone marrow, as in chronic myeloid leukaemia, chronic lymphocytic leukaemia and lymphoma, as well as by acute leukaemic tissue

Bone marrow replacement

Bone Marrow replacement: A _______picture, in which immature red and white cells appear in the peripheral blood, is often seen when the marrow is replaced by foreign tissue.

leuco-erythroblastic

``` Important causes of anaemia in childhood include 1 2 3 ```

iron-deficiency anaemia (quite common), thalassaemia major, sickle-cell anaemia and drug-induced haemolysis

Key to dx of hemoglobinopathies

children of Mediterranean, South-East Asian, Arabic or African–American descent, especially with a family history, normal ferritin level or anaemia resistant to iron therapy.