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BRS - Year 2 > 🫀🫁Cardio & Resp🫀🫁 - Anaemia > Flashcards

🫀🫁Cardio & Resp🫀🫁 - Anaemia Flashcards

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1
Q

What abnormalities can be seen in this blood film?

A

Spherocytes

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2
Q

Liver function tests show bilirubin of 30μmol/l (normal range <17), and the bilirubin was mainly unconjugated.
What does this tell us?

A

Pre-hepatic jaundice

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3
Q

High unconjugated bilirubin, and spherocytes on the blood film. What does this tell us?

A

Hereditary spherocytosis, leading to jaundice due to increased destruction in the spleen

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4
Q

What will also be seen in the blood of someone with increased erythrocyte destruction?

A

High reticulocyte (immature RBC) count

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5
Q

How are reticulocytes identifiable on a blood film?

A

Slightly larger with a bluish tinge

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6
Q

What causes the bluish tinge in reticulocytes?

A

Higher RNA content

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7
Q

How does spherocytosis occur?

A

Disruption of vertical linkages in membrane
Usually ankyrin/spectrin

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8
Q

What happens due to hereditary spherocytosis?

A

Haemolysis or haemolytic anaemia
Can result in jaundice
Increase in bone marrow production - leads to young cells found in blood

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9
Q

What is the difference between haemolysis and haemolytic anaemia?

A

Haemolysis is increased RBC destruction (reduced RBC survival)
Haemolytic anaemia is haemolysis that can’t be compensated for - leads to reduction in Hb

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10
Q

How would someone with haemolytic anaemia by treated?

A

Folic acid (because of increased erythropoiesis demand)
Splenectomy (if severe) to increased RBC life span

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11
Q

Patient with hereditary spherocytosis diagnosis presents several years later acutely with upper right abdominal pain and tenderness, marked jaundice and high bilirubin, this time conjugated.
What has happened?

A

Likely gallstones from increased breakdown of haemoglobin to bilirubin
One of the gallstones has obstructed the CBD - obstructive jaundice
Is post hepatic - hence conjugated bilirubin

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12
Q

What is AIHA?

A

Autoimmune haemolytic anaemia
Usually found in multi-system autoimmune conditions (e.g. SLE)

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13
Q

What would you see in AIHA blood count?

A

Low Hb (increased RBC destruction)
High MCV (reticulocytes)
Increased reticulocyte count
High bilirubin
LDH - due to tissue damage

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14
Q

What is the DAT?

A

Direct antiglobulin test
Tests for antibodies that bind to RBCs

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15
Q

What is the mechanism of RBC destruction in AIHA?

A

Autoantibodies bind to RBCs
Results in destruction in the spleen

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16
Q

Spherocytes are present in which two blood disorders?

A

Hereditary spherocytosis
AIHA

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17
Q

What test can distinguish between hereditary spherocytosis and AIHA?

A

DAT

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18
Q

What is the most common enzyme deficiency that results in anaemia?

A

G6PD deficiency

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19
Q

What does a G6PD deficiency result in for a RBC?

A

Inhibits the pentose shunt
Key process that protects the RBC from oxidant damage

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20
Q

How does G6PD lead to more oxidative damage being received by a RBC?

A

G6PD deficiency reduces the ability of red blood cells to regenerate glutathione, a critical antioxidant

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21
Q

What type of jaundice will be exhibited in someone with G6PD deficiency?

A

Pre-hepatic jaundice
Unconjugated bilirubin

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22
Q

What would you expect to see in the blood count of someone with anaemia caused by G6PD deficiency?

A

Low Hb
High MCV
High reticulocytes
Classic haemolysis

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23
Q

What will you see in the blood film of someone with G6PD deficiency?

A

Ghost cells
Heinz body
Hemighosts
(cells with haemoglobin abnormalities due to oxidising damage)

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24
Q

What advice should be given to patients with G6PD?

A

Avoid oxidant drugs
Don’t eat broad beans (fava beans)
Avoid napthalene
Be aware that haemolysis can result from infection

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25
How can haemolytic anaemia be categorised?
Haemolysis can result from an intrinsic abnormality of the red cells Haemolysis can result from extrinsic factors acting on normal red cells **ALTERNATIVELY** Inherited haemolytic anaemia can result from abnormalities in the cell membrane, the haemoglobin or the enzymes in the red cell Acquired haemolytic anaemia usually results from extrinsic factors such as micro-organisms, chemicals or drugs that damage the red cell Extrinsic factors can interact with red cells that have an intrinsic abnormality
26
How can haemolytic anaemia be classified in terms of vascularity?
Intravascular haemolysis - occurs when there is acute damage to the RBC Extravascular haemolysis - defective RBCs removed by the spleen
27
What general things would you be looking for in haemolytic anaemia?
Otherwise unexplained anaemia, normochromic and either normocytic or macrocytic Evidence of morphologically abnormal red cells Evidence of increased red cell breakdown Evidence of increased bone marrow activity
28
Give a summary of the inherited haemolytic anaemias
29
Give a summary of the acquired haemolytic anaemias
30
Would would you expect to see in the blood count of someone with iron deficiency anaemia?
Low Hb Low MCV (microcytic anaemia) Low MCH and MCHC Low RBC High platelets
31
What extra tests would you request if you suspected microcytic anaemia (due to iron deficiency)?
Ferritin Serum iron Transferrin
32
What questions would you ask a patient suspected of having iron deficiency anaemia?
Diet - vegetarian/vegan GI symptoms Menstrual history/post-menopausal bleeding Weight loss Medications - e.g. aspirin/NSAIDs
33
What clinical signs might you see in iron deficiency anaemia?
34
What investigations would you send for in someone suspected of iron deficiency anaemia?
Investigating for blood in stool (faecal immunochemical test, FIT) GI investigations - endoscopy, duodenal biopsies, colonoscopy Coeliac antibody testing
35
What would you expect to see in a blood film of someone with iron deficiency anaemia?
Elliptocytes are the feature you would be looking for, more than target cells
36
What are the causes of iron deficiency anaemia?
Increased loss (from blood loss) Insufficient iron intake Increased iron requirements
37
In what scenarios would blood loss cause iron deficiency anaemia?
Commonest cause in adults Hookworm commonest cause worldwide Menstrual (menorrhagia) Gastrointestinal (often occult)
38
How might insufficient iron intake arise?
Dietary - vegetarians/vegans Malabsorption -Coeliac disease -H. pylori gastritis
39
What can lead to increased iron requirements
Physiological -Pregnancy -Infancy
40
Why is transferrin high in iron deficiency anaemia?
Increase iron absorption capabilities Compensatory mechanism
41
Why is there reduced ferritin in iron deficiency anaemia?
Attempt to increase iron supply Reduced hepcidin production - leads to increased iron absorption in gut and release of storage iron
42
What is the treatment for iron deficiency anaemia?
Iron replacement therapy e.g. ferrous sulphate tablets
43
What type of anaemia would accompany a case of, for example, severe rheumatoid arthritis for many years?
Anaemia of chronic disease
44
What would you expect to see in the MCV in anaemia of chronic disease?
Decrease Microcytic anaemia
45
What would the reticulocyte levels look like in anaemia of chronic disease?
Normal
46
What profile of results would you expect to see in the blood test of someone with anaemia of chronic disease?
High ferritin Low serum iron Low transferrin Normal transferrin saturation High ESR Hypochromic, microcytic red blood cells
47
Explain the significance of the blood test results of someone with anaemia of chronic disease
High ESR - ongoing inflammatory or chronic disease process, as inflammation increases fibrinogen and other acute-phase proteins Ferritin is an acute-phase reactant that is elevated in inflammatory states Low serum iron - reduced availability of iron for erythropoiesis - due to sequestration of iron by macrophages Transferrin levels reduced in ACD - liver reduces its production in response to inflammation Transferrin Saturation: Normal - iron and transferrin are lowered in proportion
48
What is ferritin, and what is it's significance in ACD?
Storage protein for iron In ACD, ferritin is elevated due to its role as an acute-phase reactant, even though the body has functionally low iron available for red blood cell production
49
What is transferrin, and what is it's significance in ACD?
Protein responsible for transporting iron in the bloodstream In ACD, transferrin levels are low due to reduced hepatic production during inflammation, limiting iron mobilization
50
What is ESR, and what is it's significance in ACD?
ESR measures the rate at which erythrocytes sediment in a test tube over one hour, reflecting inflammation Elevated ESR indicates a chronic inflammatory or autoimmune process contributing to the anaemia
51
How would two people with ACD and iron deficiency anaemia's blood tests compare?
52
What is the basic mechanism of ACD?
Hepcidin is usually secreted by the liver in response to high iron stores Hepcidin production is also increased in inflammatory states (ACD results from a prolonged inflammatory state i.e. chronic disease) This reduces iron supply as hepcidin blocks absorption of iron from the gut and release of storage iron
53
How is ACD treated?
Underlying cause must be treated
54
What is pernicious anaemia?
Anaemia caused by a deficiency of vitamin B12 SPECIFICALLY due to autoimmune destruction of intrinsic factor i.e. vitamin B12 deficiency anaemia
55
What would you expect to see in the blood tests of someone with B12 deficiency leading to anaemia?
High MCV - macrocytic anaemia Low WBC - ineffective haematopoiesis Low platelets - suggest bone marrow involvement - problem lies in haematopoiesis Normal reticulocytes - bone marrow unable to respond to the anaemia High LDH - increased cell turnover and haemolysis Unconjugated bilirubin increased - increased haemolysis
56
Why might patients with B12 deficiency describe "walking on cotton wool" or other physical sensation disturbances?
Vitamin B12 deficiency can lead to neuropathy - demyelination of peripheral nerves and spinal cord
57
What would you see in the blood film and bone marrow aspirate of someone with B12 deficiency?
Macrocytosis, poikilocytosis (irregularly shaped RBCs) and hypersegmented neutrophils Megaloblastic changes (large, immature, nucleated red cell precursors) - suggests impaired DNA synthesis
58
How would a normal bone marrow aspirate look compared to a bone marrow aspirate taken from someone with megaloblastic anaemia?
59
What are the causes of megaloblastic change in the bone marrow?
Vitamin B12 and Folate -Required for DNA synthesis -Absence leads to severe anaemia which can be fatal -Secondary to agents or mutations that impair DNA synthesis -Drugs: azathioprine, cytotoxic chemotherapy -Folate antagonists: methotrexate -BM cancers: myelodysplastic syndrome
60
What is vitamin B12 required for?
DNA synthesis Integrity of the nervous system
61
What is folic acid required for?
DNA synthesis Homocysteine metabolism
62
Outline dietary B12 deficiency
B12 present in animal products Deficiency can result from poor diet/veganism Oral supplementation
63
Outline gastric B12 deficiency
Intrinsic factor required for B12 absorption Deficiency arise after some bariatric procedures (e.g. gastrectomy), or autoimmune conditions (pernicious anaemia) Treated with hydroxocobalamin injections (IM)
64
Outline B12 deficiency based in the bowels
Terminal ileum site of B12 absorption Crohn's disease, Ileal resection - things that can effect absorption in the terminal ileum Treated with hydroxocobalamin injections (IM)
65
What are the 2 main mechanisms behind folic acid deficiency?
Reduced availability Increased demand
66
What are the causes for reduced availability of folic acid?
Dietary -Poverty -Alcoholism Malabsorption -Coeliac disease -Jejunal resection
67
What are the causes for the increased demand of folic acid?
Pregnancy Lactation Increased cell turnover - haemolysis
68
How are all forms of folic acid treated?
Oral supplementation
69
(Broad review) What are the 2 primary possible mechanisms of anaemia?
RBC failure of production OR RBC excess loss/destruction
70
(Broad review) What are some causes of anaemia due to reduced RBC survival (i.e. excess destruction)?
Hereditary spherocytosis, thalassaemias, sickle cell Autoimmune haemolytic anaemia (AIHA) G6PD deficiency (some infections, e.g. malaria) (hypersplenism)
71
(Broad review) What are some of the causes of anaemia due to reduced RBC production?
Iron deficiency anaemia Anaemia of chronic disease (ACD) Megaloblastic anaemia (B12/folic acid deficiency) Bone marrow disorders (myelodysplastic syndromes (MDS), aplastic anaemia, marrow infiltration by malignancy) (CKD) (alcohol and drug (e.g. chemotherapy) induced anaemia)
72
(Broad review) How can anaemias be classified based on their size?
73
(Broad review) What causes microcytic anaemias?
Defect in haem synthesis -Iron deficiency anaemia -Anaemia of chronic disease (ACD) Defect in globin synthesis -Defect in α chain synthesis (α thalassaemia) -Defect in β chain synthesis (β thalassaemia)
74
(Broad review) Outline the mechanisms and causes of normocytic anaemia
75
(Broad review) Outline the common causes of macrocytic anaemia
76
(Broad review) What is megaloblastic anaemia?

BRS - Year 2 (75 decks)

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