common cause of anaemia and thrombocytopenia Flashcards Preview

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Flashcards in common cause of anaemia and thrombocytopenia Deck (57):
1

what are the main causes of anaemia

haematinic deficiencies.
haemolysis
secondary to a chronic condition
alcohol, drugs
renal impairment -EPO
primary marrow disease- malignant, haemoglobin disorder, aplasia, congenital.

2

causes of macrocytic anaemia

B12, folate, metabolic (e.g. thyroid/liver disease), marrow damage (alcohol, drugs, marrow disease), haemolysis (due to reticulocytosis)- breaking down RBC.

3

causes of normocytic anaemia

anaemia of chronic disease/inflammatory.

4

causes of microcytic anaemia

iron deficiency, haemoglobin disorders- sickle cell anaemia, thalassemia

5

is iron excreted from the body

no

6

how is iron balance controlled
(where is iron levels controlled)

gut mucosa
most iron is absorbed in the duodenum

7

what molecule transfers iron

transferrin

8

what molecule is iron stored in

ferrtin/haemosiderin

9

what food products contain iron

red meat
chicken contains some iron
baked beans
boiled eggs
canned sardiness, oily fish and mussels.
breakfast cereals with added vitamins
green leafy vegetables, dried fruit, wholemeal bread, lentils, beans, peas and nuts.

10

what lab tests establish low iron

FBC and film
ferritin- key marker (for iron deficiency)
Hypochromic cells
serum iron/TIBC
marrow.

11

what can causes anaemia
(not individual factors general factors)

blood loss- gut, respiratory
increased demand- pregnancy and growth
reduced intake- diet and malabsorption.

12

in children what are the main causes of anaemia

diet, growth, malabsorption

13

in young women what are the main causes of anaemia

menustral loss, pregnancy, diet

14

in the elderly what are the main causes of anaemia

bleeding, GI problems (ulcer, gastritis, aspirin, malignancy, diverticulis, GI surgery of various types)

15

main side effect of oral iron

stomach upset

16

main side effect of IM iron

painful

17

most common cause of megaloblastic change.

B12 and/ Folic acid and deficiency- most common cause.

18

causes of megalobastic change

alcohol, drugs, haematological malignancy, congenital rarities

19

pathogenesis of folate and B12 anaemia

DNA= purine and pyrimidine bases.
folate required for DNA base synthesis.
B12 needed for folate synthesis.
so deficiency in either starves DNA bases.

20

what source does B12 come from

animal source

21

what cells and factors are involved in B12 absorption

gastric parietal cells
Intrinsic factor produced by parietal cells
receptors in terminal ileum which internalise B12.

22

most common causes for B12 deficiency

nutritional- vegans
gastric problems- gastrectomy or pernicious anaemia
small bowel problem- terminal ileum resection, crohn's, jejunal diverticulosis, fish tapeworm.

23

what sources contain folic acid

green veg, beans, peas, nuts and liver

24

where is folic acid absorbed

upper small bowel

25

how long would the body's store of folic acid last before it runs out

4 months.

26

main causes of folic acid deficiency

Mainly dietary / malnutrition
Malabsorption / small bowel disease
Increased usage-preganancy, haemolysis and inflammatory conditions, drug use

27

main cause of B12 deficiency

problem in absorption

28

symptoms of B12 or folate deficiency.

Megaloblastic anaemia, panctopenia, mild jaundice, glosstiis and angular stomatitis
anoexia
sterility

29

Lab features of B12 and folate deficiency

• Blood count and film - marrow sometimes
• Bilirubin and LDH - ‘haemolysis’
• B12 and folate levels
• Antibodies
• B12 absorption tests +/- IF- no longer used.
• GI investigations:
– Crohn’s
– malabsorption
– blind loop etc

30

cause of perincious anaemia

B12 deficency

31

SADC (subacute combined degeneration of the cord) occurs due to

severe B12 deficency.

32

pathogenesis of subacute combine degeneration of the cord.

Demyelination of dorsal + lateral columns

33

symptoms of subacute combined degeneration of the cord

• Peripheral neuropathy / Paraesthesiae
• Numbness and distal weakness
• Unsteady walking
• Dementia

34

treatment for B12 deficiency.

• B12 + Folate until B12 deficiency excluded
• B12 x5 then 3 monthly for life for PA
• Folic acid 5mg daily to build stores

35

why is it important to give a patient both folic acid and B12 until the cause of anaemia has be diagnosed as one or the other/

Folic acid in isolation without knowing B12 status- can exacerbate B12 neuropathy

36

define haemolysis

breakdown of RBC

37

causes of haemolysis inside the RBC

haemoglobinopathy (sickle cell)
Enzyme defects (G6PD)

38

causes of haemolysis in the RBC membrane

Hereditary Spherocytosis / elliptocytosis

39

causes of haemolysis outside the RBC

Antibodies (warm / cold)
Drugs, toxins
Heart valves
Vascular / vasculitis / ‘microangiopathy’

40

what tests show that haemolysis is present

anaemia
high MCV, macrocytic.
high reticulocytes
blood film
raised billirubin and LDH- present due to breakdown of RBC an recycle of haemoglobin.
low haptoglobins used in haemolysis
Urinary Haemosiderin- haemoglobin comes out in urine.

41

what is the treatment for autoimmune haemolytic anaemia

steroids

42

why is transfusion of blood difficult in autoimmune haemolytic anaemia

blood is difficult to match.

43

what is the MCV in anaemia of the chronic disease

normal

44

why do you have reduced RBC production in anaemia of the chronic disease.

Abnormal iron metabolism, poor erythropoetin response and blunted marrow response.

45

where is hepcidin produced

liver

46

what is the function of hepcidin

regulator of iron absorption and release from macrophages

47

diagnosis of anaemia of a chronic disease

• No other causes of anaemia
• No test, so diagnosed by excluding other causes.
• Usually mild anaemia, normal MCV
• Often raised inflammatory markers
• ESR, CRP, PV etc
• Normal/high ferritin + low serum iron
• Normal % Saturation transferrin

48

treatment for anaemia of the chronic disease.

Erythropoetin (SC)
Iron (IV)
Transfusion in severe cases.

49

common causes of thrombocytopenia

• ITP (sometimes associated with lymphoma/CLL/HIV)
• Other autoimmune diseases
• Liver disease and / or hypersplenism
• Pregnancy (physiological and a range of complications e.g. eclampsia)
• Haematological / marrow diseases
• Infections acute or otherwise e.g.
• Acute sepsis / HIV / other viral infections (EBV and many others)
• Disseminated Intravascular Coagulation (DIC)
• Range of congenital conditions

50

is Immune thrombocytopenic purpura (ITP) an immune disorder

yes

51

treatment for immune thrombocytopenic purpra (ITP)

young children lower than 12 can get bruising, but it is self limiting, but is hemorrhagic can be treated with steroids, doesn’t come back.

52

What causes immune thrombocytopenic purport in children, but not in adults

post viral infection

53

common feature os immune thrombocytopenic purpaura in adults

relapsing and remitting.

54

symptoms of immune thrombocytopenic purpura

bruising and petichae
plalatet count

55

treatament for mmune thrombocytopenic purpura

steroid
IV immunoglobulin- saturating spleen with antibodies so that it cannot get rid of platelets which are coated with antibodies.
Immunosupresants or spleenectomy.
Newer thrombo-mimetics make more paltelets

56

2 examples of thrombomimetics

• Eltrombopag
• Romiplostin

57

what symptoms alongside thrombocytopenia indicate thrombotic thrombocyotpenia

• Fever
• Neurological symptoms
• Haemolysis (retics / LDH)