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CP3 Medicine > HAEM - Micro and Macrocytic Anaemia > Flashcards

HAEM - Micro and Macrocytic Anaemia Flashcards

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1
Q

Def anaemia

A

Decreased haemaglobin in blood such that = inadequate O2 delivery to the tissues

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2
Q

Hb value anaemia men

A

<135g/L

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3
Q

Hb value anaemia women

A

<115g/L

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4
Q

Sx anaemia (non-specific)

A

Fatigue
Weakness
Headaches

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5
Q

Sx anaemia (CV)

A

Intermittent claudication
Dyspnoea on exertion
Angina

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6
Q

Signs anaemia (4)

A

Pallor
TachyC
Systolic flow murmur
Cardiac failure

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7
Q

Specific sign IDA

A

Koilonychia

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8
Q

Specific sign haemolytic anaemia

A

Jaundice

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9
Q

Specific sign sickle cell anaemia

A

Leg ulcers

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10
Q

What drug should be given alongside blood transfusions and WHY

A

Furosemide

HF risk

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11
Q

Ways iron is stored

A

As intracellular ferritin + hemosiderin - macrophages, of spleen, liver, BM
Intracellular ferritin - hepatocytes
Myoglobin in Fe-containing enzymes

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12
Q

What 4 things should a low Hb be considered in relation to?

A

WBC count
Platelet count
Reticulocyte count
Blood film

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13
Q

Microcytic anaemia value

A

<80fL

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14
Q

Causes microcytic anaemia

A

Sideoblastic anaemia
Lead poisoning
Thalassaemia
IDA

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15
Q

Causes normocytic anaemia (8)

A 
Acute blood loss 
Anaemia chronic disease 
Renal anaemia 
Haemolytic anaemia 
Marrow failure 
Pregnancy 
CT disease 
Diamorphic blood film
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16
Q

Macrocytic anaemia value

A

> 96fL

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17
Q

Causes macrocytic anaemia

A 
B12 defic
FOlate defic
Alcohol XS
Myelodysplastic syndrome 
Severe hypothyroidism
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18
Q

What is diamorphic blood film?

A

Combined macro/microcytic processes

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19
Q

Clinical examination findings IDA (5)

A 
Koilonychia 
angular stomatitis 
brittle hair/nails 
atrophy of papillae of tongue 
Syndromes dysphagia/glossitis
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20
Q

What are the 4 Fe studies

A

Serum Fe
Serum ferritin
Total Fe binding capacity
Serum soluble transferrin receptors

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21
Q

What does IDA look llike on blood film

A

Microcytic, hypochromic (pale on blood film)
Poikilocytosis
Anisocytosis

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22
Q

What is the latent Fe deficiency period?

A

Where normal Hb is maintained despite Fe deficiency

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23
Q

What is the most common cause of IDA in the world?

A

Hookworm

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24
Q

What are the most common causes of IDA in the UK?

A

Blood loss

Menstruation

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25
Other causes of IDA
Decreased absorption - coeliac/antacids/post gastrectomy Increased demand - growth/pregnancy Inadequate intake
26
Poikilocytosis
Shape variation
27
Anisocytosis
Size variation
28
Fe marker values IDA
Serum Fe = decreased TIBC = increased Serum ferretin = decreased Soluble transferrin receptor = increased
29
Which is the most specific test for IDA
Soluble transferrin receptor
30
DDx IDA
Anaemia of chronic disease
31
Fe marker values anaemia of chronic disease
Serum Fe = decreased TIBC = decreased Serum ferritin = increased STR = normal
32
What does serum ferretin represent in anaemia of chronic disease?
Increased stored iron (b.c is an acute phase reactant)
33
Mx IDA
``` Address underlying cause PO FeSO4 200mg t.d.s Increase dietary intake Monitor - blood parameters after 1 month Continue for 3 months after blood parameters return to norm ```
34
What can be done if pt is not tolerating Ferrous sulphate
Switch to ferrous gluconate
35
SE ferrous sulphate
``` Cramping Bloating N+V Constipation Black stools ```
36
Rules of 10's
Max [Hb] in 1 week = 10g/L If >10g/L decline in 1 week - blood is being lost When transfusing - 1 bag will raise Hb [ ] by 10g/L
37
Who gets Plummer-Vinson syndrome
post-menopausal women
38
Mx Plummer-Vinson syndrome
Fe | Mechanical widening of oesophagus
39
Sx beta-thalassaemia minor
Usually asymp
40
What state can make minor beta thalassaemia worse?
Pregnancy
41
PS B-thalassaemia major
Severe anaemia HSmegaly FTT +/- facial deformities
42
Blood film b-thalassaemia major
Hypochromic microcytic cells + target cells + nucleated RBC
43
Mx major b-thalassaemia
Lifelong blood transfusions
44
What is Bart's hydrops
Deletion of all 4 alpha genes --> HbBarts (y4)
45
Outcome Bart's hydrops
Death in utero
46
Deletion of 3 genes in alpha thalassaemia -->
Moderate microcytic anaemia + features haemolysis
47
Deletion of 2 genes in alpha thalassaemia -->
Asymp carrier with reduced MCV
48
Deletion of 1 gene in alpha thalassaemia -->
Clinically normal
49
Cause sideroblastic anaemia
Congenital Or Acquired in myelodysplastic syndrome
50
Approach to macrocytic anaemia
Blood film LFT/TFT Serum B12/folate levels BM biopsy
51
Relevance of serum folate levels
reflects recent intake
52
Next Ix to do if B12 is low
Anti-parietal cell Ab Anti-IF Ab Schilling test
53
Schilling test
Distinguishes between pernicious anaemia and small bowel disease
54
Deoxyuridine suppression test
Differentiate B12/folate deficiency in vitro after BM biopsy
55
mechanism by which b12 and /or folate deficiecy lead to anaemia
B12 - coenzyme for conversion folate to activated folate ac folate = req for DNA synthesis DNA fails to stop erythrocyte development --> v large cells = trapped = destroyed in reticuloendothelial system
56
causes vit B12 definciency (3)
Chronic low uptake (vegan) Impaired binding in stomach Small bowel disease/terminal ileium disease
57
What 3 things can cause mild impairment Vit B12 absorption
Pancreatitis Coeliac disease Metformin use
58
What is pernicious anaemia
Autoimmune disease leading to severe B12 deficiency
59
What are the 2 types of antibodies that may contribute to pernicious anaemia?
Blocking autoantibodies | Binding autoantibodies
60
Blocking autoantibodies pernicious anaemia
Prevent IF-B12 binding
61
Binding autoatibodies pernicious anaemia
Prevent if binding to ileal receptors
62
Features pernicious anaemia
Lemon skin Intramedullary haemolysis High unconjugated bilirubin
63
What is subacute combined degeneration of the cord
Simultaneous posterior column (LMN) and CST (UMN) loss
64
What is subacute combined degeneration of the cord due to?
B12 deficiency
65
Triad subacute combined degeneration of the cord
Extensor plantars Brisk knee jerk Absent ankle jerks
66
PS subacute combined degeneration of the cord (6)
``` Peripheral neuropathy Extensor plantars Brisk knee jerk Absent ankle jerks Tone and power normal Gait may be ataxic ```
67
Where in the digestive system is folate absorped?
Jejunum
68
How long do the body's reserves of folate last?
3 months
69
Causes folate deficiency
Poor nutritional intake Malabsorption - Chrons Anti-folate drugs XS physiological - pregnancy, prematurity XS pathological - XS eryhtrocyte prod, malig, Inflamm disease
70
E.g.s of drugs that cause folate deficiecy (3)
Methotrexate Trimethroprim Anti-convulsants
71
Tx folate deficiency
folic acid 5mg /day PO for 4 months | Always combine w/ B12 (unless Pt known to have norm B12 levels)
72
what condition can XS folate precipitate?
Subacute combined degeneration of cord

CP3 Medicine (29 decks)

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