Flashcards in Haematology Deck (210)
What is anaemia?
Low concentration of haemoglobin in blood due to reduced number of red blood cells
What are the specific Hb cut-offs for anaemia in males and females?
Males: Hb less than 130 g/l
Females: Hb less than 120 g/l
Pregnant females: Hb less than 110 g/l
What are the two main categories of aetiology for anaemia?
Reduced production of red blood cells (ineffective erythropoiesis), causing reduced reticulocytes
Increased destruction of red blood cells (haemolysis, bleeding), causing increased reticulocytes
List clinical features of anaemia
What investigations would you do for anaemia?
FBC - red cells, white cells, platelets, reticulocytes
Mean cell volume (distinguish between microcytic and macrocytic)
Bone marrow aspirate
What is microcytic anaemia?
Reduced Hb production that results in small, hypochromic cells
Defined by reduced MCV
List aetiology for microcytic anaemia
Haem deficiency: iron deficiency, anaemia of chronic disease, defective porphyrin synthesis
Globin deficiency: thalassaemia
What is macrocytic anaemia?
Delayed nuclear maturation of erythroblasts due to defective DNA [megaloblastic macrocytic]
Normoblastic bone marrow [non-megaloblastic macrocytic]
Defined by raised MCV
List aetiology for macrocytic anaemia
Megaloblastic: B12/folate deficiency, enzyme deficiency, myelofibrosis
List aetiology for normocytic anaemia (normal MCV)
Acute blood loss
Anaemia of chronic disease
Bone marrow failure (esp if leukopenia/thrombocytopenia)
List aetiology/risk factors for iron-deficiency anaemia
List clinical features of iron-deficiency anaemia
Spoon-shaped nails (koilonychia)
Features of microcytic anaemia
What investigations would you do for iron-deficiency anaemia?
Blood film: hypochromic microcytic cells, anisocytosis (varied shape), poikilocytosis (varied size)
Reduced ferritin, iron, MCV
Endoscopy if suspected GI bleeding
Outline management of iron-deficiency anaemia
Oral ferrous sulphate
IV iron if intolerant
List aetiology/risk factors for anaemia of chronic disease
Chronic infection (TB, osteomyelitis)
What investigations would you do for anaemia chronic disease?
Reduced serum iron
Increased hepcidin (inhibits iron absorption)
Outline management of anaemia of chronic disease
Treat underlying cause
EPO injections stimulate RBC production
What is sideroblastic anaemia?
Refractory anaemia usually unresponsive to iron therapy
List aetiology/risk factors for sideroblastic anaemia
Inherited X-linked disease
What investigations would you do for sideroblastic anaemia?
Blood film: hypochromic cells, ring sideroblasts
Increased iron absorption + loading +- haemosiderosis
Outline management of sideroblastic anaemia
Pyroxidine (B6 supplement)
Transfuse if severe
Describe MCV, serum iron, serum ferritin and serum transferrin in iron deficiency anaemia
Describe MCV, serum iron, serum ferritin and serum transferrin in anaemia of chronic disease
What is pernicious anaemia?
B12 deficiency caused by autoimmune destruction of gastric parietal cells, causing reduced absorption of B12
List clinical features of pernicious anaemia
Symptoms of anaemia
Subacute cord degeneration (posterolateral)
What investigations would you do for pernicious anaemia?
Blood film: hypersegmented polymorphs, oval macrocytes
Anti- parietal cell/intrinsic factor antibodies
Outline management of pernicious anaemia
Treat other causes (diet, malabsorption)
Oral B12 supplements
Where is B12 absorbed?
Where is folate absorbed?