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Flashcards in Haematology Deck (210)
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1

What is anaemia?

Low concentration of haemoglobin in blood due to reduced number of red blood cells

2

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

3

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

4

List clinical features of anaemia

Tiredness, fatigue
Breathlessness
Pallor
Headache
Palpitations
Syncope

5

What investigations would you do for anaemia?

FBC - red cells, white cells, platelets, reticulocytes
Mean cell volume (distinguish between microcytic and macrocytic)
Blood film
Bone marrow aspirate

6

What is microcytic anaemia?

Reduced Hb production that results in small, hypochromic cells
Defined by reduced MCV

7

List aetiology for microcytic anaemia

Haem deficiency: iron deficiency, anaemia of chronic disease, defective porphyrin synthesis
Globin deficiency: thalassaemia
Sideroblastic anaemia

8

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

9

List aetiology for macrocytic anaemia

Megaloblastic: B12/folate deficiency, enzyme deficiency, myelofibrosis

10

List aetiology for normocytic anaemia (normal MCV)

Acute blood loss
Anaemia of chronic disease
Bone marrow failure (esp if leukopenia/thrombocytopenia)
Renal failure
Hypothyroidism
Pregnancy

11

List aetiology/risk factors for iron-deficiency anaemia

Dietary insufficiency
Menorrhagia
Malabsorption (Coeliac)
GI bleeding

12

List clinical features of iron-deficiency anaemia

Spoon-shaped nails (koilonychia)
Glossitis
Angular cheilitis
Brittle hair
Features of microcytic anaemia

13

What investigations would you do for iron-deficiency anaemia?

FBC
Blood film: hypochromic microcytic cells, anisocytosis (varied shape), poikilocytosis (varied size)
Reduced ferritin, iron, MCV
Endoscopy if suspected GI bleeding

14

Outline management of iron-deficiency anaemia

Treat causes
Oral ferrous sulphate
IV iron if intolerant

15

List aetiology/risk factors for anaemia of chronic disease

Chronic infection (TB, osteomyelitis)
Vasculitis
Rheumatoid arthritis
IBD
SLE
Polymyalgia rheumatica
Malignancy

16

What investigations would you do for anaemia chronic disease?

Normal/raised ferritin
Reduced serum iron
Increased hepcidin (inhibits iron absorption)

17

Outline management of anaemia of chronic disease

Treat underlying cause
EPO injections stimulate RBC production

18

What is sideroblastic anaemia?

Refractory anaemia usually unresponsive to iron therapy

19

List aetiology/risk factors for sideroblastic anaemia

Inherited X-linked disease
Myelodysplasia
Myeloproliferative disease
Myeloid leukaemia
Drugs, alcohol

20

What investigations would you do for sideroblastic anaemia?

Blood film: hypochromic cells, ring sideroblasts
Increased iron absorption + loading +- haemosiderosis

21

Outline management of sideroblastic anaemia

Treat cause
Pyroxidine (B6 supplement)
Transfuse if severe

22

Describe MCV, serum iron, serum ferritin and serum transferrin in iron deficiency anaemia

Reduced MCV
Reduced iron
Reduced ferritin
Increased transferrin

23

Describe MCV, serum iron, serum ferritin and serum transferrin in anaemia of chronic disease

Variable MCV
Reduced iron
Normal/increased ferritin
Normal transferrin

24

What is pernicious anaemia?

B12 deficiency caused by autoimmune destruction of gastric parietal cells, causing reduced absorption of B12

25

List clinical features of pernicious anaemia

Symptoms of anaemia
Lemon-yellow skin
Polyneuropathy
Dementia
Psychosis
Subacute cord degeneration (posterolateral)
Paraesthesiae

26

What investigations would you do for pernicious anaemia?

Blood film: hypersegmented polymorphs, oval macrocytes
Reduced B12
Anti- parietal cell/intrinsic factor antibodies

27

Outline management of pernicious anaemia

Treat other causes (diet, malabsorption)
Oral B12 supplements
IM hydroxycobalamin

28

Where is B12 absorbed?

Ileum

29

Where is folate absorbed?

Duodenum
Jejunum

30

List aetiology/risk factors for folate deficiency

Poor diet
Increased demand (pregnancy, haemodialysis, malignancy)
Alcohol excess
Anti-folate agents (phenytoin, methotrexate, anti-epileptics, trimethoprim)