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Flashcards in Haematology Anaemia Deck (70)
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1

WHO definition of anaemia

Anaemia is a condition in which the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body’s physiological need

2

Anemia Varies by

Age – older lower hb
Gender – more in males
Altitude – higher hb from hypoxic dribe
Smoking behaviour
Stage of pregnancy – haemodilute (although RBC is raised despite increased fluid)

3

Most useful parameter when assessing anaemia

Mean cell volume (MCV) is the most useful parameter when considering the cause of anaemia

4

Hb (g/L)

F:115-155
M:130-170

5

RBC volumes

F:3.8-5.3
M:4.5-6.0

6

Haematocrit ranges

F:0.37-0.45
M:0.40-0.52

7

MCV ranges

F:83-96
M:83-96

8

Mean cell haemoglobin

F:27-32
M:27-32

9

MCV <83 fL

Microcytic

10

MCV 83-96 fL

Normocytic

11

MCV >96 fL

Macrocytic

12

Microcytic

Iron defiency
Thalassemia
Anaemia of chronic disorder

13

Normocytic

Acute blood loss
Haemolysis
Anaemia of chronic disorder
Bone marrow infiltration
Combined haematinic deficiency

14

Macrocytic

B12/folate deficiency
Haemolysis
Hypothyroidism
Liver disease
Alcohol excess
Myelodysplasia

15

Microcytic Anaemia: types

• Iron deficiency (covering this)
• Thalassaemia – covered elsewhere
• Anaemia of chronic disease

16

Iron deficiency Epi

Most common cause worldwide

17

Iron deficiency Causes (most common)

1. Dietary insufficiency (80% from meat, 20% from vegetables) -
2. Physiological (infancy, adolescence, pregnancy)
3. Blood loss (GI, mennorhagia)
4. Malabsorption e.g. coeliac disease

18

Iron deficiency Total body iron

4g:
1. Hb 3g
2. Reticuloendothelial system 1g

19

Iron deficiency Normal diet

Absorption = loss

20

Iron deficiency Clinical Features

1. Angular stomatitis
2. Glossitis
3. Koilonchia
4. Pharyngeal and oesophageal webs

21

Iron deficiency Laboratory Features

Microcytic hypochronic anaemia (Greater central pallor)
Low serum ferritin (beware: acute phase protein) *
Absent iron stores in bone marrow (rare late stage)

22

Further investigations: Physiological

Treat with oral iron

23

Further investigations: Females: pre-menopausal

Localising GI symptoms or signs
• Treat with oral iron
• Colonoscopy/Barium Enema OGD (Smal bowel study)

24

Further investigations: Males and post-menopausal women

Investigate:
Colonoscopy/Barium Enema OGD (Smal bowel study)

25

Normocytic Anaemias: types

• Acute blood loss
• Anaemia of chronic disease – insufficient production
• Bone marrow infiltration
• Combined haemotinic deficiency
• Haemolysis (exam favourite) - augmented destruction

26

Anaemia of Chronic disease: Definition




Depression of erythropoiesis of multifactorial aetiology seen as a secondary manifestation in a wide variety of disorders:
• Mild to moderate (hb 90-110 g/L)
• Normochromic/microcytic hypochromic
• Serum ferritin normal or increased

27

Anaemia of Chronic disease: Mechanisms

Main defect is failure of transport of iron from RE system to developing red cells
→ Proteins in liver/spleen/ bone marrow defect and therefore preventing transport to red cells

28

Anaemia of Chronic disease: Common causes

Chronic infection/inflammation – RA/SLE
Malignancy – nutritionally deficient and malignancy supresses erythropoiesis
Uraemia – high concentrations suppress erythropoiesis (kidney disease double hit)
Endocrine disorders – poorly controlled (hypothyroidism/diabetes)

29

Anaemia of Chronic disease: Treatment

Correction of underlying causes
Erythropoietin (+iron Iv) – potentially in inflammatory conditions. Floods bone marrow with iron readily available to ue and doesn’t rely on transport from elsewhere.

30

Haemolytic Anaemia: Definition

Increased destruction of red cells; reduced life span.
Compensation: expansion of erythropoiesis can increase red cell production 7x without anaemia presenting (will see haemolysis)
Decompensating: due to infection, folate deficiency or other stressors – when the anaemia presents

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