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module 103 - theme 2 > introduction to anaemia > Flashcards

introduction to anaemia Flashcards

1
Q

what is anaemia?

A

when the haemoglobin concentration falls below defined level (outside normal range)

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2
Q

what are the units of haemoglobin?

A

g/L

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3
Q

what are 3 causes of anaemia?

A
  • lowered Hb content
  • lowered red blood cell count
  • altered Hb does not carry sufficient O2
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4
Q

what is the normal haemoglobin range in children?

A

110-160g/L

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5
Q

what is the normal haemoglobin range in women?

A

115-165g/L

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6
Q

what is the normal haemoglobin range in pregnant women?

A

110-160g/L

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7
Q

what is the normal haemoglobin range in men?

A

130-180g/L

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8
Q

what are the symptoms of anaemia?

A
  • fatigue
  • shortness of breath
  • palpitations
  • headache
  • worse: acute bleed/haemolysis
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9
Q

what are the signs of anaemia?

A
  • skin pallor
  • pale conjuncitvae
  • tachypnoea
  • tachycardia
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10
Q

what are the 2 main causes of anaemia?

A
  • problems of inadequate synthesis

- problems of blood loss or consumption

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11
Q

what causes problems of inadequate synthesis?

A
  • deficiency in necessary components (iron, B12 and folic acid)
  • bone marrow dysfunction/infiltration
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12
Q

what causes problems of blood loss of consumption?

A
  • bleeding

- haemolytic (increased red cell destruction or shortened RBC lifespan)

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13
Q

what are the 3 classifications of anaemia?

A
  • size of red blood cell
  • acute or chronic
  • underlying aetiology
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14
Q

what is the most common type of anaemia?

A

iron deficiency

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15
Q

what are the causes of iron deficiency?

A
  • bleeding
  • nutritional deficiency
  • increased requirements
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16
Q

what iron studies do you do to confirm iron deficiency?

A
  • Ferritin
  • Serum Fe
  • Transferrin
  • Transferrin saturation %
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17
Q

what is the serum ferritin diagnostic test?

A
  • storage form of iron

- low = iron deficient

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18
Q

what is the serum iron diagnostic test?

A

labile in blood, so reflects recent intake of iron

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19
Q

what is the serum transferrin diagnostic test?

A
  • carrier molecule for iron from gut to stores
  • homeostatically goes up if iron is deficient
  • reflects total iron binding capacity of the blood
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20
Q

what is the % transferrin saturation diagnostic test?

A
  • sensitive measure of iron status
  • reflects proportion of transferrin with iron bound
  • low TF saturation indicates iron deficiency
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21
Q

what are the 3 causes of iron deficiency in the UK?

A
  • bleeding (GI, menstrual, renal tract)
  • inadequate intake
  • increased requirements (pregnancy)
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22
Q

what is the mean corpuscular volume?

A
  • this is the size of the red blood cells

- usually about 80-100fL

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23
Q

what are microcytic red blood cells?

A
  • small
  • iron deficiency
  • inherited disorders of haemoglobin (beta-thalassemia trait)
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24
Q

what are macrocytic red blood cells?

A
  • large
  • B12 and folate deficiency
  • myelodysplasia (causes defective erythropoiesis)
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25
Q

what are normocytic red blood cells?

A
  • normal
  • anaemia of chronic disease
  • acute haemorrhage
  • renal failure (caused by low erythropoietin levels)
26
Q

what is a blood film good for and why?

A
  • quick, easy and useful
  • microcytic/macrocytic
  • hypochromic
  • sickled cells
  • polychromasia
  • white cells, platelets, leukaemic cells
27
Q

how long do red blood cells circulate in the blood?

A

100-120

28
Q

what is a reticulocyte count?

A

reticulocytes represent newly produced RBC ~1 day old

29
Q

how can you calculate the reticulocyte count?

A
  • calculated on a blood film using a stain to detect RNA
30
Q

what is a reticulocyte count used for?

A
  • the rate of production of RBCs by bone marrow
  • low during percursor deficiencies
  • low if bone marrow is infiltrated
  • high in chronic bleeding
  • high is haemolysis
  • useful to monitor response to treatment
31
Q

what is red blood cell production driven by?

A

erythropoietin from kidney

32
Q

what history do you need to take when anaemia suspected?

A
  • GI symptoms
  • menstrual history
  • bowel history
  • dietary history
  • travel history
  • ethnic origin
  • family history
33
Q

what is megaloblastic anaemia?

A

anaemia caused by deficiency of vitamin B12 and folate

34
Q

what is B12 needed for?

A
  • DNA synthesis

- results in impaired cell division when it lacks

35
Q

what are hyper-segmented neutrophils?

A

neutrophils with more than 4 nuclear lobes

36
Q

what is B12 deficiency caused by (mechanism)?

A

when the body cannot absorb B12 in terminal ileum where IF receptors are located

37
Q

how do you treat B12 deficiency?

A

B12 injections, load initially with 5 doses alternate days then every 3 months

38
Q

what causes vitamin B12 deficiency?

A
  • pernicious anaemia
  • dietary
  • malabsorption (coeliac disease and Crohn’s disease)
39
Q

what causes folate deficiency?

A
  • dietary
  • malabsorption
  • excess utilisation
  • alcohol
  • drugs
40
Q

what are the common causes of anaemia of chronic disease?

A
  • chronic inflammation
  • chronic infection
  • auto-immune conditions
  • cancer
  • renal failure
  • poor utilisation of iron in the body
  • dysregulation of iron homeostasis
  • impaired proliferation of erythroid progenitors
41
Q

what is the most common form of anaemia in hospitalised patients?

A

anaemia of chronic disease

42
Q

what does it mean if there is poor utilisation of iron in the body?

A
  • iron is stuck in macrophages of the reticuloendothelial system
  • there is poor mobilisation of the iron from the stores into the erythroblasts
43
Q

what is dysregulation of iron homeostasis?

A
  • decreased transferrin
  • increased ferritin
  • increased hepcidin
44
Q

what is impaired proliferation of erythroid progenitors?

A
  • blunted response EPO (erythropoietin)

- iron is functionally unavailable

45
Q

what is sickle cell anaemia?

A

point mutation in the beta globin gene causing HbS (sickle Hb)

46
Q

how does sickle cell anaemia affect the red blood cells?

A
  • increases the turnover of red cells

- survival is approximately 20 days due to haemolysis

47
Q

what is a sickle cell crisis?

A
  • it is triggered by low blood O2 level
  • vaso-occlusive due to sickling in the vessels
  • causes ischaemia leading to pain, necrosis and potential organ damage
48
Q

how do you manage sickle cell anaemia?

A

analgesics, hydration, transfusion

49
Q

what type of disease is sickle cell anaemia?

A

autosomal recessive

50
Q

what is the mechanism of sickle cell anaemia?

A
  • mutated sickle haemoglobin
  • forms long filamentous strands
  • insoluble at low O2 tension
  • RBCs become inflexible + spiky leading to crisis
51
Q

what is the sickle cell trait?

A
  • heterozygous
  • 50% HbS and 50% HbA
  • much lower risk of sickling and crisis
  • resistance to malaria infection
52
Q

what is thalassaemia?

A
  • insufficient production of normal Hb
  • imbalance of alpha and beta chains
  • inherited autosomal recessive
53
Q

what are the clinical features of thalassaemia?

A
  • enlarged spleen, liver and heart

- may be misshapen (frontal bossing)

54
Q

what is beta-thal major?

A
  • homozygous

- requires long-life transfusions

55
Q

what is beta-thal minor?

A
  • heterozygous
  • carrier
  • clinically healthy
56
Q

what are the character indicies of beta-thalassaemia?

A
  • microcytic

- hypochromic

57
Q

what are the 3 types of bone marrow infiltration?

A
  • leukaemia
  • lymphoma
  • myeloma
58
Q

why is bone marrow sample obtained from iliac crest?

A
  • aspirate film for morphology of cells

- trephine biopsy for histological section

59
Q

how do you treat chronic anaemia?

A

erythropoietin (EPO) weekly sib-cut injections in patients receiving haemodialysis or with kidney failure

60
Q

what are the long-term transfusion causes of chronic anaemia?

A
  • iron overload

- allo-antibodies

61
Q

what is the worldwide impact of anaemia?

A
  • increased risk of morbitiy in children
  • impaired physical and cognitive development
  • poor pregnancy outcome
  • contributes to 20% of all maternal deaths
  • reduced work productivity in adults

module 103 - theme 2 (8 decks)

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