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Systems: Haematology + Immunology > RBC: Acquired Anaemias > Flashcards

RBC: Acquired Anaemias Flashcards

(62 cards)

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1
Q

What is the normal haemoglobin level for a male 12-70?

A

140-180

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2
Q

What is the normal haemoglobin level for a male>70?

A

116-156

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3
Q

What is the normal haemoglobin level for a female 12-70?

A

120-160

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4
Q

What is the normal haemoglobin for a female >70?

A

108-143

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5
Q

What are the clinical features of anaemia?

A

General features due to reduced oxygen delivery to tissues:

  • Tiredness/pallor
  • Breathlessness
  • Swelling of ankles
  • Dizziness
  • Chest pain

Depend on age and Hb level

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6
Q

What features of anaemia may relate to the underlying cause?

A 
Evidence of bleeding
-Menorrhagia
-Dyspepsia, PR bleeding				
Symptoms of malabsorption
-Diarrhoea
-Weight loss

Jaundice

Splenomegaly/Lymphadenopathy

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7
Q

What is the approach to diagnosing cause of anaemia?

A

Bone marrow

  • Cellularity
  • Stroma
  • Nutrients

Red cell

  • Membrane
  • Haemoglobin
  • Enzymes

Destruction loss

  • Blood loss
  • Haemolysis
  • Hypersplenism
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8
Q

What are red cell indices?

A

Automated measurement of red cell size and haemoglobin content

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9
Q

MCV

A

Mean cell volume (cell size)

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10
Q

MCH

A

Mean cell haemoglobin

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11
Q

What can red indices tell us?

A

A morphological description of anaemia

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12
Q

Give 3 morphological descriptions of anaemia.

A
  • Hypochromic microcytic
  • Normochromic normocytic
  • Macrocytic
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13
Q

What does investigation of anaemia involve?

A
  • Investigation involves use of a discriminating test to guide further investigations
  • If laboratory is given adequate clinical information it will advise on further appropriate investigations
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14
Q

What investigation should be carried out to establish cause of hypochromic microcytic anaemia?

A

Serum ferritin

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15
Q

What investigation should be carried out to establish cause of normochromic normocytic anaemia?

A

Reticulocyte count

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16
Q

What investigation should be carried out to establish cause of macrocytic anaemia?

A
  • B12 and folate levels

- Bone marrow

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17
Q

What does low serum ferritin suggest in hypochromic microcytic anaemia?

A

Iron deficiency

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18
Q

What does normal/increased serum ferritin suggest in hypochromic microcytic anaemia?

A
  • Thalassaemia
  • Secondary anaemia
  • Sideroblastic anaemia
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19
Q

What are the features of iron metabolism?

A
  • Total body iron approx. 4g
  • Dietary intake balanced by loss
  • Most of the body’s iron is in Hb and is recycled
  • no pathway for excretion of excess iron
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20
Q

What happens to absorbed iron?

A
  • Bound to mucosal ferritin and sloughed off OR
  • Transported across the basement membrane by ferroportin
  • Then bound to transferrin in the plasma
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21
Q

Whhat happens to the iron absorbed in the duodenum?

A
  • Fe2>Fe3
  • Transported from eneterocytes and macrophages by ferroportin
  • Transported in plasma bound to transferrin
  • Stored in cells as ferritin
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22
Q

What reduced intestinal iron absorption?

A

Hepcidin synthesised in hepatocytes in response to inflammation (also renal failure and increased iron levels) so reduced intestinal iron absorption and mobilisation from reticuloendothelial cells

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23
Q

What is the commonest cause of anaemia worldwide?

A

Iron deficiency anaemia

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24
Q

What is normally in the history of iron deficiency anaemia?

A
  • Dyspepsia GI bleeding
  • Other bleeding, eg menorrhagia
  • Diet (NB children and elderly)
  • Increased requirement - pregnancy
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25
What can be found on examination of iron deficiency anaemia?
Signs of iron deficiency - Koilonychia - Atrophic tongue - Angular cheilitis Abdominal and rectal examination (bleeding)
26
Give some examples of causes of iron deficiency.
- GI blood loss - Menorrhagia - Malabsorption (can be due to gastrectomy of coeliac disease) - Diet
27
How is iron deficiency anaemia managed?
Correct the deficiency -Oral iron usually sufficient - IV iron if intolerant of oral - Blood transfusion rarely indicated Correct the cause - - Diet - Ulcer therapy - Gynae interventions - Surgery
28
What does increased reticulocyte count suggest in normochromic normocytic?
- Acute blood loss | - Haemolysis
29
What does a normal or low reticulocyte count suggest in normochromic normocytic anaemia?
- Secondary anaemia - Hypoplasia - Marrow infiltrate
30
What happens in haemolytic anaemia?
- Accelerated res cell destruction (decreases Hb) - Compensation by bone marrow (Increase in retics - Level of Hb= balance between red cell production and destruction
31
What are the 2 forms of haemolysis?
- Extravascular | - Intravascular
32
What are some congenital causes of haemolytic anaemia?
- Hereditary spherocytosis (HS) - Enzyme deficiency (G6PD deficiency) - Haemoglobinopathy (HbSS)
33
What are some acquired causes of haemolytic anaemia?
Extravascular -Auto-immune haemolytic anaemia Intravascular - Mechanical e.g. artificial valve - Severe infection/DIC - PET/HUS/TTP
34
How can acquired haemolytic anaemia be subdivided?
- Immune (mostly extravascular) | - Non-immune (mostly intravascular)
35
What is a direct antiglobulin test?
-A test which detects antibody or complement on red cell membrane
36
How does the DAGT work?
- Reagents contain either anti-human IGG or anti-complement - Reagent binds to Ab (or complement) on red cell surface and causes agglutination in vitro - Implies immune basis for haemolysis
37
What does a positive DAGT suggest in in haemolytic anaemia/
Immune mediated
38
What does a negative DAGT suggest in haemolytic anaemia?
Non-immune mediated
39
In human haemolysis of haemolytic anaemia, what does a warm-auto-antibody suggest?
- Auto-immune - Drugs - CLL
40
In human haemolysis of haemolytic anaemia, what does a cold auto-antibody suggest?
- CHAD - Infections - Lymphoma
41
In human haemolysis of haemolytic anaemia, what does an alloantiody suggest?
Transfusion reaction
42
What can be seen on blood film of immune haemolysis?
- Spherocytes on film | - Agglutination in cold AIHA
43
What can be seen on blood film of intravascular haemolysis?
Red cell fragments called schistocytes
44
How is the mechanism of haemolytic anaemia established?
- History and examination - Blood film - Direct Antiglobulin Test (Coombs’ test) - Urine for haemosiderin/urobilinogen
45
What is the management for haemolytic anaemia?
Support marrow function -Folic acid Correct the cause - Immunosuppression if autoimmune (steroids, treat the trigger)) - Remove site of red cell destruction (splenectomy) - Treat sepsis, leaky preosthetic valve, malignancy etc. if intravascular Consider transfusion
46
What is secondary anaemia?
Anaemia of chronic disease
47
How does secondary anaemia present morphologically?
- 70% normochromic normocytic | - 30% hypochromic microcytic
48
What is the cause of secondary anaemia?
Identifiable underlying disease including infection, inflammation and malignancy
49
Why does secondary anaemia occur?
Defective iron utilisation - Increased hepticidin in inflammation - Ferritin is often elevated
50
In macrocytic anaemia, what can results of B12 and folate assays, blood films and bone marrow tell us?
- Megaloblastic | - Non-megaloblastic
51
What can cause megaloblastic macrocytic anaemia?
- B12 deficiency | - Folate deficiency
52
What can cause non-megaloblastic macrocytic anaemia?
- Myelodysplasia - Marrow infiltration - Drugs
53
How can B12/folate deficiency present?
- Anaemia | - Neurological symptoms (subacute combined degeneration of the cord in B12 deficiency)
54
What can cause B12 deficiency?
- Pernicious anaemia | - Gastric/ilieal disease
55
What can cause folate deficiency?
-Dietary Increased requirements (haemolysis) -GI pathology (e.g. coeliac disease)
56
Why do people have a lemon yellow tinge in megaloblastic anaemia?
- Due the bilirubin and LDH | - Red cells are friable
57
How is vitamin B12 absorbed?
``` -Dietary B12 binds to intrinsic factor, secreted by gastric parietal cells -B12-IF complex attaches to specific IF receptors in distal ileum -Vitamin B12 bound by transcobalamin II in portal circulation for transport to marrow and other tissues ```
58
What is the commonest cause of B12 deficiency?
Pernicious anaemia
59
What is pernicious anaemia?
- An autoimmune condition where the bodies make antibodies against intrinsic factor (sometimes gastric parietal cells) - It results in malabsorption of dietary B12
60
How long does it take for signs and symptoms of pernicious anaemia to develop?
1-2 years due to B121 stores
61
What is the treatment for megaloblastic anaemia?
Replace vitamin B12 -B12 intramuscular injection Loading dose 3 then 3 monthly maintenance Replace folate - Oral folate replacement - Ensure B12 normal if neuropathic symptoms
62
What are 'other' causes of macrocytosis?
- Alcohol - Drugs (Methotrexate, Antiretrovirals, hydroxycarbamide) - Disordered liver function - Hypothyroidism - Myelodysplasia

Systems: Haematology + Immunology (19 decks)

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