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Red Cells 2 Flashcards

1
Q

When revieweing someones Hb blood results and deciding if they are anaemic or not, what other information should you take into account?

A

The age and sex of the person

Their ethnic origin

The time of day the sample was taken

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2
Q

How is the normal range of hameoglobin defined?

A

The mean of haemoglobin of subjects without disease +- 2 standard deviations

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3
Q

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

A

140-180

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4
Q

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

A

120-160

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5
Q

What are the general clinical features of someone with anaemia?

A

Tiredness/pallor

Breathlessness & chest pain

Swelling of ankles

Dizziness

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6
Q

What is a red cell indices?

A

They are diagnostic tests that are part of the FBC and are used to diagnose anaemias

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7
Q

What information does a red cell indices tell you?

A

Mean Cell Volume (cell size)

Mean Cell Haemoglobin

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8
Q

What are the different morphological descriptions of anaemia?

A

Hypochromic Microcytic

Normochromic Normocytic

Macrocytic

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9
Q

What is meant by the term hypochromic?

A

Pale looking RBC’s

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10
Q

What is meant by the term microcytic?

A

RBC’s smaller than the normal range of MCV

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11
Q

What is meant by the term macrocytic?

A

RBC’s larger than the normal size range for MCV

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12
Q

What investigations are carried out to confirm a hypochromic microcytic anaemia?

A

Serum Ferritin

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13
Q

What further tests are carried out to diagnose a normochromic normocytic anaemia?

A

Reticulocyte count

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14
Q

What further tests are carried out to confirm a diagnosis of macrocytic anaemia?

A

Check Vitamin B12 & Folate levels

Bone Marrow sample

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15
Q

After identifying a hypochromic microcytic anaemia from red cell indices and a blood film, what would a low serum ferritin result indicate?

A

The anaemia is caused by an Iron deficiency

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16
Q

After identifying a hypochromic microcytic anaemia from red cell indices and a blood film, what would a normal or increased serum ferritin result indicate?

A

Thalassaemia OR

Secondary anaemia

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17
Q

Which protein is responsible for binding Heme Iron absorbed from the duodenum?

A

Ferritin

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18
Q

What happens to Iron which has been absorbed and become bound to ferritin?

A

1) Sloughed off by shedding of epithelial cells
2) Transported across basement membrane by ferroportin

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19
Q

Once Iron is in the plasma, to which protein does it become bound to?

A

Transferrin

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20
Q

How is Iron stored in RBC’s?

A

As Ferritin

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21
Q

What is Hepcidin and where does it come from?

A

Hepcidin is a protein which regulates the intake of Iron of into the blood stream

Hepcidin is produced by hepatocytes in the Liver

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22
Q

What does hepcidin do?

A

Hepcidin blocks ferroportin therefore reducing intestinal Iron absorption

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23
Q

In what situations is hepcidin required?

A

Inflammation

Renal failure

Increased Iron levels

24
Q

What are the reasons someone might present with an Iron deficiency anaemia?

A

1 - GI bleeding

2 - Menorrhagia

3 - Diet low in Iron

4 - Being pregnant

25
Q

What are the clinical features of iron deficiency?

A

Koilonychia

Atrophic tongue

Angular cheilitis

26
Q

What are the causes of Iron deficiency anaemia?

A

GI blood loss (colon cancer, gastric ulcer)

Menorrhagia (heavy period)

Malabsorption (Coeliac disease)

27
Q

How is Iron deficiency anaemia managed?

A

1) Correct the deficiency - Oral Iron tablets
2) Correct the cause - diet, ulcer therapy, gynae interventions

28
Q

After identifying a normochromic normocytic anaemia from red cell indices and a blood film, what would an increased reticulocyte count indicate?

A

1) Acute blood loss
2) Haemolysis

29
Q

After identifying a normochromic normocytic anaemia from red cell indices and a blood film, what would a normal or low reticulocyte count indicate?

A

1) Secondary anaemia
2) Hypolasia
3) Marrow infiltration

30
Q

What is haemolytic anaemia?

A

Accelerated red cell destruction (causing reduced Hb)

31
Q

How does the body compensate for the loss of RBC’s by haemolysis?

A

Bone marrow increases production of reticulocytes

32
Q

What are the general causes of haemolytic anaemias?

A

1) Congenital
2) Acquired

33
Q

What are the congenital causes of haemolytic anaemia?

A

1) Hereditary spherocytosis
2) G6PD
3) Haemoglobinopathy

34
Q

What are the acquired causes of haemolytic anaemia?

A

1) Auto-immune haemolytic anaemia
2) Artifical valve
3) Severe infections/DIC

35
Q

What are the two locations where haemolytic anaemia can occur?

A

1 - Extravascular

2 - Intravascular

36
Q

Where are the immune causes of haemolytic anaemia most likely to occur?

A

Extravascular

37
Q

How is haemolytic anaemia tested for?

A

Direct antiglobulin test

38
Q

If the direct anti-globulin test is positive what does that indicate about the haemolytic anaemia?

A

It is immune mediated

39
Q

If the direct anti-globulin test is negative what does that indicate about the haemolytic anaemia?

A

It is non-immune mediated

40
Q

What are the different types of immune mediated haemolysis?

A

1) Warm auto-antibody
2) Cold auto-antibody
3) Alloantibody

41
Q

What tests would you run to identify if a patient is currently haemolysing?

A

1) FBC
2) Reticulocyte count
3) Blood film

42
Q

How is haemolytic anaemia managed?

A

1) Folic acid to support marrow function
2) Immunosuppression if auto-immune
3) Splenectomy
4) Treat sepsis

43
Q

What is the most common type of secondary anaemias?

A

Normochromic normocytic

44
Q

What is the main cause of seoncdary anaemia?

A

Increased Hepcidin in chronic inflammatory condition

45
Q

After identifying a macrocytic anaemia from B12/Folate assay , what would a megaloblastic macrocytic anaemia (identified on blood film) indicate was causing the anaemia?

A

B12 and Folate deficiency

46
Q

After identifying a macrocytic anaemia from B12/Folate assay , what would a non-megaloblastic macrocytic anaemia (identified on blood film) indicate was causing the anaemia?

A

Myelodysplasia

Marrow infiltration

47
Q

What can be the cause of a Vitamin B12 deficiency?

A

1 - Pernicious anaemia

2 - Gastric disease

48
Q

What can be the cause of a folate deficiency?

A

Dietary

Increased folate requirements (haemolysis)

49
Q

What is the appearance of someone with megaloblastic anaemia?

A

Lemon yellow tinge

50
Q

How is Vitamin B12 absorbed?

A

Vitamin B12 binds to Intrinsic Factor which then attaches to Intrinsic Factor recptors on distal Ileum

51
Q

From where is intrinsic factor produced?

A

Gastric parietal cells

52
Q

What is the cause of pernicious anaemia?

A

Antibodies against Intrinsic factor

53
Q

Why is it called ‘pernicious’ anaemia?

A

The symptoms take 1-2 years to develop

54
Q

How is megaloblastic anaemia treated?

A

Correct Vitamin B12 and Folate deficiency

55
Q

What are some of the other causes of macrocytosis?

A

Alcohol

Drugs (e.g. methotrexate)

Disordered Liver function

Hypothyroidism

SAQ's (22 decks)

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