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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
What are the clinical features of iron deficiency?
Koilonychia Atrophic tongue Angular cheilitis
26
What are the causes of Iron deficiency anaemia?
GI blood loss (colon cancer, gastric ulcer) Menorrhagia (heavy period) Malabsorption (Coeliac disease)
27
How is Iron deficiency anaemia managed?
1) **Correct the deficiency** - Oral Iron tablets 2) **Correct the cause** - diet, ulcer therapy, gynae interventions
28
After identifying a normochromic normocytic anaemia from red cell indices and a blood film, what would an increased reticulocyte count indicate?
1) Acute blood loss 2) Haemolysis
29
After identifying a normochromic normocytic anaemia from red cell indices and a blood film, what would a normal or low reticulocyte count indicate?
1) Secondary anaemia 2) Hypolasia 3) Marrow infiltration
30
What is haemolytic anaemia?
Accelerated red cell destruction (causing reduced Hb)
31
How does the body compensate for the loss of RBC's by haemolysis?
Bone marrow increases production of reticulocytes
32
What are the general causes of haemolytic anaemias?
1) Congenital 2) Acquired
33
What are the congenital causes of haemolytic anaemia?
1) Hereditary spherocytosis 2) G6PD 3) Haemoglobinopathy
34
What are the acquired causes of haemolytic anaemia?
1) Auto-immune haemolytic anaemia 2) Artifical valve 3) Severe infections/DIC
35
What are the two locations where haemolytic anaemia can occur?
1 - Extravascular 2 - Intravascular
36
Where are the immune causes of haemolytic anaemia most likely to occur?
Extravascular
37
How is haemolytic anaemia tested for?
Direct antiglobulin test
38
If the direct anti-globulin test is positive what does that indicate about the haemolytic anaemia?
It is immune mediated
39
If the direct anti-globulin test is negative what does that indicate about the haemolytic anaemia?
It is non-immune mediated
40
What are the different types of immune mediated haemolysis?
1) Warm auto-antibody 2) Cold auto-antibody 3) Alloantibody
41
What tests would you run to identify if a patient is currently haemolysing?
1) FBC 2) Reticulocyte count 3) Blood film
42
How is haemolytic anaemia managed?
1) **Folic acid** to support marrow function 2) **Immunosuppression** if auto-immune 3) **Splenectomy** 4) **Treat sepsis**
43
What is the most common type of secondary anaemias?
Normochromic normocytic
44
What is the main cause of seoncdary anaemia?
Increased Hepcidin in chronic inflammatory condition
45
After identifying a macrocytic anaemia from B12/Folate assay , what would a megaloblastic macrocytic anaemia (identified on blood film) indicate was causing the anaemia?
B12 and Folate deficiency
46
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?
Myelodysplasia Marrow infiltration
47
What can be the cause of a Vitamin B12 deficiency?
1 - Pernicious anaemia 2 - Gastric disease
48
What can be the cause of a folate deficiency?
Dietary Increased folate requirements (haemolysis)
49
What is the appearance of someone with megaloblastic anaemia?
Lemon yellow tinge
50
How is Vitamin B12 absorbed?
Vitamin B12 binds to **Intrinsic Factor** which then attaches to Intrinsic Factor recptors on **distal Ileum**
51
From where is intrinsic factor produced?
Gastric parietal cells
52
What is the cause of pernicious anaemia?
Antibodies against Intrinsic factor
53
Why is it called 'pernicious' anaemia?
The symptoms take 1-2 years to develop
54
How is megaloblastic anaemia treated?
Correct Vitamin B12 and Folate deficiency
55
What are some of the other causes of macrocytosis?
Alcohol Drugs (e.g. methotrexate) Disordered Liver function Hypothyroidism

SAQ's (22 decks)

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