Tennis anaemia tut Flashcards
(98 cards)
1
Q
How do you tell the difference between B12 deficiency and folate deficiency?
A
With folate deficiency there are muted or no neuro signs
2
Q
What specific bloods might you when investigating anaemia?
A
FBC Transferrin Ferritin Total iron binding capacity Serum lead Intrinsic factor antibodies Anti ttg antibody Serum 12 Serum folate
3
Q
What is Hb, MCV, transferrin and ferritin microcytic anaemia? what else is seen on bloods
A
Low haemoglobin, low MCV, transferrin and ferritin
High reticulocytes
If anti ttg its coeliacs
4
Q
Who is coeliacs disease prominent in?
A
Young men
5
Q
What is total iron binding capacity high in iron deficiency anaemia?
A
There is low iron so theres lots of space
6
Q
What is MCV, iron, TIBC and transferrin in thalassemia?
A
V low MCV
Normal or higher iron
Total iron binding capacity is low
Transferrin high
7
Q
What is ferritin in anaemia of chronic disease?
A
High
8
Q
What is seen on bloods in macrocytic anaemia?
A
High MCV
Pancytopenia in megaloblastic
9
Q
When is pancytopenia seen in anaemia?
A
Megaloblastic
10
Q
What order are antibodies ordered in anaemia? Why
A
First line intrinsic factor antibodies- specific
Second line gastric parietal- sensitive
11
Q
What special test is used in pernicious anaemia
A
Shilling test
12
Q
How is total iron binding capacity calculated?
A
13
Q
When do you consider transfusion?
A
When iron is below 70
When iron is below 80 if they have ACS or any cardiac issues
14
Q
What is sideroblastic anaemia?
A
Abnormal heam synthesis
15
Q
What causes sideroblastic anaemia?
A
Inherited
Secondary to alcohol or drugs
16
Q
How is normocytic anaemia managed?
A
If renal cause refer
Prescribe erythopoeitin
17
Q
Do you treat B12 or folate deficiency first?
A
B12
18
Q
What is aplastic anaemia?
A
Pancytopenia
19
Q
What is pancytopenia?
A
all 3 cellular components of blood are not produced (this inc RBC, platelets and white cells)
20
Q
Who is more likely to get aplastic anaemia?
A
30 y/o men
21
Q
What cell abnormalities are seen in aplastic anaemia?
A
Normochromic
Normocytic
Leukopenia
Thrombocytopenia
22
Q
How do you differentiate purpura and petechiae?
A
Purpura= 4mm-10mm Petechiae= less than 4mm
23
Q
What is seen on bloods in aplastic anaemia?
A
Everything low
MCV normal
24
Q
What are the 2 hereditary haemolytic anaemias
A
Membrane defects- hereditary spherocytosis
Metabolic defects- G6 PD
25
What is seen on blood film in G6PD deficiency?
heinz bodies
26
What are the causes of acquired anaemia
```
MAID
Microangiopathic
Autoimmune
Infection
Drugs
```
27
What infections cause acquired anaemia?
Malaria
| Sepsis
28
What is the difference between cold and warm autoimmune anaemia?
Cold- at cold temps- they get raynauds
| Warm- at normal body temp
29
What organomegaly do you get with cold and warm autoimmune anaemia?
Hepatosplenomegaly
30
In haemolytic anaemia what do you get alongside normal anaemia symptoms
Jaundice
Haematuria
Hepatospenlomegaly
31
What test is used to test for autoimmune haemolytic anaemia
Direct coombs test
32
What is MCV in micro/normo/macrocytic anaemia?
```
Micro= <80
Normo= 80-100
Macro= >100
```
33
What is the most common type of microcytic anaemia?
Iron deficiency
34
What are some ways microcytic iron deficiency anaemia may arise?
Blood loss eg GI
Reduced absorption eg small bowel disease
Increased demand eg pregnancy, growth
Reduced intake eg vegans
35
What are the main types of microcytic anaemia?
```
Iron deficiency
Anaemia of chronic disease
Thalassaemia
Sideroblastic
Lead poisioning
```
36
What are the main types of normocytic anaemia?
```
Anaemia of chronic disease
CKD
Aplastic
Sickle cell
Haemolytic
Acute blood loss
Pregnancy
Fluid overload
```
37
What type of anaemia is anaemia of chronic disease usually?
Normocytic but it can be microcyti
38
What are the 2 types of macrocytic anaemia?
Megaloblastic and normoblastic
39
What type of anaemia is megaloblastic and what is it caused by?
It is a type of macrocytic anaemia caused by B12 or folate deficiency or drugs
40
What are some ways normoblastic macrocytic anaemia arises?
```
Alcohol excess
Liver disease
Myelodysplasia
Hypothyroidism
Alcoholics may have liver failure
```
41
What drug most commonly causes megaloblastic anaemia?
Methotrexate
42
What drugs cause megaloblastic anaemia?
Methotrexate
Hydroxyurea
Azothioprine
Zidovudine
43
What are causes of megaloblastic anaemia?
Reduced GI absorption of B12/folate- terminal ileum disease or jejunal disease (coeliacs), gastrectomy etc
Reduced intake- vegans, alcoholics, malnutrition, eating disorders
Very recent alcohol intake
Increased demand= not enough absorption eg pregnancy, malignancy
44
What is a common jejunal disease that causes anaemia?
Coeliacs
45
How does anaemia present?
```
Tiredness
Lethargy
Dyspnoea
Malaise
Tachycardia
Pallor
```
46
What are specific sign and symptoms of lead poisoning anaemia?
```
Anorexia
Nausea and vomitting
Abdo pain
Constipation
Peripheral nerve lesions (foot or wrist drop)
Blue gumline
Convulsions
```
47
What are specific sign and symptoms of pernicious anaemia?
```
Family hx of autoimmune disease
Mild jaundice
Glossitis
Angular stomatitis
Weight loss
```
48
What are signs of B12 deficiency?
Peripheral neuropathy
Ataxia
Gait disturbance
49
How is normocytic anaemia diagnosed?
Do FBC to exclude micro or macrocytic anaemia
Check for hx of haemorrhage
Check for reticulocytes (raised in sickle cell)
50
What type of anaemia do those with sickle cell have? Why?
Normocytic- abnormal cells are destroyed so remaining are normal cells but they are reduced in number
51
In what disease do you get normocytic anaemia with raised reticulocyte count?
Sickle cell
52
What will you see on bloods in megaloblastic anaemia?
Pancytopenia
53
What LFT will be deranged and how in macrocytic anaemia?
Bilirubin will be high
54
What test is used to test for pernicious anaemia?
Schilling
55
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in iron deficiency anaemia
```
Iron= low
MCV= low
TIBC= high
Ferritin= low
Transferrin sat= low
```
56
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in thalassaemia
```
Iron= very low
MCV= high
TIBC= low
Ferritin= high
Transferrin sat= very high
```
57
Why is ferritin high in thalassaemia?
Due to multiple iron transfusions
58
Describe levels of iron, MCV, TIBC, ferritin and transferrin saturation (iron/TIBC) in anaemia of chronic disease
```
Iron= normal or low
MCV= normal
TIBC= low
Ferritin= normal or high
Transferrin sat= normal or low
```
59
How do you calculate transferrin sat?
Iron level/ total iron binding capacity
60
What test is similar to TIBC?
Transferrin
61
How do you differentiate between anaemia of chronic disease and iron deficiency anaemia?
Ferritin in IDA= low and in ACD= normal or high
TIBC in IDA= high and in ACD= low
ACD is often normocytic
62
What do you see on blood film in microcytic anaemia?
Hypochromia
Anisocytosis
Poikilocytosis
63
How is iron deficiency anaemia managed?
Oral suppplements
| Blood transfusion and iron chelation if hb <70g/L
64
How is sideroblastic anaemia managed?
Treat the cause
| Pyridoxine in inherited forms
65
What drug is used to treat inherited sideroblastic anaemia?
Pyridoxine
66
How is lead poisoning anaemia managed?
Remove the source of lead
Dimercaprol
D- penicillinamine
67
How is renal related normocytic anaemia managed?
refer to renal team
| prescribe EPO
68
How is b12 deficiency anaemia managed?
IM 1mg hydroxycobalamin every 2-3 months
Dietary advice
Oral cyanocobalamin
69
How is folate deficiency anaemia managed?
Oral folic acid
70
What is aplastic anaemia?
Pancytopenia and hypoplastic bone marrow
71
What anaemia is pancytopenia associate with?
Aplastic and macrocytic
72
What are causes of aplastic anaemia? Which is most common
Idiopathic- 40%
Acquired- drugs eg methotrexate
Inherited
73
Who is aplastic anaemia more common in?
30 y/o men
74
What are the main features of aplastic anaemia?
Normocytic anaemia- fatigue, dyspnoea, pallor
Leukopenia- infections
Thrombocytopenia- spontaneous bleeding
75
What will Hb, platelets, WCC, MCV and reticulocytes be in aplastic anaemia?
```
Hb= low
Platelets= low
WCC= low
MCV= low
Reticulocytes= low or absent
```
76
What is haemolytic anaemia?
Premature erythrocyte breakdown causing shortened erythrocyte life span (<120) with anaemia
77
What will RBC lifespan be in haemolytic anaemia?
<120 days
78
What are causes of haemolytic anaemia?
```
Hereditary spherocytosis
Metabolic defects
G6PD deficiency
Pyruvate kinase deficiency
Cold and warm autoimmune anaemia
Drugs
Trauma
Infection
```
79
What drugs cause haemolytic anaemia?
Penicillin and quinine
80
What infections cause haemolytic anaemia?
Malaria and sepsis
81
What is hereditary spherocytosis?
An inherited disorder where there RBCs are small, round, lack central pallor and are therefore removed prematurely by the spleen causing haemolytic anemia
82
What type of anaemia does hereditary spherocytosis cause?
Haemolytic
83
How will someone with hereditary spherocytosis present?
```
Anaemia- SOB, pallor, fatigue
Intermittent scleral icterus
Jaundice
Dark urine
Viral infections
```
84
What test is used to help diagnose hereditary spherocytosis?
Osmotic fragility test
85
What is an osmotic fragility test?
When RBCs are exposed to varying concs of saline to see how likely they are to breakdown
86
In what demographic is G6PD deficiency prominent?
African countries
87
What is seen on blood film in G6PD deficiency?
Heinz bodies
88
How will G6Pd deficiency present in children?
With jaundice and anaemia
89
What should those with G6Pd deficiency be told not to eat?
Flava beans
90
What is cold autoimmune anaemia?
Haemolysis at cold temps
| Presents with raynaud's phenomenon
91
What is warm autoimmune anaemia? What organomegaly is seen?
Haemolysis at extravascular sites at body temp
| Hepatosplenomegaly as haemolysis is markedly in the spleen
92
What additional signs and symptoms of anaemia do you get in autoimmune haemolytic anaemia?
Jaundice
Haematuria
Hepatosplenomegaly
93
What is the first line investigation for autoimmune haemolytic anaemia?
Bloods
94
What are the diagnostic investigations for autoimmune haemolytic anaemia?
Bloods and blood film
| Can do direct coombs test
95
In what type of anaemia might you do direct coombs test?
Autoimmune haemolytic anaemia
96
What will you see in urine in autoimmune haemolytic anaemia?
High urobilinogen
| Haemoglobinuria
97
What does high ferritin mean? When might it be seen
It means there is excess storage of iron in the body and this is a bad thing.
May be seen in anaemia of chronic disease and haemochromatosis
98
What are iron levels and iron availability in anaemia of chronic disease?
Iron levels are high
| Availability of this iron is low which explains why TIBC is low but ferritin is high
