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Flashcards in Acquired Anaemias Deck (22)
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1

Firstly define Anaemia

A haemoglobin below the normal range for Age/Sex/Ethnicity

2

What are the clinical features of anaemia

Think poor perfusion:
- Fatigue
- SOB
- Ankle Swelling
- Dizziness
- Chest Pain
Symptoms of the cause

3

What is your first test when suspecting anaemia?

A FBC
Tells you the haemoglobin and the MCV/MCH

4

How do we describe anaemias?

Morphologically based on MCH & MCV
1) Hypochromic, Microcytic
2) Normochromic, Normocytic
3) Macrocytic

5

FBC shows hypochromic, microcytic anaemia, what are the likely causes?

Most likely Fe-deficiency Anaemia, if you're in any doubt do a serum Ferritin to check (should be low)

If Ferritin is fine then it may be a secondary anaemia or Thalassaemia

6

Fe-deficiency anaemia is not a diagnosis but must have a cause, what could cause it?

Malabsorption e.g. gastritis or coeliac

Blood loss e.g. GI or menorrhagia

7

What elements of a history/exam could suggest iron deficiency anaemia?

Evidence of bleeds e.g. dyspepsia, PR bleeding or menorrhagia
Diet (in kids/elderly)
Pregnancy (increases Fe need)

Koilonychia, atrophic tongue & angular stomatitis

Also do Abdo & rectal exam looking for the cause

8

What tests can we do if we get a case of Fe-deficiency anaemia?

Endoscopy & barium study can be done if there's evidence of GI blood loss

9

How do you treat Fe-deficiency anaemia?

Oral Iron +/- transfusion

Treat the cause

10

Patient presents with a Normochromic, normocytic anaemia, how would you proceed?

Test their Reticulocyte count.
If it's increased it means you're losing RBCs and the marrow is compensating --> Blood loss of haemolysis

If its normal or low --> Secondary anaemia, marrow infiltration etc

11

So lets say this patient's reticulocyte count is high and you suspect a haemolytic anaemia. What could cause that?

Autoimmune HA (Extravascular haemolysis)

Or an intravascular cause:
- Mechanical e.g. art valve leaking
- Severe inf
- Pre-eclampsia, HUS or DIC
- Drugs

Congenital causes e.g.:
- G6PD deficiency
- Hereditary Spherocytosis
- Haemoglobinopathies e.g. Sickle cell

12

So we've done a FBC (normocytic/chromic) & a reticulocyte count (high).
How would we test a patient to see if they're haemolysing?

Blood film = can see haemolysed cells
Serum Bilirubin = High
LDH = High
Serum Haptoglobin = low (eats up free haemoglobin)

13

How would we identify the cause of a haemolytic anaemia?

Coomb's Test:
Detects Ab/complement on the red cell membrane so if +Ve suggests an immune source

Can also test urine for Haemosiderin & Urobilinogen
- Haemosiderinuria in intravascular haemolysis
- Extravascular haemolysis increases serum bilirubin --> high Urobilinogen

14

What can trigger an auto-immune haemolytic anaemia and how does coomb's test help us with that?

Auto-antibodies from different triggers will agglutinate at different temperatures in coomb's test so:
- Warm temps = idiopathic, drugs or CLL
- Cold Temps = CHAD, infection or lymphoma

15

How would we manage a haemolytic anaemia?

Support the marrow with Folic Acid
~Transfusion

Correct cause:
- IV Abx if septic
- Prosthetic valve replacement if leaky
- Immunosuppression & treat trigger if immune

Can also remove the site of haemolysis i.e. spleen

16

Most secondary anaemias are Normochromic Normocytic, some are Hypochromic, microcytic. What causes them?

Something causes inflammation --> Increased hepcidin --> Decreased Fe absorption

Look for infection, inflammatory disorders and malignancy

17

Ok so a FBC identifies a Macrocytic Anaemia, what would you do from there?

A blood film to test for Megaloblastic vs non-megaloblastic

18

Megaloblastic anaemia? how would you proceed?

It's probably a B12 or Folate Deficiency so do a B12/folate assay to identify which one

Also look out for neuro symptoms from Subacute Combined Degeneration of the cord in B12 deficiency

19

What causes a B12 deficiency?

Gastric/ileal disease stopping absorption

More likely pernicious anaemia, an autoimmune attack on your gastric parietal cells/intrinsic factor

20

What causes a folate deficiency?

Diet
Haemolysis
GI pathology e.g. Coeliac

21

How do we treat a megaloblastic anaemia?

Oral Folate
B12 IM inj

22

What could cause a non-megaloblastic Macrocytic anaemia?

Some problem with the marrow e.g. Myelodysplasia, Marrow infiltration or drugs:
- Alcohol
- MTX
- Anti-retrovirals
- Hydroxycarbamide