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Flashcards in Review of Anaemia Deck (34)
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1

What is the definition of anaemia

Number of red cells or their oxygen-carrying capacity: insufficient to meet physiological needs

2

What is the most common disorder globally

anaemia

3

How many people does anaemia effect

- it effects 1.6 billion people

4

where are red blood cells produced

RBCs produced in the bone marrow (BM) from myeloid progenitor cells

5

What do red blood cells need to be produced

1. permissive BM micro-environment
2. adequate substrate :
- iron
- vitamin B12
- folate

6

What is erythropoiesis

Production of red blood cells

7

What controls erythropoiesis

= Erythropoietin

8

Where is EPO synthesised

= Synthesis at peritubular fibroblasts in the renal cortex

9

What is the aim of EPO

reduction of oxygen tension

10

How do you classify anaemia

based on red cell size and morphology
- Microcytic - under 80fl
- macrocytic - over 96
- normochromic - 80-96fl

or

Decreased BM production/output
1. BM aplasia/infiltrate
2. ineffective haematopoiesis such as HIV, MDS
3. substrate deficiency e.g. iron or folate deficiency
4. EPO insufficiency

or

underlying mechanism - peripheral loss/destruction
1. bleeding
2. sequestration
3. haemolysis

11

What is the differenced in how anaemia is investigated by pulmonologists and cardiologists

• Pulmonologists and Cardiologists - hypoxia on anatomical level

• Haematologists – hypoxia at molecular and cellular levels

12

what are the general symptoms of anaemia

1. increased tiredness/fatigue
2. dyspnoea
3. decreased effort tolerance

13

What does the severity of symptoms of anaemia depend on

1. degree of anaemia
2. rate of haemoglobin decrease

14

What should you include in a history with anaemia

- information about the presenting complaint and duration of the problem
-transfusion history
- dietary history including pica(craving for unusual food items, generally associated with iron deficiency)
- travel history (to endemic malarial or other infectious areas)
- change in bowel habits
- bleeding (such as GI and genito-urinary)
- drug history (e.g. anticoagulants, antiplatelet agents, Reno toxic agents)
- chronic disease (e.g. HIV and TB)
- Surgery (e.g. gastrectomy, small-bowel surgery, bariatric surgery)
- current or recent pregnancy
- family history

15

What are the clinical signs in a clinical examination of anaemia

Skin and mucous membrane
- Pallor is the cardinal clinical sign
- angular stomatitis - caused by iron deficiency
- glossitis in nutritional deficiency - B12 deficiency
- Kolionychia (spoon-shaped nails) - caused by iron deficiency
- premature greying
- scleral icterus

16

What causes angular stomatitis and koilonychia

iron deficiency

17

What deficiency causes glossitis

B12 deficiency

18

what would you find of a neuromuscular clinical examination on someone with anaemia

1. Muscle weakness
2. Headache, lack of concentration, drowsiness
3. Tinnitus
4. Paraesthesias, peripheral neuropathy, ataxia and loss of vibration sense

19

Name some cardiovascular examination findings that you would find on someone with anaemia

1. Hyperdynamic circulation with ‘flow’ murmurs
2. Cardiac failure

20

Name the clues for infection and malignancy that you can find on someone who is anaemic

1. Hepatosplenomegaly
2. Lymphadenopathy
3. Bleeding manifestations (petechiae, purpura, ecchymosis)

21

what laboratory tests do you carry out

- FBC
- Reticulocyte counts
- microscopic blood smear

22

What is the normal range of haemoglobin for males, females and pregnancy

• Male Hb: 13.8 - 17.9 g/dL (anaemia <13 g/dL)
• Female Hb: 12.4 - 15.5 g/dL (anaemia <12
g/dL;
• Pregnancy <11 g/dL).

23

What is hematocrit

- the volume percentage of red blood cells in blood

24

What is the percentage of hematocrit in adult males and women

• Adult males: 42%-54%
• Adult women: 38%-46%

25

What is MCV

- Mean corpuscular volume or mean cell volume = this is the average volume of a red blood cell

26

How do you work out the MCV

the hematocrit (Hct) is divided by the
concentration of RBCs

27

What is the MCH

mean corpuscular haemoglobin
- this is the average mass of haemoglobin per red blood cell

28

How do you work out the MCH

- calculated by dividing the total mass of haemoglobin by the number of red blood cells in a volume of blood

29

What can cause microcytic anaemia

- iron deficiency anaemia
- lead poisoning
- anaemia of chronic inflammation
- sideroblastic anaemia

30

What can cause normocytic anaemia

- haemolytic anaemias
- bone marrow disorders
- hypersplenism
- acute blood loss
- anaemias of chronic disease