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Flashcards in Anaemia Deck (14):
1

Pathophysiology

- hypovolaemia- GI bleed, trauma, menorrhagia.
- increased RBC breakdown- malaria, sickle cell, sphero or elliptocytosis.
- decreased production- iron deficiency, folate deifciency, B12 deficiency, bone marrow neoplasm, renal disease less EPO and abnormal substance accumululation.

2

Definition

Low Hb concentration due decreased RBC mass or increased plasma volume. Reduced production or increased loss.
Under 1355g/L men, 115 women.

3

Symptoms

Fatigue, weakness, lethargy
SOB
Dyspnoea
Faintness
Palpitations
Headache
Tinnitus
Anorexia
Pallor
Altered taste
Angina, HF, claudication, confusion.
Mood change
Peripheral neuropathy
Haemolytic- jaundice, dark urine.

4

Signs

Can be none even if severe
Pallor
Hyperdynamic circulation eg tachy, systolic flow murmur, cardiac enlargement, retinal haemorrhage, later HF.
Koilonykia
Atrophic glossitis
Jaundice
Hepatosplenomegaly
Gallstones
Leg ulcer
Angular stomatitis
HF

5

Management

Treat cause
Fe supplement
Transfusion only if very severe
Search for bleed if iron deficiency suggested
Renal transplant
Recombininant EPO

6

Diagnosis

FBC for RBC count and Hb
Blood film
Folate, Fe and B12 levels
Investigate internal bleeding

7

Differentials

Haemoglobinopathy eg sickle, thalassaemia, Hb uria.
Enzyme deficiency (PK)
Meds
AI
Trauma to RBCs eg fragmentation
Ovalocytosis
Liver disease
Osmotic fragility in hereditary sphero and elliptocytosis
G6PD deficiency
Infection
Splenic destruction
Transfusion related eg thalassaemia

8

Low MCV microcytic

- Causes-
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead
Sideroblastic
Blood loss
Poor diet
Malabsorption
Hookworm

9

Normal MCV normocytic

Acute blood loss
chronic disease
bone marrow fail
renal fail
hypothyroid
haemolysis
pregnancy
myeloma

10

High MCV macrocytic

Causes-
-B12 deficiency eg pernicious autoAb to IF, vegan, crohns, gastrectomy, tapeworm, metformin, NO tx, alcohol.
-folate deficiency or antifolates eg phenytoin.
-alcoholism/liver disease
-poor diet or poor absorption eg coeliac, malignancy
-lactation
-reticulocytosis
-cytotoxics
-marrow infiltration
-drugs eg trimethoprim, methotrexate, sulfasalazine.

11

Anaemia of chronic disease

malignancy
inflammation eg RA
infection eg TB
renal fail
Vasculitis

12

Drug effects

-Drugs that interfere with Fe absorption- cimetidine, ranitidine.
-Fe can decrease absorption of- tatracyclines, quinolones, levodopa, levothyroxine.

13

haemolytic normo or macrocytic

Causes-
-autoimmune
-infection eg malaria
-G6PD and PK deficiency
-hereditary sphero or elliptocytosis
-sickle cell
-thalassaemia
Sickle cell- beta chain glu to val causes HbS not HbA. HbS polymerises when deO forming fragile deformed cells. Pain triggered by cold, dehydration, infection, hypoxia.

14

Explanation

-RBCs are cells in the blood that carry oxygen. The part that carries it is called haemoglobin. Anaemia is where you dont have enough functional Hb so cant get enough oxygen around the body.
-LT this will dad to worsening symptoms and can cause damage to organs that use a lot of oxygen from the blood.
-can be related to diet- so foods high in iron and folate.
-iron supplements