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29 Cards in this Set
- Front
- Back
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What is the indicator of microcyic RBC
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MCV is below 80fl
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What is the indicator for normocytic RBC
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80-100fl
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What is the indicator for macrocytic
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above 100fl
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List disorders due to defective haem synthesis
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Iron defiency anaemia
Anaemia of chronic disease lead poisoning congential sideroblastic anaemia |
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List disorders due to defective globin synthesis
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Thalassaemia alpha or beta
haemaglobinopathies |
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What do we see in iron deficiency anaemia (IDA)
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- low or borderline Hb
- Low number or normal RCC - Low or normal Hct - low MCV - low MCHC - high RDW (anicytosis) (MEPT) Microcytes Elliptocytes Pencil cells Target cells are seen in severe IDA Can see eosinophilia if the reason is parasitism |
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List the iron studies
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Serum ferritin
Transferrin Serum iron Transferrin saturation Hb concentration |
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What should we see in IDA in iron studies
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serum ferritin <20
Transferrin >3.4 Serum iron <10 Transferrin saturation <16 Below reference range Hb High TIBC Low Hepcidin |
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What is the therapy for IDA
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Dietary adjustment or supplement
Oral ferrous sulphate IV iron if necessary |
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Picture of recovering IDA
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reticulocytes (pressure of early release of new RBCs)
dimorphic RBC very high RDW indicates recovering IDA |
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Describe ACD
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Anaemia of chronic disease
- second most common - chronic and acute, inflammation and infections |
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What do iron studies show in ACD?
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high hepcidin
low ferroportin high IL-6 |
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What is the cause of ACD
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increased hepcidin conc, release of iron from splenic and hepatic macrophages and hepatocytes is decreased. take from plasma iron causing hypoferremia and limiting iron delivery to erythropoeitic tissues.
hypoferraemia, shut down of iron transport |
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What are the quantitative characteristics of ACD?
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- low or borderline Hb
- normal or low MCV (indicates stage of illness) - normal MCH - normal MCHC -elevated or normal RDW |
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What are the qualitative characteristics of ACD?
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small oval microcytes
contracted and crenated cells ?Rouleaux absence of pencil or targets |
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What are the other markers of ACD?
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high ESR and CRP
low fasting serum iron low TIBC high N serum ferritin |
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What is the treatment for anaemia of chronic disease or inflammation
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- treat underlying cause
- iron therapy not indicated |
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How does lead poisoning affect anaemia
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sylphydral groups inhibits:
- haem and globin synthesis by inhibiting pyrimidine 5' nucleotidase results in accumulated RNA in red cells |
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What is the film view of lead toxicity?
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between normocytic and microcytic
basophilic stippling mild haemolysis |
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What is congential sideroblastic anaemia?
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inherited X linked disorder
involves mutation in ALAS2 gene low protoporphyrin accumulation of sideroblasts in bone marrow RBC precursers with perinuclear ring og iron containing mitochondira dimorphoc red cell picture |
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What is the film appearance of congential sideroblastic anaemia?
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RBC precursers with perinuclear ring of iron containing mitochondria
Results in dimorphic red cell picture microcytes |
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What are the causes of spuriously low MCV
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- red cell shrinkage
? under-filled EDTA tube ? increased plasma osmolarity - hyperglycaemia - hypernatraemia |
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IDA
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absent BM iron stores
reduced MCV and MCH Raised TIBC |
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Chronic inflammation
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normal or rasied serum ferritin
normal or mild reduction in MCV and MCH Reduced TIBC |
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Describe the causes of microcytic anaemias, and how
abnormalities in either haem or globin chain production lead to these disorders. |
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Discuss the role of iron in Hb and how the body maintains the required levels of iron, i.e. absorption and regulation.
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Outline the aetiology, pathophysiology, laboratory investigation and treatment of iron deficiency anaemia. How do these results change when iron replacement therapy commences?
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Outline the aetiology, pathophysiology, laboratory investigation of sideroblastic anaemia, lead poisoning and anaemia of chronic disease (NB: will add thalas saemia in more detail next).
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Describe how you would apply FBE results, RBC indices, morphology and further tests results to differentiate the microcytic anaemias.
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