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19 Cards in this Set
- Front
- Back
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What is anemia |
The World Health Organization (WHO) Hb thresholds of less than 13 g/dL for men and less than 12 g/dL for women |
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Where does the normal erytheopoesis occur |
Normal erythropoiesis in adults occurs exclusively in the bone marrow and is generally restricted to the pelvis, vertebrae, sternum, ribs, and proximal femurs. |
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What are the basic requirements of blood cell production |
Blood cell production requires stem cells, a functioning bone marrow microenvironment, nutrients, and cytokines |
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In the majority of cases of anemia in elderly persons, an etiology can be found. What are the common causes of anemia in elderly |
Cause Prevalence Iron deficiency15-23% Chronic disease/inflammation15-35% Chronic kidney disease8% Endocrinopathies(hypothyroidism )Less than 5% Vitamin B-12 or folate deficiency 0-14% Myelodysplastic syndromes 0-5%( Unexplained17-45%
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What are the other causes of anaemia |
aplastic anemia, paroxysmal nocturnal hemoglobinuria, myeloproliferative syndromes, acute or chronic leukemia, lymphoma), hypersplenism, and hemolytic anemia. |
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What is the commonest cause of iron deficiency anaemia in elderly |
underlying gastrointestinal pathology, including malignancy 😲 |
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What is Anemia of chronic disease and inflammation |
hypoproliferative anemia characterized by low serum iron and adequate to increased iron stores. This appears to be primarily related to inflammation. Inflammation inhibits erythropoiesis through a variety of mechanisms |
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What has hepcidin got to do with anaemia of chronic disease (inflammation ) |
Hepcidin is a hepatically synthesized, 25-amino acid peptide that serves as a primary regulator of iron homeostasis. Hepcidin directly inhibits ferroportin, a protein that transports iron out of cells that store it. (So can't utilise them) Inflammation, particularly with IL-6, increases hepcidin expression. |
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Why is it hard to come into a conclusion to anaemia of chronic disease as the diagnosis |
Because many conditions coexist which are not considered causes for anaemia off chronic disease ( CKD/ endocrine causes ) |
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What are the characteristics of anaemia of chronic disease that helps it's diagnosis |
low serum iron (eg, < 60 μg/dL), with or without low to normal transferrin, |
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What are the tests that help to do a comprehensive evaluation of anaemia which help come to a diagnosis in about 2/3 of patients |
•CBC count (with WBC differential, platelet count, and RBC parameters [MCV])•Examination of peripheral blood smear•Reticulocyte count•LDH•Serum ferritin•Serum iron•Total iron-binding capacity•Vitamin B-12•Folate•Thyroid-stimulating hormone•Serum creatinine and estimated glomerular filtration rate•Serum protein electrophoresis, especially if total globulins are elevated
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How does CKD contribute to anaemia |
is an important cause of anemia in elderly persons, especially considering that renal function declines with aging. Reduced renal EPO production is the primary factor leading to anemia in chronic kidney disease. Serum EPO levels have been shown to be inappropriately low at a creatinine clearance of less than 40 mL/min. |
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Why is it important to identify Nutrient deficiencies causing anaemia |
Vitamin B12 deficiency and folate deficiency are uncommon causes of anemia in elderly. But they may indicate other pathologies.(pernicious anemia or hemolysis) And they are reversible causes of anemia. |
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When should we consider Myelodysplastic syndrome as a cause of anemia |
They are more common in older adults and may present as an isolated anemia. In the elderly, anemia in conjunction with macrocytosis, thrombocytopenia, or neutropenia absent another cause raises the suspicion of myelodysplastic syndrome. |
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When should we consider Myelodysplastic syndrome as a cause of anemia |
They are more common in older adults and may present as an isolated anemia. In the elderly, anemia in conjunction with macrocytosis, thrombocytopenia, or neutropenia absent another cause raises the suspicion of myelodysplastic syndrome. |
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What are the Other primary hematologic disorders associated with anaemia |
TTP-ALTHOUGH uncommon should be considered in all MM-should always be considered, particularly in patients with elevated globulin levels MYELOPROLIFERATIVE DISEASES-often have an elevated WBC count; however, some patients with myelofibrosis will have anemia as the prominent abnormality. CLL- common in elderly persons. Although most patients will have either an elevated WBC count or lymphadenopathy at presentation, some patients will present with autoimmune hemolytic anemia Aplastic anemia - will have a low WBC and/or platelet count |
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What is TTP |
should be considered in every patient with anemia, as this a medical emergency requiring prompt intervention. Often (but not always), patients will have other cardinal features of the disease, including thrombocytopenia, altered mental status, and renal insufficiency. |
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How does thyroid function affect anaemia |
most patients with thyroid abnormalities are not anemic. Hypothyroidism and hyperthyroidism may be associated with pernicious anemia, Hypothyroidism - normocytic by reducing RBC mass / macrocytosis without anaemia Generally, the more severe the thyroid dysfunction, the more likely anemia will occur |
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What is unexplained anaemia |
Unexplained anemia is generally a condition of elderly persons. It appears more commonly with advancing age. Despite advances in investigations a significant amount belongs to this category. |
