L02 Blood Introduction to Anaemias

Introduction to Anaemias

Anaemia

Anaemia is reduced haemoglobin level depends on hormonal sex

Symptoms

• mild often none
• weakness fatigue
• short of breath
• palpitations, “heart racing”
• angina
• claudication - ioschaemic leg pain
• feel cold

signs

• pallor
• increased pulse
• severe anaemia
  • heart failure
  • with other vascular disease
    • myocardial infarction
  • confusion

Classification of anaemia

Hg cell size

Counts and measures

• reticulocyte count
• high reticulocyte count can show blood loss (due to increased production)
• marrow dysfunction can have low reticulocyted
• reticulocytes are slightly larger and can show as macrocytic

Aetiological causes

Increased loss

• blood loss
  • trauma or surgery
• haemolysis
  • inherited
  • acquired Impaired red cell production
• deficiencies
• globin gene abnormality
• distrubances of bone marrow and stem cell proliferation

Globin deficiency

lack of globin production - thalassaemia reduced production in alpha and/or beta thalassemia 4 alpha genes 2 beta 2 delta 2 gamma

Iron deficiency

ferritin test when giving iron you begin to get a binomial distribution tends to microcytic i think

Anaemia of inflammation

Anaemia of inflammation iron is unavailable for red cells liver releases Hepcidin which restrict iron in blood as an offensive measure against bacteria does not respond to iron therpy anaemia resolves if the underlying condition is treated iron uptake is lowered aswell tends towards microcytic anaemia

can be triggered by autoimmune or really anything that causes inflammation additionally reduced response to erythropoeitin

additional measures platelets up neutrophils up CRP up

Common causes for different classifications of anaemia

Macrocytic anaemia

Folic acid or vitamin b12 deficiency folic acid or vitamin b12 is needed for nucleic acid production

the erythroblasts would spend ages maturing bc they had bottlenecks

alcohol and liver disease can also lead to macrocytic

also increased blood loss due to reticulocytes

Normocytic anaemia

anaemia of renal disease kidneys make EPO and so damaged kidneys lead to less epo

haemolytic anaemia can be autoimmune can be hereditary

can be an artificital heartvalve

pancytopenia

from degraded bone marrow

tests for anaemis

blood count reticulocyte count bilirubin haptoglobin

Anaemia is reduced haemoglobin level in relation to age sex or physiological state (eg pregnancy)

Clinical symptoms of anaemia are Mild or none, weakness and fatigue, short of breath, heart racing and palpatations, coldness, and vascular disease

Causes of anaemia Increased loss or destruction of RBCs - Blood loss ○ Eg injury - Haemolysis ○ Inherited (genetic abnormality ○ Acquired (Drugs antibodies etc)

• Impaired RBC production
  • Disturbance of erythroblast maturation
    • Deficiencies
    • Globin gene abnormalities
    • Disturbances of bone marrow and stem cell proliferation

Classifications Cell size Microcytic Causes often are related to lack of haemoglobin - Iron deficiency (hypochromic) ○ Most common cause of anaemia ○ Tested via ferritin - Thalassaaemias (need to do more research) ○ Reduced production of a or b globin proteins - Anaemia of inflammation (normo to microcytic) ○ Lack of iron avalibility ○ Hepcidin is released from liver and this decreases all iron gates to attempt to hamper bacteria proliferation ○ Doesnt respond to iron suppliments ○ Anaemia resolves as inflammation is treated ○ Causes retention of iron in macrophages and less intestinal uptake

Note: often other causes of anaemia can coexist with anaemia of inflammation

Normocytic There are many causes - Lack of EPO from renal trouble - Blood loss and haemodilution - Bone marrow disease - Anaemia of inflammation - Haemolytic anaemias ○ Tests for haemolysis is § Blood count § Reticulocyte count § Bilirubin § Haptoglobin § And more

Macrocytic - Folic acid or Vitamin B12 deficiency = Megaloblastic anaemia ○ Folate and b12 are needed to make nucleic acid ○ Delayed maturation ○ They are bigger when they are released - Liver disease/alcohol ○ Can delay maturation - Increased redblood cell production ○ Reticulocytes are bigger and high RET count lead macrocytosis - And more later on

Pancytopenia Decrease in haemoglobin platelets and neutrophils commonly involves cancer or cancer therapy

Laborotory measures:

Haemoglobin Hct MCV: Mean cell Volume This is the average volumes of cells in the MCH