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Haematology - Anaemia. Dr Paul Grant

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This is an overview of the causes of anaemia and platelet disorders for final year medical students.
There are links to some online tests and reference to the ITSA CHARM FARM mnemonic.
We cover all the major causes, touch on the practicalities of transfusion and discuss the treatments and manifestations of the underlying conditions.

Publié dans : Santé & Médecine
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Haematology - Anaemia. Dr Paul Grant

  1. 1. Dr Paul Grant
  2. 2.  Men <135 g/L  Women <115 g/L  When to transfuse? ◦ Depends on acute vs chronic ◦ In acute, <80 g/L ◦ In chronic can cope with lower ◦ Take care in heart failure
  3. 3.  Group and save vs crossmatch?
  4. 4.  https://www.nobelprize.org/educational/med icine/bloodtypinggame/gamev2/index.html
  5. 5.  Iron deficiency anaemia  Thalassaemia  Sideroblastic anaemia  Anaemia of chronic disease
  6. 6.  Not a diagnosis on its own, there’s always a cause  Bleeding ◦ GI- endoscopy ◦ Menorrhagia  Malabsorption ◦ Coeliac  Hookworm
  7. 7.  Mutated Hb  Normal adult Hb (HbA)= 2α + 2β  α chain has 2 genes (4 alleles)  β chain has 1 gene (2 alleles)  Diagnosis= Hb electrophoresis Microcytic
  8. 8.  Minor= 1 mutated allele= asymptomatic  Major= both alleles mutated ◦ Anaemia  Poor RBC production  Haemolysis in speen (extravascular haemolysis)- splenomegaly ◦ Secondary haemochromatosis ◦ Skeletal deformities Microcytic
  9. 9. Microcytic
  10. 10. Microcytic
  11. 11.  One allele mutated= silent carrier  2 alleles= trait- like β minor  3 alleles= HbH disease- more like β major  4 alleles= Hydrops foetalis (death in utero) Microcytic
  12. 12. Microcytic
  13. 13.  Acute blood loss  Anaemic of chronic disease (or microcytic)  Bone marrow failure  Renal failure  Hypothyroidism (or macrocytic)  Haemolysis (or macrocytic)  Mixed  Dilutional
  14. 14.  Megaloblastic anaemia ◦ B12 and folate deficiency  Non-megaloblastic anaemia ◦ Alcohol ◦ Reticulocytosis (e.g. haemolysis) ◦ Hypothyroid, pregnancy, liver disease
  15. 15. Macrocytic
  16. 16.  Folate deficiency ◦ Diet  B12 deficiency ◦ Pernicious anaemia- parietal cell/ intrinsic factor antibodies ◦ Sub-acute combined degeneration of the cord ◦ Replace B12 first! Macrocytic
  17. 17.  Extravascular vs intravascular  Features ◦ Increased bilirubin (unconjugated) ◦ Increased reticulocyte count (hence increased MCV) ◦ Decreased haptoglobin (less so in extravascular) ◦ Haemoglobinuria (not in extravascular) Macrocytic
  18. 18.  Hereditary ◦ G6PD (Heinz bodies, bite cells) ◦ Pyruvate kinase deficiency ◦ Hereditary spherocytosis / elliptocytosis ◦ Sickle cell/ thalassaemia Macrocytic
  19. 19.  Acquired ◦ Autoimmune haemolytic anaemia- warm vs cold (Coombs test- direct vs indirect) ◦ Microangiopathic haemolytic anaemia- HUS, TTP, DIC (schistocytes) ◦ Macroangiopathic haemolytic anaemia- heart valves ◦ Paroxysmal nocturnal haemoglobinuria Macrocytic
  20. 20. Macrocytic
  21. 21. Macrocytic
  22. 22. Macrocytic
  23. 23.  Decreased production ◦ Generalised bone marrow dysfunction  Decreased survival ◦ Immune mediated- ITP, HIT ◦ Consumption- microangiopathic haemolytic anaemia- DIC, TTP, HUS
  24. 24.  Chronic ◦ Women 20-40 ◦ Antibodies against platelet membrane glycoproteins resulting in destruction by spleen  Acute ◦ Self limiting, children after viral infections ◦ Petechiae and increased bleeding tendency
  25. 25.  Consumption of platelets due to deficiency in ADAMTS 13  Degrades certain vWF, promotes platelet aggregation  Fever, thrombocytopaenia, microangiopathic haemolytic anaemia, transient neurological defects, renal failure
  26. 26.  Acute renal failure more severe than in TTP  Largely due to E coli 0157- produces a toxin which damages endothelial cells  Patients present with bloody diarrhoea, followed a few days later by acute renal failure and microangiopathic anaemia
  27. 27.  Massive activation of clotting cascade due to severe physiological stressor  Obstetric complications, infections (sepsis), neoplasms, massive tissue injury (burns)
  28. 28.  ANAEMIA – consider by size  KNOW different cell types / names / describe  PLATELET DISORDERS  TRANSFUSION  Signs & symptoms
  29. 29.  What is your own blood type?  Why give B12 before folate?  What is the COOMB’s test?  Take the Haematology quiz - https://www.proprofs.com/quiz- school/story.php?title=hematology- competency-quiz

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