Anaemia. Under... of RBCs. Over... of RBCs. Anaemia. CP1 MedSoc Teaching by Suraj Shah. Question: What is the most common cause of anaemia worldwide?

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1 CP1 MedSoc Teaching by Suraj Shah Anaemia Question: What is the most common cause of anaemia worldwide? Definition:.. such that there is insufficient quantity of. to deliver enough Oxygen to the tissues. Clinically evaluated in the blood as a Hb <135g/L for men and <115g/L for women Presentation Pathophysiology RES Anaemia Under..... of RBCs Over... of RBCs Look at the.! Less than 2%. Cannot increase as problem lies with production Greater than 2% Will increase as body is encouraging bone marrow production

2 Overdestruction Anaemias = Haemolytic Anaemias Intrinsic causes (-opathies) opathies - Sickle Cell Rbc s are being destroyed quicker than can be produced so overall net. Extrinsic causes Immune related - Autoimmune - Drug induced (Penicillin) - Blood transfusion - Thalassemia 2..opathies - Spherocytosis - Eliptocytosis Others: - Microangiopathic haemolytic anaemias 3...opthaies - Malaria - G6PD deficiency Anaemia Reticulocytes <2% >2% Destruction Anaemias (Hameolytic Anaemias) Underproduction Anaemias M C.. V. Low MCV High MCV Normal MCV [Haemoglobin problems] [DNA problems] [Other problems]

3 LOW MCV Anaemias A LACK OF THIS WILL LEAD TO HAEM. THE MOST COMMON TYPE OF ANAEMIA DEFICIENCY O ANAEMIA GLOBIN A 2 B 2 A problem with this will lead to the thalessemias In IDA: Hb Hb The RBCs are now both In the FBC as: Hb Hb Hb Hb cytic chromic MCV MCHC Hb How can you tell it is IDA? Fe is stored in all cells as F. Ferritin IDA - Serum Ferritin Some leaks from cells giving us an idea of total body iron stores. Seen in blood as.. Fe Serum ferritin Iron is transported to our cells via The... is the reflection of the amount of iron that transferrin is able to take up Transferrin (measured as TIBC) - Serum Iron - TIBC CAUSES B A D I

4 High MCV Anaemias (DNA problems) Main causes are deficiencies of.... and.. Folate B12 Activated folate A So B12 and Folate = G Having bad DNA means that the developing RBCs are not told by cells checking system. B12 Deficiency - Stores last for.. - Found in... - Caused by: - Malnutrition - Bowel resection - Lack of intrinsic factor B12 Deficiency - Stores last for.. - Found in... - Caused by: - Malnutrition - Duodenal pathology - Can also cause neurological deficits. Tx Tx

5 NORMAL MCV Anaemias (Other problems) 1) Anaemia of Disease Occurs whenever you have chronic inflammation e.g. chronic infection, malignancy, autoimmune conditions. With inflammation is the release of... Body acts to prevent supply of.. What will this look like? Increase in cytokines Ferritin Fe TIBC 2) Bone marrow working slower Renal failure due to reduction in.. Bone marrow suppression e.g... Bone marrow infiltration e.g 3) ACUTE blood loss.. and. have not had enough time to compensate for loss of blood so cells will appear normocytic.

6 Cases (all the following patients are found to have a low haemoglobin on their Full Blood Count) Case 1: 26 y/o male with history of Chrons complaining of SOBOE and looks pale - Reticulocytes - MCV Dx? Case 2: Patient treated with antibiotics for a sore throat. Presents with yellowing of skin and dark urine. - Reticulocytes - Bilirubin Dx? Case 3: Patient with known metastatic bowel cancer - Reticulocytes - MCV - Ferritin - Fe - TIBC Dx? Case 4: Patient come into hospital 3 times a week for regular dialysis - Reticulocytes - MCV - MCHC Dx?

7 Glomerular Disease Juliet Bottle Role of the Glomerulus - The kidney needs to move chemicals from the blood into the urine - To do this they need to create a porous barrier between the capillaries (blood) and the tubules (urine) Everything has to pass through: The Three Layers 1) Capillary endothelium with fenestrations 2) Basement membrane 3) Visceral layer podocytes which interdigitate and form filtration slits This creates a sieve through which - Proteins and blood cannot get through - Small, charged ions can pass through easily

8 Glomerular Disease Glomerular Disease and Glomerulonephritis are roughly interchangeable. They refer to any pattern of injury to the glomerulus. How does the injury happen? Initial insult = Immunological attack by: Antibody On an antigen in the glomerulus. This antigen could be PRIMARY or SECONDARY Primary always there Secondary acquired / deposited due to: N S A I D H S P What happens to the glomerulus after injury? The Glomerulus responds by one or more of the following ways : 1. CAPILLARY: a. Endothelial cell proliferation b. Proliferation of mesangial cells ( glomerulosclerosis ) c. Capillary wall necrosis 2. BASEMENT MEMBRANE: thickening 3. TUBULE: (deposition of cells in the Bowman s space)

9 Words used to describe the glomerular pathology : Global: vs Segmental Diffuse vs Focal Naming Glomerular Diseases: Called by a description: focal segmental glomerulosclerosis Called by a cause diabetic glomerulosclerosis Clinical Manifestations of disease: The clinical syndromes that can occur in Glomerulonephritis are: Acute Kidney Injury Chronic Kidney Disease Asymptomatic Haematuria Nephrotic Syndrome Nephritic Syndrome Rapidly Progressive Glomerulonephritis (see below) (see below)

10 Nephrotic Syndrome Pathology : No change in number of cells (nonproliferative) Nephritic Syndrome Pathology: Increased in number of cells (proliferative) Damage to the basement membrane = red blood cells AND protein can leak through Casts (dead red blood cells) in the urine Reduced GFR

11 Nephrotic Syndrome common causes: The swollen 2-3 year old The 55 year old male with unexplained Chronic Kidney Disease and ankle swelling Nephritic Syndrome Common Causes: This child with a sore throat a few days ago 1) 2)

12 Secondary Causes of Glomerulonephritis (and nephritic/nephrotic syndrome The child with a rash and tummy pain Rapidly Progressive Glomerulonephritis : The man with who is coughing blood and has blood in his urine Other causes include:

13 Nephrotic Mixed Nephritic/Nephrotic Nephritic Asymptomatic Haematuria Primary Minimal change Membranous Nephropathy Focal Segmental Glomerulosclerosis Mesangiocapillary Glomerulonephritis Mesangioproliferative Glomerulonephritis Ig A Nephropathy Acute Diffuse Proliferative Glomerulonephritis IgA Nephropathy Secondary Amyloid Diabetes Infection eg hepatitis, HIV SLE Malignancy SLE Henoch Schonlein Purpura (HSP) Poststreptococcal Post Non Streptococcal infection Infective Endocarditis HSP

14 Haematological malignancies Common symptoms Common investigations

15 Leukaemia (Malignancy of blood cells focussed in the bone marrow) Acute Chronic Myeloid Lymphoblastic Myeloid Lymphoblastic Features + demographics Features + demographics Features + demographics Features + demographics Specific investigations Specific investigations Specific investigations Specific investigations Prognosis + management Prognosis + management Prognosis + management Prognosis + management

16 Lymphoma (Malignancy of lymphocytes focussed in the lymph nodes) Hodgkin s lymphoma Non-Hodgkin s lymphoma Features + demographics Features + demographics Specific investigations Specific investigations Prognosis + management Prognosis + management