ABSTRACT
A N A E
1. Acute haemorrhage Restoration of plasma volume (over hours) is quicker than RBC t (over days)
2. Haemolytic anaemias Hereditary:
• Haemoglobinopathy: Hb S (sickle cell); Unstable Hb or altered 0. affinity
• Membrane defect: hereditary elliptocytosis
• Enzyme defect: G6PD or Pyruvate kinase deficiency
Acquired: Spleen enlargement PNH Liver disease Immune, e.g. SLE Toxin, e.g. MeDOPA Trauma to RBCs (MAHA) Infection, e.g. malaria Neoplasia, e.g. adenocarcinoma Graft, arterial
Acquired mutation, PNH, Leukaemia, Autoimmune, Sniffing glue, Toxins, Infection, Congenital
Bone marrow replacement: • Myelofibrosis, myeloma, leukaemia • Malignancy: osteoblastic metastases • Infection: TB, Brucella, Candida
Chronic disease, anaemia of Path: Failure of iron recycling Cause: Infection, autoimmunity, malignancy
Diet: malnutrition, malabsorption (protein 1) Endocrine: Addison's, dysthyroidism
MAR.MAL.A.D.E. 1. Megaloblastic Vit B12 deficiency
a) Intake i : vegetarian, e.g. Hindus b) Absorption i :
• Stomach (IF and R protein synthesis): pernicious anaemia, gastrectomy
• Duodenum, pancreas (R protein dissociation): coeliac, chronic pancreatitis
• Small bowel (sequestration): bacterial overgrowth, e.g. blind-loop
• Terminal ileum (absorption): Crohn's, TB c) Drugs: metformin, colchicine, N20 anaesthesia
Folate deficiency a) Intake 1 : 'tea + biscuits' diet - elderly b) Absorption 4: coeliac, Crohn's, AIDS c) Drugs:
DHFR inhibitor: methotrexate, trimethoprim Dihydropteroate synthetase inhibitor:
d) Demand t: • Physiological: pregnancy, infancy • Neoplasia: myeloproliferative • Haemolysis, erythroderma, autoimmune
Other: orotic aciduria, transcobalamin-ll deficiency
e.g. acute haemolysis or BM replacement
chronic idiopathic, or Fanconi's
7. Disordered iron t haemochromatosis, or haemosiderosis
424 HAEMATOLOGY
The following cause either a peripheral blood pancytopenia or anaemia due to failure of haematopoeisis.
