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Residency Exam > RBC and Anaemias (part 2) (Panopto video link) > Flashcards

RBC and Anaemias (part 2) (Panopto video link) Flashcards

1
Q

Broadly speaking, what does a complete blood count consist of?

A
  1. Haemoglobin
  2. White Blood Cells
  3. Platelet count
  4. Red Blood Cells count
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2
Q

What are the factors pertaining to red blood cells assessed in a complete blood count?

A
  1. Red Blood Cells (RBC)
  2. Haematocrit (HCT)
  3. RBC indices (MCV, MCH, MCHC)
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3
Q

For anaemia, what 3 factors pertaining to red blood cells should you focus on?

A
  1. haematocrit (HCT)
  2. haemoglobin (Hb)
  3. mean cell volume (MCV)
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4
Q

What is the packed cell volume also called?

A

Haematocrit

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5
Q

What is haemoglobin a direct indication of?

A

Oxygen transport capacity

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6
Q

Describe the relationship between haemoglobin and anaemia

A

Haemoglobin is proportionately low in anaemia

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7
Q

What does haematocrit (packed cell volume) refer to?

A

The percentage of blood composed of erythrocytes (red blood cells)

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8
Q

What does mean cell volume measure?

A

The average volume of a single red blood cell

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9
Q

What is a standard haematocrit (packed cell volume)?

A

0.46

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10
Q

What is a standard haematocrit (packed cell volume)?

A

0.46

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11
Q

What is a standard haematocrit (packed cell volume)?

A

0.46

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12
Q

What does mean cell haemoglobin refer to?

A

Haemoglobin divided by the RBC count

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13
Q

What does mean cell haemoglobin concentration refer to?

A

Haemoglobin divided by the haematocrit

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14
Q

What does mean cell haemoglobin concentration refer to?

A

Haemoglobin divided by the haematocrit

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15
Q

What does red cell distribution width refer to?

A

It is a measure of variability in the size of red blood cells

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16
Q

How does anaemia of chronic disease affect red cell distribution width (RDW)?

A

It is normal in anaemia of chronic disease

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17
Q

What is the usual range for red cell distribution width?

A

<15%

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18
Q

What is a condition in which red cell distribution width (RDW) is increased?

A

Iron deficiency

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19
Q

How does anaemia of chronic disease affect red cell distribution width (RDW)?

A

It is normal in anaemia of chronic disease

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20
Q

What is the standard formula for determining red cell distribution width (RDW)?

A

Standard deviation of mean cell volume (MCV) * 100

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21
Q

What is the reference range for red cell distribution width (RDW)?

A

11.5% to 14.6%

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22
Q

If the mean cell volume (MCV) is high and the red cell distribution width (RDW) is normal, what are the two likely causes?

A
  1. Alcohol/liver disease
  2. Bone marrow problem (caused by chemotherapy or aplastic anaemia)
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23
Q

What are the cellular components of blood derived from?

A

Pluripotential stem cells in the bone marrow

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24
Q

What is the lifespan of reticulocytes?

A

1 to 2 days

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25
Q

What is the lifespan of reticulocytes?

A

1 to 2 days

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26
Q

What is the lifespan of red blood cells (erythrocytes)?

A

120 days

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27
Q

What is the reticulocyte count an indirect measurement of?

A

Red blood cell (erythrocyte) production

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28
Q

What is the reticulocyte usually equivalent to?

A

Approximately 1% of the red blood cell count (RCC) in the basal state

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29
Q

When will reticulocyte count not be increased?

A

When red blood cell (erythrocyte) count is deficient

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30
Q

When will reticulocyte count not be increased?

A

When red blood cell (erythrocyte) count is deficient

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31
Q

In anaemia, what does the reticulocyte count reflect?

A

Both the increased production and reduced number of red blood cells (erythrocytes)

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32
Q

What is a correct reticulocyte count adjusted to?

A

A normal haematocrit (HCT)

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33
Q

What does the reticulocyte count depend on?

A

The type of anaemia

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34
Q

When may reticulocyte count be increased?

A

In acute blood loss

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35
Q

When will reticulocyte count not be increased?

A

When red blood cell (erythrocyte) is deficient

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36
Q

What are 3 causes of deficient red blood cell (erythrocyte) production?

A
  1. Folate deficiency
  2. Iron deficiency
  3. Vitamin B12 deficiency
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37
Q

What can reticulocyte count be used to monitor?

A

Response to the treatment of anaemia

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38
Q

What can reticulocyte count be used to monitor?

A

Response to the treatment of anaemia

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39
Q

What laboratory value will reflect megaloblastic anaemia?

A

A large mean cell volume (MCV)

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40
Q

What is sickle cell anaemia?

A

A condition by which the body forms odd-shaped red blood cells (erythrocytes) and thus has reduced capacity to carry oxygen around the body.

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41
Q

Describe the lifespan of red blood cells (erythrocytes) in sickle cell anaemia

A

Sickle cells usually die in 10 to 20 days (compared to 120 days for healthy red blood cells (erythrocytes))

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42
Q

Describe the lifespan of red blood cells (erythrocytes) in sickle cell anaemia

A

Sickle cells usually die in 10 to 20 days (compared to 120 days for healthy red blood cells (erythrocytes))

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43
Q

What is a secondary complication of sickle cell anaemia besides anaemia?

A

The sickle cells can get stuck in small blood vessels, causing pain

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44
Q

What occurs to iron in sideroblastic anaemia?

A

The body has iron available but cannot incorporate it into haemoglobin (Hb)

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45
Q

What is sideroblastic anaemia?

A

A rare, refractory anaemia caused by microcytic hypochromic cells in peripheral blood, with ring sideroblasts in bone marrow and excess iron

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46
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
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47
Q

What occurs to iron in sideroblastic anaemia?

A

The body has iron available but cannot incorporate it into haemoglobin (Hb)

48
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
49
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
50
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
51
Q

What are the 2 forms of sideroblastic anaemia?

A
  1. Congenital
  2. Acquired
52
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
53
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
54
Q

What are the 2 forms of acquired sideroblastic anaemia?

A
  1. Primary (idiopathic)
  2. Secondary
55
Q

What are 6 causes of secondary sideroblastic anaemia?

A
  1. Drugs
  2. Alcohol
  3. Lead poisoning
  4. Myeloproliferative disorders
  5. Leukaemia
  6. Connective tissue disorders
56
Q

What is haemochromatosis?

A

An inherited iron overload disorder

57
Q

What is the mechanism of iron overload in haemochromatosis?

A

The body absorbs too much iron from food

58
Q

What is the usual treatment for haemochromatosis?

A

Venesection

59
Q

What is venesection?

A

The removal of blood from the body

60
Q

What class of drugs is commonly implicated in causing megaloblastic anaemia?

A

Cytotoxics which disrupt DNA synthesis

61
Q

What is a common cause of Vitamin B12 deficiency?

A

Medication-induced Vitamin B12 deficiency

62
Q

What are the 3 main causes of megaloblastic anaemias?

A
  1. Vitamin B12 deficiency
  2. Folate deficiency
  3. Medications
63
Q

What class of drugs is commonly implicated in causing megaloblastic anaemia?

A

Cytotoxics which disrupt DNA synthesis

64
Q

What are 3 examples of cytotoxics which disrupt DNA synthesis?

A
  1. 5-fluorouracil
  2. Cytosine arabinoside
  3. Hydroxycarbamide
65
Q

What is the mechanism by which megaloblastic anaemias occur?

A

While DNA synthesis is defective, RNA synthesis continues, giving increased cytoplasmic mass and thus large cells

66
Q

Describe the ratio of RNA to DNA in megaloblastic cells

A

There is an increased ratio of RNA to DNA

67
Q

Which cells are primarily affected in megaloblastic anaemias?

A

Cells with relatively rapid turnover

68
Q

What are 2 examples of drugs which can contribute to Vitamin B12 deficiency?

A
  1. Metformin
  2. Proton pump inhibitors
69
Q

What are 5 uncommon causes of macrocytosis?

A
  1. Hypothyroidism
  2. Aplastic anaemia
  3. myelodysplasia
  4. liver disease
  5. alcohol excess
70
Q

What are 5 uncommon causes of macrocytosis?

A
  1. Hypothyroidism
  2. Aplastic anaemia
  3. myelodysplasia
  4. liver disease
  5. alcohol excess
71
Q

What is a common complication of Vitamin B12 deficiency?

A

Neurological disorders

72
Q

Why are folate and Vitamin B12 always assessed together?

A

Because if a person is B12 deficient, and you replace folate, you will correct the anaemia, but you will not reduce the risk of neurological damage

73
Q

How does Vitamin B12 deficiency affect reticulocyte count?

A

Vitamin B12 deficiency causes a low reticulocyte count

74
Q

How does Vitamin B12 deficiency affect lactate dehydrogenase (LDH)?

A

Lactate dehydrogenase (LDH) is often markedly increased in Vitamin B12 deficiency

75
Q

How does Vitamin B12 deficiency affect homocysteine levels?

A

Vitamin B12 levels increase in Vitamin B12 deficiency

76
Q

What is the initial treatment dose for B12 replacement?

A

Hydroxocobalamin IM 1000 micrograms on alternate days for 1 to 2 weeks or until improvement occurs

77
Q

If you take a total Vitamin B12 test, and it is low, does this indicate deficiency?

A

Yes

78
Q

If you take a total Vitamin B12 test, and it is high, does this mean you are unlikely to be deficient?

A

Yes

79
Q

An active Vitamin B12 test gives context to undefinitive Total B12 levels, what range is undefinitive?

A

Between 150 – 300 pmol/L

80
Q

If a patient has a Total B12 between 150 and 300 pmol/L, and their active B12 is <35 pmol/L, what does this indicate?

A

They are likely deficient

81
Q

If a patient has a Total B12 between 150 and 300 pmol/L, and their active B12 is >35 pmol/L, what does this indicate?

A

They are unlikely to be deficient

82
Q

What is anaemia of chronic disease?

A

Anaemia associated with inflammation, infection, tissue injury, and conditions associated with the release of proinflammatory cytokines

83
Q

When is an active B12 test usually ordered?

A

When the patient has macrocytic anaemia but the Total B12 test is not definitive

84
Q

Describe the difference in efficacy between hydroxocobalamin and cyanocobalamin

A

IM hydroxocobalamin produces a greater and more sustained increase in serum Vitamin B12 than the same dose of cyanocobalamin

85
Q

Describe the relationship between adult and children dosing of B12 replacement

A

Use the same doses for adults and children

86
Q

What is anaemia of chronic disease?

A

Anaemia associated with inflammation, infection, tissue injury, and conditions associated with the release of proinflammatory cytokines

87
Q

What is the initial treatment dose for B12 replacement?

A

Hydroxocobalamin IM 1000 micrograms on alternate days for 1 to 2 weeks or until improvement occurs

88
Q

What is the prevention and maintenance dose for B12 replacement?

A

Hydroxocobalamin IM 1000 micrograms every 2-3 months

89
Q

What is the prevention dose for B12 deficiency due to inadequate diet?

A

Cyanocobalamin, oral 50-200 micrograms oral, given between meals

90
Q

What is the oral bioavailability of vitamin B12?

A

0.5 to 4%

91
Q

What is the oral bioavailability of vitamin B12?

A

0.5 to 4%

92
Q

What are the characteristics of anaemia of renal failure?

A

Normocytic, normochromic

93
Q

Describe the severity of anaemia of renal failure

A

It is often more severe than with other chronic diseases

94
Q

What is the common haemoglobin (Hb) range observed in anaemia of renal failure?

A

Haemoglobin (Hb) < 80 g/L

95
Q

What are 3 activities of cytokines produced in inflammatory diseases which contribute to anaemia of chronic disease?

A
  1. Decreased erythropoietin production
  2. Suppression of erythroid progenitors
  3. Blockade of reticuloendothelial iron release
96
Q

Describe the incidence of anaemia of renal failure

A

It occurs in almost all patients with GFR < 10 mL/min

97
Q

Describe the tolerability of anaemia of renal failure

A

It is often tolerated due to compensatory changes in oxygen transfer

98
Q

Describe the incidence of anaemia of renal failure

A

It occurs in almost all patients with GFR < 10 mL/min

99
Q

What are 4 components of the pathogenesis of anaemia of renal failure?

A
  1. Inhibitors of erythropoietin
  2. Reduced red blood cell (erythrocyte) lifespan
  3. Chronic blood loss
  4. Reduced secretion of erythropoietin
100
Q

What 2 drugs are used to treat anaemia of renal failure?

A
  1. Erythropoietin
  2. Darbepoetin
101
Q

What is the etiology of anaemia of chronic disease?

A

Decreased lifespan of red blood cells (erythrocytes) and presence of inhibitory factors

102
Q

What is the site of production of physiological erythropoietin?

A

The kidneys

103
Q

What is anaemia of chronic disease?

A

Anaemia associated with inflammation, infection, tissue injury, and conditions associated with the release of proinflammatory cytokines

104
Q

What are 4 disease states associated with anaemia of chronic disease?

A
  1. Rheumatoid arthritis
  2. Systemic lupus erythaematosus
  3. Tuberculosis
  4. Carcinoma
105
Q

What are 4 disease states associated with anaemia of chronic disease?

A
  1. Rheumatoid arthritis
  2. Systemic lupus erythaematosus
  3. Tuberculosis
  4. Carcinoma
106
Q

What is the etiology of anaemia of chronic disease?

A

Decreased lifespan of red blood cells (erythrocytes) and presence of inhibitory factors

107
Q

What is the etiology of anaemia of chronic disease?

A

Decreased lifespan of red blood cells (erythrocytes) and presence of inhibitory factors

108
Q

What must you always give with erythropoietin?

A

Iron replacement

109
Q

Why must you always give iron replacement with erythropoietin?

A

To provide the body with the raw materials required to produce red blood cells (erythrocytes)

110
Q

Broadly speaking, which disease states are associated with anaemia of chronic disease?

A

Inflammatory diseases

111
Q

What is the usual treatment for anaemia of chronic disease?

A

Management of the condition, rather than treatment of the secondary anaemia

112
Q

What are 3 activities of cytokines produced in inflammatory diseases which contribute to anaemia of chronic disease?

A
  1. Decreased erythropoietin production
  2. Suppression of erythroid progenitors
  3. Blockade of reticuloendothelial iron release
113
Q

Describe the characteristics of anaemia of chronic disease

A

It is generally mild (haemoglobin 100 – 110 g/L) and asymptomatic. It is usually normocytic but may be microcytic, and typically does not get worse with time

114
Q

Describe the usual management of anaemia of chronic disease

A

It is generally not treated

115
Q

Describe the role of blood transfusions in anaemia of chronic disease

A

They may be used if the patient is symptomatic

116
Q

Describe the role of erythropoietin in anaemia of chronic disease

A

Large doses are required, so it is generally not cost effective

117
Q

Describe the role of iron in anaemia of chronic disease

A

Iron is not effective

Residency Exam (22 decks)

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