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Residency Exam > Haematology/Iron Studies Tutorial > Flashcards

Haematology/Iron Studies Tutorial Flashcards

1
Q

What are 4 ways to classify anaemias based on pathophysiology?

A
  1. Blood loss
  2. Decreased production
  3. Dysfunctional red blood cells (erythrocytes) such as in sickle cell anaemia
  4. Increased destruction
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2
Q

What are 4 ways to classify anaemias based on pathophysiology

A
  1. Blood loss
  2. Decreased production
  3. Dysfunctional red blood cells (erythrocytes) such as in sickle cell anaemia
  4. Increased destruction
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3
Q

What is a drug commonly implicated in causing haemolytic anaemias?

A

Methyldopa

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4
Q

What is an example of a condition which causes dysfunctional red blood cells (erythrocytes)?

A

Sickle cell anaemia

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5
Q

What are the 3 ways to classify anaemias based on morphology?

A
  1. Normocytic
  2. Microcytic
  3. Macrocytic
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6
Q

What is the most common cause of microcytic anaemia?

A

Iron deficiency

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7
Q

Which type of white blood cell has the fastest turnover?

A

Neutrophils

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8
Q

What is the use of knowing neutrophils have the fastest turnover of all types of white blood cells?

A

They are most useful in identifying trends in white blood cells early

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9
Q

What is the use of knowing neutrophils have the fastest turnover of all types of white blood cells?

A

They are most useful in identifying trends in white blood cells early

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10
Q

What is the use in a red blood cell count (RCC)?

A

It can be a useful marker of production of red blood cells (erythrocytes)

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11
Q

What does a high red cell distribution width (RDW) indicate?

A

Dysfunction in red blood cell (erythrocyte) production

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12
Q

What are 3 causes of microcytic anaemia?

A
  1. Iron deficiency
  2. Thalassaemia
  3. Chronic inflammation
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13
Q

What are 5 causes of normocytic anaemia?

A
  1. Acute bleeding
  2. Haemolysis
  3. Chronic inflammation
  4. Chronic kidney disease
  5. Concomitant micro- and macrocytic anaemia
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14
Q

What are 5 causes of normocytic anaemia?

A
  1. Acute bleeding
  2. Haemolysis
  3. Chronic inflammation
  4. Chronic kidney disease
  5. Concomitant micro- and macrocytic anaemia
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15
Q

What are 5 causes of normocytic anaemia?

A
  1. Acute bleeding
  2. Haemolysis
  3. Chronic inflammation
  4. Chronic kidney disease
  5. Concomitant micro- and macrocytic anaemia
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16
Q

What are 5 causes of normocytic anaemia?

A
  1. Acute bleeding
  2. Haemolysis
  3. Chronic inflammation
  4. Chronic kidney disease
  5. Concomitant micro- and macrocytic anaemia
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17
Q

What are 9 causes of macrocytic anaemia?

A
  1. Vitamin B12 deficiency
  2. Folate deficiency
  3. Drugs
  4. Alcohol
  5. Liver disease
  6. Thyroid disease
  7. Myelodysplastic syndrome (MDS)
  8. Reticulocytosis
  9. Laboratory artifact
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18
Q

Anaemia is considered microcytic if mean cell volume (MCV) is less than what value?

A

80 fL

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19
Q

When is anaemia considered macrocytic?

A

If mean cell volume (MCV) is over 95

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20
Q

How will iron levels typically present in iron deficiency?

A

They will be low

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21
Q

How will total iron binding capacity (TIBC) typically present in iron deficiency?

A

It will be high

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22
Q

How will transferrin saturation typically present in iron deficiency?

A

It will be under 20%

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23
Q

How will ferritin typically present in iron deficiency?

A

It will be low

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24
Q

What 2 laboratory values should you refer to if a patient with microcytic anaemia is not iron deficient?

A
  1. EPO
  2. Haemoglobin electrophoresis
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25
Q

What 2 laboratory values should you refer to if a patient with microcytic anaemia is not iron deficient?

A
  1. EPO
  2. Haemoglobin electrophoresis
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26
Q

How will red cell distribution width (RDW) typically present in iron deficiency?

A

It will be elevated

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27
Q

How will platelets typically present in iron deficiency?

A

They will be elevated

28
Q

How will soluble transferrin receptor (STR) typically present in iron deficiency?

A

It will be high

29
Q

What 2 laboratory values should you refer to if a patient with microcytic anaemia is not iron deficient?

A
  1. EPO
  2. Haemoglobin electrophoresis
30
Q

What are the first two laboratory values to refer to in a patient with anaemia?

A
  1. Mean cell volume (MCV)
  2. Red cell distribution width (RDW)
31
Q

What should you always ask a patient about if they present with macrocytic anaemia?

A

Their alcohol use

32
Q

What are 6 laboratory values to refer to if a patient presents with macrocytic anaemia?

A
  1. Red cell distribution width (RDW)
  2. Vitamin B12
  3. Folate
  4. Thyroid-stimulating hormone
  5. Peripheral smear
  6. Liver function tests
33
Q

How may we differentiate macrocytic anaemia as being caused by either liver or thyroid disease compared to another cause?

A

Cells tend to be round in macrocytic anaemia caused by liver and thyroid disease

34
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count?

A

Check the iron studies and replete if low

35
Q

How may we differentiate macrocytic anaemia as being caused by Vitamin B12 or folate deficiency?

A

Cells will be oval in shape in macrocytic anaemia caused by liver and thyroid disease

36
Q

How may we differentiate macrocytic anaemia as being caused by lab artifact?

A

Cells tend to be normal in macrocytic anaemia caused by lab artifact

37
Q

If a standard macrocytic anaemia workup (red cell distribution width (RDW), Vitamin B12, folate, thyroid-stimulating hormone, peripheral smear and liver function tests) is negative, what should you do?

A

Take a bone marrow biopsy and suspect myelodysplastic syndrome (MDS)

38
Q

If a standard macrocytic anaemia workup (red cell distribution width (RDW), Vitamin B12, folate, thyroid-stimulating hormone, peripheral smear and liver function tests) is negative, what should you do?

A

Take a bone marrow biopsy and suspect myelodysplastic syndrome (MDS)

39
Q

What laboratory value should you refer to if a patient has normocytic anaemia?

A

Reticulocyte count

40
Q

What laboratory value should you refer to if a patient has normocytic anaemia?

A

Reticulocyte count

41
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count?

A

Check the iron studies and replete if low

42
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count and normal iron studies?

A

Check erythropoietin and haemoglobin

43
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count and normal iron studies?

A

Check erythropoietin and haemoglobin

44
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count and normal iron studies?

A

Check erythropoietin and haemoglobin

45
Q

What should you do if a patient has normocytic anaemia with high reticulocyte count?

A

Check the peripheral smear and evaluate for haemolysis

46
Q

What is the purpose of increased hepcidin secretion?

A

To prevent an overload of the body with dietary iron and to starve microorganisms of iron, limiting their growth

47
Q

What should you do if a patient has normocytic anaemia with a low reticulocyte count and normal iron studies?

A

Check erythropoietin and haemoglobin

48
Q

What should you do if a patient has normocytic anaemia with a normal reticulocyte count?

A

Check EPO and haemoglobin electrophoresis

49
Q

What 3 laboratory values consistent with haemolysis?

A
  1. Unconjugated hyperbilirubinaemia
  2. Low haptoglobin
  3. High lactate dehydrogenase (LDH)
50
Q

What 3 laboratory values consistent with haemolysis?

A
  1. Unconjugated hyperbilirubinaemia
  2. Low haptoglobin
  3. High lactate dehydrogenase (LDH)
51
Q

What should you do if a patient has normocytic anaemia with high reticulocyte count?

A

Check the peripheral smear and evaluate for haemolysis

52
Q

What 3 laboratory values consistent with haemolysis?

A
  1. Unconjugated hyperbilirubinaemia
  2. Low haptoglobin
  3. High lactate dehydrogenase (LDH)
53
Q

What is a potentially serious complication of Vitamin B12 deficiency?

A

Neurological damage

54
Q

What is the purpose of increased hepcidin secretion?

A

To prevent an overload of the body with dietary iron and to starve microorganisms of iron, limiting their growth

55
Q

What is the mechanism of iron deficiency in anaemia of chronic disease?

A

There is usually sufficient iron, but it cannot be released from hepatocytes due to the activity of hepcidin

56
Q

What are three negative acute-phase reactants which decrease in inflammation?

A
  1. Albumin
  2. Iron
  3. Transferrin
57
Q

What is the transporter on hepatocytes which hepcidin blocks to prevent iron from being released from hepatocytes?

A

Ferroportin

58
Q

What are 3 positive acute-phase reactants which increase in inflammation?

A
  1. C-reactive protein
  2. Fibrinogen
  3. Ferritin
59
Q

What are three negative acute-phase reactants which decrease in inflammation?

A
  1. Albumin
  2. Iron
  3. Transferrin
60
Q

What is the risk associated with increased fibrinogen in chronic inflammatory disease?

A

Clotting risk (i.e. DVTs, PEs)

61
Q

What is the earliest abnormality revelated on iron studies of haemochromatosis?

A

A high transferrin saturation (>50%) on a fasting blood sample

62
Q

What is the pathophysiology which leads to a large red cell distribution width (RDW)?

A

The body is not producing enough red blood cells (erythrocytes) to meet demand, so it pushes immature blood cells into the plasma to compensate

63
Q

What does a high reticulocyte count refer to?

A

A large concentration of immature blood cells in the plasma

64
Q

Which laboratory value should you refer to if a patient has high ferritin to check for iron overload?

A

Transferrin saturation

65
Q

What may an isolated elevation of lactate dehydrogenase (LDH) suggest?

A

Haemolysis

66
Q

What is a usual cause of pancytopaenia?

A

Bone marrow deficiency

67
Q

What is the mechanism by which haemochromatosis is harmful?

A

There is inappropriate deposition of iron in organs as the body is unable to clear it. This can lead to irreversible organ damage

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