3. Anaemia

Question 1

Definition of anaemia

Answer 1

Reduction in Hb in the blood (not necessarily red cells)

Question 2

Causes of anaemia (3)

Answer 2

Reduced production
Increased losses
Increased demand (pregnancy)

Question 3

Reduced Hb production occurs because of (2)

Answer 3

Reduction in haem

Reduction in globin

Question 4

Reasons for haem reduction (2)

Answer 4

Reduced number of normal cells (due to marrow failure)
Deficiency states (iron, folate, B12)

Question 5

Reasons for global reduction

Answer 5

Abnormal global chains (thalassemia, sickle cell, chronic inflammatory disease)

Question 6

Definition and examples (3) of haematinics

Answer 6

Things used to make up RBCs
Iron
Vitamin B12
Folate

Question 7

Diseases that reduce iron absorption (2)

Answer 7

Achlorhydria (lack of stomach acid, may be drug-induced, PPIs)
Coeliac disease

Question 8

Causes of iron loss (4)

Answer 8

Gastric erosion and ulcers
IBDs
Bowel cancer
Haemorrhoids

Question 9

Causes of vitamin B12 deficiency (3)

Answer 9

Lack of intake
Lack of intrinsic factor
Disease of terminal ileum (Crohn’s)

Question 10

Causes of folate deficiency (2)

Answer 10

Lack of intake

Absorption failure

Question 11

Complication of foetal folate deficiency

Answer 11

Spina bifida (open spinal defect/neural tube defect)

Question 12

Definition of thalassemia

Answer 12

Normal haem production, genetic mutations of global chains

Question 13

Types of thalassemia (2)

Answer 13

A-thalassemia

B-thalassemia

Question 14

Clinical effects of thalassemia (5)

Answer 14

Chronic anaemia
Marrow hyperplasia (skeletal deformities)
Splenomegaly
Cirrhosis
Gall stones

Question 15

Thalassemia management (2)

Answer 15

Blood transfusions

Prevention of iron overload

Question 16

Definition of sickle cell anaemia

Answer 16

Abnormal global chains - change in shape of RBCs

Question 17

Cause of shape change

Answer 17

Due to low Hb and O2 environments

Question 18

Effects of sickle cell anaemia (2)

Answer 18

RBCs cannot pass through capillaries

Can lead to tissue ischaemia (pain, necrosis)

Question 19

Anaemics can have (2)

Answer 19

Normal RBCs but heavier bleeding

Abnormal red cells (autoimmune, hereditary)

Question 20

Types of anaemia (3)

Answer 20

Microcytic (RBCs too small)
Macrocytic (RBCs too large)
Normocytic (fewer RBCs)

Question 21

Causes of microcytic anaemia (2)

Answer 21

Iron deficiency

Thalassemia

Question 22

Causes of microcytic anaemia (2)

Answer 22

Vitamin B12 deficiency

Folate deficiency

Question 23

Causes of normocytic anaemia (2)

Answer 23

Bleeding

Renal and chronic disease

Question 24

Definition of reticulocytes

Answer 24

Immature (almost mature) RBCs

Question 25

What should be measured to diagnose anaemia (4)

Answer 25

Measure Hb
Measure RCC
Measure HCT
Measure MCV

Question 26

Clinical presentations of anaemia (2)

Answer 26

Pale mucosa

Smooth (iron/ferritin deficiency) or beefy (vitamin B12 deficiency) tongue

Question 27

Signs of anaemia (3)

Answer 27

Pale
Tachycardia
Enlarged liver/spleen (rare)

Question 28

Symptoms of anaemia (5)

Answer 28

Tired
Weakness
Dizziness
SoB
Palpitations

Question 29

Anaemia investigation (5)

Answer 29

MH
FBC
FOB
Endoscopy/colonoscopy
Renal function
Bone marrow examination

Question 30

Anaemia treatment (3)

Answer 30

Replace haematinics
Transfusions (production failure)
EPO replacement (production failure)

Question 31

Differences between bleeding and deficiency (3)

Answer 31

RCC - reduced number/different RBC structure
HCT - abnormal HCT
MCV - reduced mean cell volume