8. Red Cells 2

Question 1

Anaemia symptoms

Answer 1

Shortness of breath on exertion

Palpitations

Weakness, lethargy

Headaches

Heart failure symptoms

Visual disturbances

Question 2

Anaemia signs

Answer 2

Pallor of mucous membranes

Hyperdynamic circulation

tachycardia, bounding pulse, systolic flow murmur

Congestive cardiac failure

Retinal haemorrhages

Question 3

Microcytic anaemias

Answer 3

Anaemia + MCV < 80 fl

Question 4

Microcytic anaemia Causes

Answer 4

Iron deficiency

Thalassaemia

Anaemia of chronic disease

Question 5

Hepcidin

Answer 5

Produced by liver cells

Inhibits ferroportin

Reduces iron absorption and iron release from macrophages

↓ in iron deficiency

↑ by IL-6

Question 6

Causes of Iron Deficiency

Answer 6

1) Chronic blood loss 2) Increased demands 3) Malabsorption 4) Poor diet

Question 7

Microcytic anaemia Lab findings

Answer 7

↓Hb

MCV < 80 fl

Serum ferritin ↓

Serum iron ↓

Total iron binding capacity ↑

Question 8

Further investigations in Microcytic anaemia

Answer 8

Premenopausal women→  menorrhagia

Men + postmenopausal women→ exclude gastrointestinal blood loss

Malabsorption (e.g. coealiac disease) if no blood loss is found.

Question 9

Treatment of Microcytic anaemia

Answer 9

Oral iron Ferrous sulphate 200 mg 3 times per day For 3 months after Hb has been normalised

Parenteral iron

Question 10

Anaemia of chronic disease

Answer 10

Inflammation

↑IL-6

↑hepcidin

↓ferroportin

↓iron to red cells

Question 11

Macrocytic anaemia

Answer 11

Anaemia + MCV > 100 fl

Question 12

Macrocytic anaemia Causes

Answer 12

Vitamin B12 or folate deficiency (Megaloblastic anaemias)

Liver disease

Alcohol abuse

Reticulocytosis

Bone marrow disorders (Myelodysplasia)

Question 13

Vitamin B12 malabsorption

Answer 13

1) Lack of intrinsic factor 2) Ileal disease 3) Dietary deficiency

Question 14

Pernicious Anaemia

Answer 14

Anaemia + MCV > 100 fl

Low serum vitamin B12 levels

Autoantibodies to intrinsic factors

Associated with neuropathy, subacute combined degenration of the spinal cord

Question 15

Treatment of Pernicious Anaemia

Answer 15

Intramuscular vitamin B12 (hydoroxocobalamin)

1 mg every 3 months for an indefinite period

Question 16

Folate deficiency

Answer 16

1) Increased demand 2) Coeliac disease 3) Dietary deficiency

Question 17

Folate deficiency anaemia

Answer 17

Anaemia with MCV > 100 fl

Serum folate reduced

Red cell folate reduced

As a rule, no neuropathy is present.

Question 18

Causes of Haemolytic anaemia

Answer 18

1) Membrane defect
2) Globin gene synthesis defect (haemoglobinopathies)
3) Oxidant stress
4) Immune destruction of red cells
5) Infections

Question 19

Folate deficiency anaemia treatment

Answer 19

Give folic acid

5 mg daily for 3 months