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Haematology > Anaemia – in Practice > Flashcards

Anaemia – in Practice Flashcards

1
Q

84 year old woman:

Pins and needles in feet and hands

Feels ‘as though walking on cotton wool’

  • Paraesthesia
  • Peripheral sensory neuropathy

Tired and has a sore tongue

Hb 63 (108-143)

MCV 123 (82-99)

WBC 3.2 (4-10)

Plts 90 (140-400)

Film:

  • Oval macrocytes
  • Neutrophil hypersegmentation

What is the most likely diagnosis?

A) Iron deficiency anaemia

B) Megaloblastic anaemia

C) Acute leukaemia

D) Chronic anaemia secondary to diabetes

A

B

Iron deficiency = gives you microcytic anaemia so doesn’t fit with results

Acute leukaemia – blood film would likely to have blasts there

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2
Q

What blood tests would you do to confirm your diagnosis?

A) Plasma G-6-PD levels

B) Serum Ferritin level

C) Serum B12 and folate levels

D) Reticulocyte count, bilirubin and LDH

A

C

How do you confirm it is megaloblastic anaemia?

Retic count will go up if your cells are haemolysing

Need normal B12 and folate to make normal cells so they do fall apart a bit so bilirubin may be elevated but retic count will be low as she doesn’t have the fuel to make red cells properly

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3
Q

If the patient is thought to have pernicious anaemia, which of these is a diagnostic test?

A) Antinuclear antibodies

B) Antiendomysial antibodies

C) Anti-intrinsic factor antibodies

D) Antiparietal cell antibodies

A

C

This lady has a low vitamin B12, think she had pernicious anaemia

This is a specific test that gives you a diagnosis

Antiparietal cell antibodies are not specific for just pernicious anaemia

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4
Q

84 year old woman
How would you treat her pernicious anaemia?
Hb 63, MCV 123, WCC 3.2, Plts 90

A) Oral Vitamin B12

B) IM Vitamin B12

C) Blood Transfusion

D) Immunosupression eg.steroids

A

B

IM vitamin B12

problem with vitamin B12 absorption in the stomach

Cant absorb oral B12 if you don’t have intrinsic factor to bind it

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5
Q

84 year old woman

Differential diagnosis?

Hb 63, MCV 123, WCC 3.2, Plts 90

Blood film

Hypogranular neutrophils

Red cell anisocytosis

A

Myelodysplasia

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6
Q

22 year old female medical student:

Tired

Difficulty concentrating on work

Irritable with friends

Breathless on exercise

Denies other symptoms

Looks pale

FBC and film:

Hb 84 (120-160)
MCV 77 (82-99)
MCH 23 (27-32) 
WBC 5.7 (4-10) 
Plts 434 (140-400)

What is the term used to give a morphological description of this anaemia?

A) Hypochromic, microcytic anaemia

B) Macrocytic anaemia

C) Normochromic, normocytic anaemia

D) Pancytopenia

A

A

Pale and small cells

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7
Q

22 year old female medical student
What laboratory test would you do first to investigate the cause?

A. Ferritin

B. Haemoglobinopathy screen

C. Bone marrow aspirate

D. Serum Igs

A

A

Measure of the bodies iron stores

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8
Q

22 year old female medical student

  • Ferritin 6.0ug/l
  • What is the diagnosis?
  • What questions would you ask?
A
  • Iron deficiency anaemia
  • Bleeding – menorrhagia
  • Not pregnant!
  • Diet – vegetarian
  • No GI Symptoms
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9
Q

“She should be referred for GI investigations”

  1. TRUE
  2. FALSE
A

False

Would be good to find out about menstrual history in a young women

To look for an alternative cause of blood loss

In young women of menstruating age and no GI symptoms then no need to send for GI investigation

Iron requirement also goes up during pubertal spurt

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10
Q

22 year old female medical student

Hb 84, MCV 77, WBC 5.7, Plts 434

How would I advise you to treat her?

A) IV iron

B) Blood transfusion

C) Oral iron

D) Dietary advice

A

C

Haem iron and non-haem iron have different ways of being absorbed

Digest iron from meat much better compared to plant iron

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11
Q

78 year old retired surgeon:

Hb 84 (116-156)

MCV 77 (82-99)

MCH 23 (27-32)

WBC 5.7 (4-10)

Plts 623 (140-400)

  • Tired
  • Difficulty concentrating on crosswords
  • Breathless on exercise
  • Chest pain at rest

Ferritin is low

“He should be referred for GI investigations”

A) TRUE

B) FALSE

A

A

78 year old man

Ferratin also low

Really in a man, even a younger man who doesn’t have much GI symtology, often wondering why iron level is low and you need to think that he must be losing iron somewhere (if he has a reasonable diet)

You lose iron when you bleed and most common place is the GI tract

How would you treat him?

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12
Q

How would I advise you to treat him?

A) IV iron

B) Blood transfusion

C) Oral iron

D) Dietary advice

A

B

Probably admit this chap and give blood transfusion

Chest pain at rest is unstable angina and high chance this man would have MI if left at home

Not making enough red cells to perfuse his cardiac muscle properly

IV iron doesn’t work much quicker than oral iron

In this situation, cause of unstable angina give blood

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13
Q

Hypochromic, microcytic anaemia with normal ferritin - what is a possible cause?

A. Hereditary spherocytosis

B. G6PD deficiency

C. Sickle cell anaemia

D. Thalassaemia trait

A

D

A. You get spherical cells

All are haemolysing

Carrier of thalassemia gives you small cells often confused with iron deficiency

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14
Q

what is the structure of normal adult haemaglobin?

A

Adult haemoglobin (HbA) composed of haem molecule and:

  • 2 alpha (a) chains
  • 4 alpha genes
  • 2 beta (b) chains
  • 2 beta genes

Normal Adult Hb

  • Hb A (aabb) – 97%
  • Hb A2 (aaδδ) – 2%
  • Hb F (aaγγ) – 1%
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15
Q

2 carriers of beta thalassaemia trait are partners and are planning a pregnancy.
What is the chance that they will have a baby affected by beta thalassaemia major?

A) 1 in 4 (25%)

B) 1 in 2 (50%)

C) 1 in 5 (20%)

D) Unknown without knowing the specific mutations

A

A

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16
Q

Hypochromic, microcytic anaemia:

What are Other causes apart from iron deficiency

•Normal ferritin

A

Thalassaemia trait

Secondary anaemia/anaemia of chronic disease:

  • More usually normochromic, normocytic
  • Normal or elevated ferritin
  • Ineffective iron utilisation
17
Q

what is the Role of Hepcidin in anaemia of chronic disease?

A

Role of Hepcidin in anaemia of chronic disease –blocks ferroportin

18
Q

34 year old waiter:

Tired

Noticed yellow eyes

Hb73 (140-180)

MCV 98 (82-99)

MCH 32 (27-32)

WCC 7.2 (4-10)

Plts 480 (140-400)

Blood film shows spherocytes. What other investigations would you order?

A) Reticulocyte count

B) Bilirubin, LDH

C) Serum haptoglobin

D) DAGT (Coombs test)

E) All of the above

A

E

Spherocyte don’t have pale area in middle

Large grey cells are the immature red blood cells coming out the marrow

LDH is another molecule coming from red cell breakdowns so will be high aswell

C will be low

19
Q

34 year old waiter

DAGT is positive

What is the diagnosis?

A. Autoimmune haemolysis

B. Hereditary spherocytosis

C. G6PD deficiency

D. Microangiopathic haemolysis

A

A

20
Q

34 year old waiter:

If DAGT negative is there an alternative diagnosis?

What questions could you ask?

A
  • previous episodes
  • family history
  • any precipitants eg. viral infection, drugs

Hereditary spherocytosis

21
Q

34 year old waiter:

Noticed yellow eyes

Pain in left chest

Breathless, fever

Ankle ulcer

crutch

Hb 73 (140-180)

MCV 98 (82-99)

MCH 32 (27-32)

Blood film shows sickle cells. What other lab investigations would you order?

A) Reticulocyte count

B) Bilirubin, LDH

C) Haemoglobinopathy screen

D) All of the above

WCC 7.2 (4-10)

Plts 530 (140-400)

A

D

22
Q

34 year old waiter

Diagnosis - Sickle cell disease- HbSS

What is unlikely to be the cause of his pain?

A) Bony crisis

B) Pneumonia

C) Pulmonary Embolism

D) Splenic infarction

A

D

D because adults with sickle cell disease often don’t have much of a spleen at all that infarcted as a child

23
Q

Painful sickle cell crisis- management should include:

A) Analgaesia

B) Oxygen

C) Fluids

D) All of the above

A

D

Oxygen saturation above 95%

What has precipitated it is the other thing

24
Q

34 year old waiter:

Management should include what?

A

Analgaesia-usually require opiates

Oxygen

Fluids

Antibiotics if fever

Thromboprophylaxis

Consider blood transfusion if severe anaemia, stroke or chest crisis

Call haematology Registrar!

25
Q

Sickle cell – chest crisis

what is it?

A

Chest crisis:

  • Close observation as can deteriorate rapidly
  • Worsening hypoxia
  • Fever
  • Chest pain
  • Infiltrates on chest X-Ray
  • Transfusion-top up or exchange

Haematology (15 decks)

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