Anaemia

Question 1

what is anaemia?

Answer 1

reduced total red cell mass

Question 2

what is the diagnostic criteria for anaemia in adult males?

Answer 2

Hb <130g/L
or
Hct <0.38

Question 3

what is the diagnostic criteria for anaemia in adult females?

Answer 3

Hb <120 g/L
or
Hct <0.37

Question 4

where does RBC production take place?

Answer 4

in the bone marrow

Question 5

what effect does acute blood loss have on Hb concentration?

Answer 5

no change

Hb is a poor marker of acute blood loss

Question 6

what effect can giving IV fluids have on Hb concentration?

Answer 6

can cause reduced Hb due to haemodilution

even though the number of red cells hasnt changed

Question 7

what is the normal response to anaemia?

Answer 7

produce more red cells

Question 8

what is reticulocytosis?

Answer 8

the increased production of red cells

Question 9

what are reticulocytes?

Answer 9

red cells that have just left the bone marrow

Question 10

what size are reticulocytes and what effect does this have on MCV?

Answer 10

larger than red cells

increase MCV

Question 11

describe the appearance of reticulocytes on blood film

Answer 11

stain darker red due to containing remnants of RNA

creates a polychromic picture

Question 12

how long does it take for up regulation of reticulocytes in response to anaemia to occur?

Answer 12

usually around a week

Question 13

what is anaemia with low MCV called?

Answer 13

microcytic anaemia

Question 14

what is anaemia with high MCV called?

Answer 14

macrocytic anaemia

Question 15

what causes microcytic anaemias?

Answer 15

defects in Hb synthesis combined with intact nuclear machinery allowing division into small cells

Question 16

what are the building blocks of Hb?

Answer 16

haem = iron + porphyrin 
globin = proteins

Question 17

are the cells in microcytic anaemia hypochromic or hyperchromic

Answer 17

hypochromic

Question 18

what are the five causes of microcytic anaemias?

Answer 18

thalassaemia 
anaemia of chronic disease 
iron deficiency 
lead poisoning 
sideroblastic anaemia

Question 19

what are the two causes of a haem deficiency?

Answer 19

lack of iron

problems with porphyrin synthesis

Question 20

what is the most common cause of microcytic anaemia?

Answer 20

iron deficiency

Question 21

what two things can rarely cause anaemia by causing problems with porphyrin synthesis?

Answer 21

lead poisoning

congenital sideroblastic anaemias

Question 22

what disease can result in a microcytic anaemia by causing a globin deficiency?

Answer 22

thalassaemia

Question 23

what are the two states in which iron can exist?

Answer 23

Fe2+ = ferrous 
Fe3+ = ferric

Question 24

what type of iron is required for oxygen transportation?

Answer 24

ferrous (Fe2+)

Question 25

how can iron be toxic to the body?

Answer 25

generates free radicals if going from Fe2+ to Fe3+

Question 26

around how much iron is absorbed per day?

Answer 26

1mg/day

Question 27

where is most iron in the body found?

Answer 27

in Hb

Question 28

how can you roughly calculate the mg of iron present in the body at any time?

Answer 28

blood volume divided by two

Question 29

what transfers iron from the iron stores to the Hb?

Answer 29

transferrin

Question 30

how is iron taken up into the erythroid cells?

Answer 30

via transferrin receptors

Question 31

where is the major site of iron storage in the body?

Answer 31

the liver

Question 32

how is iron stored?

Answer 32

in ferritin molecules

Question 33

what test can be done to assess functional iron status?

Answer 33

Hb concentration

Question 34

what can be measured to assess transported iron status?

Answer 34

serum iron transferrin transferrin saturation

Question 35

what can be measured to assess storage iron status?

Answer 35

serum ferritin reflects intracellular ferritin levels

Question 36

what happens to saturation of transferrin in iron deficiency?

Answer 36

reduces

Question 37

what happens to saturation of transferrin in anaemia of chronic disease?

Answer 37

reduced

Question 38

what happens to saturation of transferrin in genetic haemochromatosis?

Answer 38

increased

Question 39

what do low ferritin levels suggest?

Answer 39

an iron deficiency

Question 40

what is the first change seen in iron deficiency?

Answer 40

ferritin falls as iron stores are exhausted

Question 41

what change can be seen when iron deficient erythropoeisis begins occurring?

Answer 41

fall in MCV - cells become microcytic

Question 42

what epithelial changes can be seen in patients with chronic iron deficiency?

Answer 42

dry skin koilonychia angular chelitis

Question 43

what are the three possible causes of iron deficiency?

Answer 43

lack of dietary intake losing iron due to blood loss malabsorptio n

Question 44

where is iron absorbed?

Answer 44

proximal small bowel

Question 45

what are the two conservative measures that should be taken for patients with iron deficiency?

Answer 45

review their diet improve their gastric acidity review other medications

Question 46

why is improving gastric acidity beneficial for iron deficiency?

Answer 46

gastric acid is needed for the absorption of non-haem iron

Question 47

which type of iron is absorbed more easily?

Answer 47

haem iron

Question 48

what is the aim of treatment in ID anaemia?

Answer 48

normalise Hb | restore iron stores

Question 49

when will ferritin rise in ID anaemia?

Answer 49

when Hb returns to normla

Question 50

what increase in Hb is possible by health marrow if well supplied with iron?

Answer 50

7-10g/L per week

Question 51

what two methods of administration can be used for iron?

Answer 51

oral | IV

Question 52

name an oral iron preparation

Answer 52

ferrous fumarate

Question 53

what dose of oral iron is usually given?

Answer 53

100-200mg daily

Question 54

what oral iron is used in paeds?

Answer 54

sodium feredetate (sytron) has a lower iron concentration

Question 55

what are the possible side effects of oral iron?

Answer 55

GI symptoms such as constipation, N+V, abdo pain and dark stools

Question 56

how long does iron therapy need to be given for to replenish stores?

Answer 56

2-3 months

Question 57

what should be monitored to assess the response to iron?

Answer 57

rise in Hb, MCV and reticulocytes

Question 58

what is normal haemoglobin for children aged 6 months to 6 years?

Answer 58

above 110

Question 59

what is normal haemoglobin for children 6-14?

Answer 59

above 120

Question 60

what is normal haemoglobin for adult males?

Answer 60

above 130

Question 61

what is normal haemoglobin for adult females?

Answer 61

above 120

Question 62

what is normal haemoglobin for pregnant females?

Answer 62

above 110

Question 63

what should you look for if you suspect haemolytic anaemia?

Answer 63

evidence of RBC breakdown products | reticulocytosis

Question 64

what are possible causes of macrocytosis without a significant anaemia?

Answer 64

hypothyroidism alcohol liver disease

Question 65

what is renal anaemia?

Answer 65

an anaemia of chronic disease due to failure of erythropoietin production