Anaemia

Question 1

What are the microcytic causes of anaemia?

Hint: TAILS

Answer 1

Thalassaemia
Anaemia of chronic disease
Iron-deficiency anaemia
Lead poisoning
Sideroblastic anaemia

Question 2

What are the normocytic causes of anaemia?

Hint: 3As, 2Hs

Answer 2

Acute blood loss
Anaemia of chronic disease
Aplastic anaemia/crisis
Haemolytic anaemia - spherocytosis, elliptocytosis, G6PD deficiency, autoimmune haemolytic
Hypothyroidism

Question 3

What are the 2 causes of a megaloblastic macrocytic anaemia?

Answer 3

B12 deficiency

Folate deficiency

Question 4

What are the 5 causes of a non-megaloblastic macrocytic anaemia?

Answer 4

Alcohol
Reticulocytotic - haemolysis or blood loss
Hypothyroidism
Liver disease
Drugs e.g. azothioprine

Question 5

What would expected results for serum iron, ferritin, transferrin saturation and TIBC levels in iron-deficiency anaemia?

Answer 5

Low iron
Low ferritin
Low transferrin saturation
High TIBC

Question 6

What is the common antibody in pernicious anaemia?

Answer 6

Intrinsic factor

anti-gastric parietal cell antibodies less commonly

Question 7

What anaemia are “target-cells” seen in?

Answer 7

Iron deficiency anaemia

Question 8

What anaemias are Heinz bodies seen in? (2)

Answer 8

G6PD deficiency

alpha-thalassaemia

Question 9

What are reticulocytes? What group of anaemias are they seen in?

Answer 9

Immature RBCs

Haemolytic anaemias
Haemorrhagic (acute blood loss)

Question 10

What are schistocytes? What anaemias are they seen in?

Answer 10

RBC fragments

Haemolytic anaemias
+ other conditions e.g. DIC, TTP, HUS

Question 11

What anaemia are spherocytes seen in?

Answer 11

Hereditary spherocytosis

Question 12

What happens to mean corpuscular Hb concentration in hereditary spherocytosis?

Answer 12

Raised HCHC

Question 13

What complication may occur when someone with hereditary spherocytosis gets infected with Parvovirus?

Answer 13

Aplastic crisis

Question 14

What anaemia presents with:
A normochromic, normocytic anaemia.
Leukopenia - but lymphocytes mostly normal.
Thrombocytopenia.

Answer 14

Aplastic crisis

Question 15

What is acute and definite management of hereditary spherocytosis?

Answer 15

Acute - support and transfuse if necessary

Definitive - folate and splenectomy

Question 16

What patient group is affected by hereditary spherocytosis?

Answer 16

Neonates

European descent

Males and females equally affected

Question 17

What is the inheritance pattern of hereditary spherocytosis?

Answer 17

Autosomal dominant

Question 18

What patient group is affected by G6PD deficiency?

Answer 18

Neonates

African descent

Only males (x-linked recessive)

Question 19

What is the inheritance pattern of G6PD deficiency?

Answer 19

X-linked recessive

Question 20

What anaemia are “bite” and “blister” cells seen in?

Answer 20

G6PD deficiency

Question 21

What is a specific test for autoimmune haemolytic anaemia?

Answer 21

(Positive) direct antiglobulin test - aka Coombs test

Question 22

What are the antibody types in warm- and cold-type autoimmune haemolytic anaemia?

Answer 22

IgG (usually) in warm

IgM in cold

Question 23

What is the management for AIHA?

Answer 23

Transfusion - acutely

Prednisolone + rituximab (in warm-type)

Splenectomy

Question 24

What are thalassaemic patients at risk of? How is this complication managed?

Answer 24

Iron overload

Iron chelation (desferrioxamine)

Question 25

What would expected results for serum iron, ferritin, transferrin saturation and TIBC levels in haemachromatosis?

Answer 25

High iron High ferritin High transferrin saturation Low TIBC

Question 26

How would beta-thalassaemia trait present on blood film?

Answer 26

Mild hypochromic, microcytic anaemia

Question 27

What thalassaemia demonstrates a HbA2 > 3.5%

Answer 27

Beta-thalassaemia trait and major

Question 28

Which thalassaemia would demonstrate the following: HbA2 & HbF raised. HbA absent.

Answer 28

Beta-thalassaemia major

Question 29

What disease presents with cranial bossing?

Answer 29

beta-thalassaemia major

Question 30

In what disease would blood film demonstrate target cells and beta-4 tetramers?

Answer 30

Alpha-thalassaemia

Question 31

What anaemia may disease or surgery of the terminal ileum precipitate?

Answer 31

B12 deficiency

Question 32

What may a beefy-red, swollen tongue indicate?

Answer 32

B12 deficiency

Question 33

What would expected results for serum iron, ferritin, transferrin saturation and TIBC levels in anaemic of chronic disease?

Answer 33

Low iron High ferritin Low transferrin saturation Low TIBC

Question 34

There is a combined B12 and folate deficiency in a patient. Which is corrected first and why?

Answer 34

B12 first To avoid subacute degeneration of spinal cord.