Anaemia

Question 1

What is the normal Hb range?

Answer 1

115g/l for women
130g/l for males

Question 2

spherocytosis
(Hereditary spherocytosis) (HS):

Answer 2

defect of the RBC membrane
hereditary
RBCs are rounded and spherical
- most common in Northern Europe​

– mutation = malfunctional proteins that cause interactions between the cytoskeleton and lipid bilayer of the red cell
– lipid bilayer of RBC membrane unsupported by cytoskeleton
– cells become spherical

Question 3

elliptocytosis

Answer 3

defect of the RBC membrane
hereditary disorder
RBCs appear oval

Question 4

thalassaemia

Answer 4

Defect of haemoglobin production – too little made
- defunct production of α and β globin chains
- mainly affects people of Mediterranean, south Asian, southeast Asian and Middle Eastern origin

Question 5

Oxyhaemoglobin

Answer 5

haemoglobin bound to oxygen​

Question 6

where does oxygen loading take place?

Answer 6

in the lungs

Question 7

Deoxyhaemoglobin

Answer 7

haemoglobin after oxygen has diffused into tissues
(reduced Hb)

Question 8

Carbaminohaemoglobin

Answer 8

haemoglobin bound to carbon dioxide

Question 9

where does carbon dioxide loading take place?

Answer 9

in the tissues

Question 10

Transferrin

Answer 10

glycoprotein which transports iron and binds to transferrin receptors on certain immature RBCs
creates a transferrin/receptor complex

Question 11

where does iron absorption occur?

Answer 11

mostly in duodenum

Question 12

How does lifestyle have an effect on anemia diagnosis?

Answer 12

Not as much energy output – higher Hb not needed ​
Not classed as aneamic

Smaller person will have less heamoglobin and lower BCC than a bigger person

Question 13

what is the rule of anaemia diagnosis if the patient doesn’t exhibit any symptoms?

Answer 13

no symptoms = no diagnosis, no disease

Question 14

what does MCV measure and how is it used as an indicator of anaemia?

Answer 14

measures the size of red blood cells

It classifies anaemias based on size:
Microcytic (small) MCV <77fl​
Normocytic (normal) MCV 78-99fl​
Macrocytic (big) MCV >100fl​

Question 15

what is the reference range of MCV?

Answer 15

80-99fl

Question 16

Microcytic anaemia

Answer 16

MCV <77fl​ (small RBCs)

Question 17

Normocytic anaemia

Answer 17

MCV 78-99fl​ (normal sized RBCs)

Question 18

Macrocytic anaemia

Answer 18

MCV >100fl​ (Large RBCs)

Question 19

hypochromia

Answer 19

RBCs exhibit less colour on blood film
due to less haemaglobin = less red pigment

Question 20

rank the most likely causes of anaemia

Answer 20

iron deficiency anaemia​

Thalassaemia

General haemoglobin defects​

Metal poisoning (lead, aluminium)​

Question 21

causes of iron deficiency anaemia

Answer 21

poor diet​ - most common

Blood loss (GI, menorrhagia)​

Increased demand (pregnancy, growth)​

Dialysis​

Hookworm infestation​

Haemoglobinuria (paroxysmal nocturnal, bladder cancer)​

Epistaxis​

Question 22

3 stages of iron deficiency anaemia

Answer 22

Prelatent
​– Reduction in iron stores without reduced serum iron levels​

Hb (N)
MCV (N)
iron absorption (incr.), transferrin saturation (N),
serum ferritin (Decr.),
marrow iron (Decr.)​

Latent​
– Iron stores are exhausted, but the blood haemoglobin level remains normal​

Hb (N),
MCV (N),
serum ferritin (Decr.),
transferrin saturation (Decr.), marrow iron (absent)​
​

Iron Deficiency Anemia​
– Blood haemoglobin concentration falls below the lower limit of normal​

Hb (Decr),
MCV (Decr),
serum ferritin (Decr),
transferrin saturation (Decr),
marrow iron (absent)​

Question 23

How would Iron Deficiency anaemia show on a blood film?

Answer 23

Target cells​

Hypochromia​ - less pigment and larger white centre

Microcytes​ - small

Anisopoikilocytosis​:
combination of
- anisocytosis - irregular size
- poikilocytosis - irregular shape

Question 24

How can you identify iron deficiency anaemia through blood tests?

Answer 24

• Blood film – irregular size, shape and colour. Target cells present
• Low serum iron and ferritin (biochemistry)​
• Red cell indices fall in proportion to severity, platelet count can rise​

Question 25

what is likely causing Normocytic Anaemia​?

Answer 25

Acute blood loss​ Hereditary spherocytosis (this lecture)​ Haemolytic anaemias​ Auto immune disease​ Sickle cell (next lecture)​ Anaemia of Chronic Disease (Cancer, kidney disease, renal failure, rheumatoid arthritis)​

Question 26

what are some unlikely, rare causes of Normocytic Anaemia?

Answer 26

South East Asian ovalocytosis​ Paroxysmal nocturnal haemoglobinuria​ G6PD deficiency​

Question 27

Causes of B12 deficiency:​

Answer 27

Inadequate diet (vegans need Marmite)​ Intestinal issues (Crohn’s disease/tapeworm)​ Overuse of stocks (pregnancy/haematological disease)​ Liver disease​ Malabsorption​ Drug treatments​

Question 28

Normocytic Anaemia​ causes

Answer 28

Acute blood loss​ Hereditary spherocytosis​ Haemolytic anaemias​ Auto immune disease​ Sickle cell Anaemia of Chronic Disease (Cancer, kidney disease, renal failure, rheumatoid arthritis)​

Question 29

Hereditary Haemolytic Anaemias (HHAs)

Answer 29

Anaemia caused by an increased rate in RBC destruction includes Hereditary spherocytosis (HS)

Question 30

Hereditary spherocytosis (HS)

Answer 30

Hereditary spherocytosis (HS): -- mutation = malfunctional proteins that cause interactions between the cytoskeleton and lipid bilayer of the red cell -- lipid bilayer of RBC membrane unsupported by cytoskeleton -- cells become spherical

Question 31

Hereditary spherocytosis (HS) – Clinical features​

Answer 31

Variable clinical picture (severe neonatal haemolytic anaemia to an asymptomatic state)​ Presents at any age​ Jaundice fluctuates​ Splenomegaly in the majority of cases​ Autosomal dominant​

Question 32

How would Hereditary spherocytosis (HS) present of blood film?

Answer 32

Reticulocytes (immature red cells)​ Spherocytes​ Reduced MCV but raised MCH (the cells are dense with haemoglobin)​ Anaemia – severity is similar in family members​

Question 33

Autoimmune Haemolytic Anaemia (AIHA)

Answer 33

immune cells attacking RBCs

Question 34

what does warm/cold Autoimmune Haemolytic Anaemia refer to?

Question 35

Describe a treatment plan for someone with iron deficiency anaemia:​

Answer 35

drugs in the form of