Anaemia

Question 1

What produces RBCs in the bone marrow?

Answer 1

pluripotent stem cells

Question 2

Chemical regulation of the bone marrow is done by?

Answer 2

1. Cytokines
2. Erythroid specific growth factor
3. Erythropoietin (EPO)

Question 3

What is the lifespan of a reticulocyte?

Answer 3

4 days

Question 4

What is the lifespan of a RBC?

Answer 4

120 days

Question 5

What is anaemia?

Answer 5

values of hemoglobin, hematocrit or RBC counts which are more than 2 standard deviations below the mean

Question 6

Anaemia values for men and women?

Answer 6

1. HGB
   <13.5 g/dL (men)
   <12 (women)
2. HCT
   <41% (men)
   <36 (women)

Question 7

What symptoms would indicate decreased oxygen delivery to tissues?

Answer 7

1. Exertional dyspnea
2. Dyspnea at rest
3. Fatigue
4. Signs and symptoms of hyperdynamic state e.g. Bounding pulses, Palpitations

Question 8

Life threatening conditions that can causes decreased oxygen delivery to tissues?

Answer 8

1. heart failure
2. angina
3. myocardial infarction

Question 9

Signs and symptoms of hypovolemia?

Answer 9

1. Fatiguability
2. postural dizziness
3. lethargy
4. hypotension
5. shock and death

Question 10

Physical examination findings of an anemia patient?

Answer 10

1. Pallor
2. Jaundice
   - haemolysis
3. Lymphadenopathy
4. Hepatosplenomegally
5. Bony Pain
6. Petechiae
7. Rectal
   - Occult blood

Question 11

Initial testing of anemia?

Answer 11

1. FBC w/ differential (includes RBC indices)
2. Reticulocyte count
3. Peripheral blood smear

Question 12

Specific tests for bleeding?

Answer 12

1. HCT
2. Hb

Question 13

Lab tests for iron deficiency?

Answer 13

iron studies
- ferritin

Question 14

Lab tests for hemolysis?

Answer 14

1. Serum LDH
2. indirect bilirubin
3. haptoglobin
4. Coombs
5. coagulation studies

Question 15

Lab tests directed by clinical indication?

Answer 15

1. haemoglobin electrophoresis
2. B12/folate levels
3. bone marrow examination

Question 16

Classification of anemia by pathophysiology?

Answer 16

1. Blood Loss
2. Decreased Production
3. Increased Destruction

Question 17

Classification of anemia by morphology?

Answer 17

1. Normocytic
2. Microcytic
3. Macrocytic

Question 18

Causes of acute blood loss?

Answer 18

1. Traumatic
2. Variety of sources
   - Melena, haematemesis, menometrorrhagia

Question 19

Causes of chronic blood loss?

Answer 19

Occult bleeding
- Colonic polyp/carcinoma

Question 20

Causes of decreased production in anemia?

Answer 20

1. Infections
2. Neoplasms
3. Endocrine
4. Nutritional Deficiency
5. Anaemia of Chronic Disease

Question 21

Infectious causes of decreased production in anemia?

Answer 21

1. Bacterial
   - Tuberculosis
   - MAC
2. Viral
   - HIV
   - Parvovirus

Question 22

Neoplasms that cause decreased production in anemia?

Answer 22

1. Leukaemia
2. Lymphoma/Myeloma
3. Myeloproliferative Syndromes
4. Myelodysplasia

Question 23

Endocrine causes that cause decreased production in anemia?

Answer 23

1. Thyroid Dysfunction
   - Hypothyroidism
2. Erythropoietin Deficiency
   - Renal failure

Question 24

Nutritional deficiencies that cause a decreased production in anemia?

Answer 24

1. Iron
2. B12
3. Folate

Question 25

Hemolytic anemias that cause increased destruction of RBCs?

Answer 25

1. Immune mediated 2. Non-immune mediated

Question 26

Immune mediated anemias?

Answer 26

1. Cold agglutinin - Paroxysmal nocturnal haemoglobinuria - Post mycoplasmal haemolytic anaemia 2. Warm agglutinin - Drug induced - Autoimmune haemolytic anaemia - Transfusion reaction

Question 27

Non-immune mediated anemia?

Answer 27

1. extra-corpuscular 2. intra-corpuscular

Question 28

Non immune mediated extra-corpuscular anemia?

Answer 28

1. Macro-circulatory - Hypersplenism - Extracorporeal circulation 2. Micro-circulatory - DIC - TTP - HUS

Question 29

Non-immune mediated intra-corpuscular anemia?

Answer 29

1. RBC Wall (membrane or enzyme defects) 2. Haeme or globin abnormalities (HbS, C)

Question 30

Causes of normocytic anemia?

Answer 30

1. Infections 2. Malignancy 3. Early Anaemia of Chronic Disease 4. Acute blood loss 5. Obesity 6. Bone marrow failure

Question 31

Causes of anemia of chronic disease in normocytic anemia?

Answer 31

1. CKD 2. Heart failure 3. Immune mediated disease e.g. RA, Lupus, vasculitis, sarcoidosis, inflammatory bowel disease

Question 32

Causes of microcytic anemia?

Answer 32

1. MCV <80 2. Reduced iron availability 3. Reduced haeme synthesis 4. Reduced globin production

Question 33

Causes of reduced iron availability in microcytic anemia?

Answer 33

1. iron deficiency 2. anemia of chronic disease

Question 34

Causes of iron deficiency anemia?

Answer 34

1. Deficient diet/absorption 2. Increased requirements 3. Blood loss 4. Iron sequestration

Question 35

Causes of anemia of chronic disease?

Answer 35

1. Low serum iron, low TIBC, normal serum ferritin 2. Chronic infection 3. inflammation 4. cancer 5. liver disease

Question 36

Causes of reduced heme synthesis in microcytic anemia?

Answer 36

1. Lead poisoning 2. Acquired or congenital sideroblastic anaemia 3. Characteristic smear finding: basophylic stippling

Question 37

Causes of reduced globin production in microcytic anemia?

Answer 37

thalassemia

Question 38

Smear characteristics of reduced globin production in microcytic anemia?

Answer 38

1. Hypochromia 2. Microcytosis 3. Target Cells 4. Tear Drops

Question 39

Causes of macrocytic anemia?

Answer 39

1. MCV > 100 2. megaloblastic 2. non-megaloblastic

Question 40

Causes of megaloblastic macrocytic anemia?

Answer 40

1. Abnormalities in nucleic acid metabolism 2. B12 3. Folate

Question 41

Causes of non-megaloblastic macrocytic anemia?

Answer 41

1. Abnormal RBC maturation 2. Myelodysplasia 3. ETOH 3. liver disease 4. hypothyroidism 5. chemotherapy/drugs