Anaemia

Question 1

What is anaemia?

Answer 1

Reduced haemoglobin level

Question 2

In what situation would there be an anaemia, along with an increased plasma volume and increased red cell mass?

Answer 2

Pregnancy

Question 3

What type of anaemia is iron deficiency anaemia?

Answer 3

Microcytic

Question 4

What causes insufficient red blood cell production?

Answer 4

Haematinic deficiency: reduced levels of iron, folate and vitamin B12

Question 5

What would cause inefficient red blood cell production?

Answer 5

Infiltration of the bone marrow i.e. myelodysplasia

Question 6

What is the most common type of anaemia?

Answer 6

Iron deficiency anaemia

Question 7

Where is iron stored in the body?

Answer 7

In the red blood cells themselves

In the liver in the form of ferretin and haemocidrin

Question 8

What are the causes of iron deficiency anaemia?

Answer 8

Reduced intake
Increased demand e.g. pregnancy
Malabsorption
Blood loss

Question 9

What is the most common cause of iron deficiency anaemia?

Answer 9

Blood loss

Question 10

What are the most common sites of blood loss leading to iron deficiency anaemia?

Answer 10

Uterus - menstruating women

GI tract - particularly upper GI tract

Question 11

What would an FBC show in iron deficiency anaemia?

Answer 11

Reduced MCV
Reduced Hb
Reduced ferritin

Question 12

What are the main causes of non-megaloblastic anaemias?

Answer 12

Alcohol intake

Liver disease

Question 13

What four abnormalities can be noted on blood film in iron deficiency anaemia?

Answer 13

Microcytic cells
Hypochromic
Varied size and shape of cells

Question 14

How is iron deficiency anaemia treated?

Answer 14

1st line ferrous fumarate

Question 15

How long is iron supplementation prescribed?

Answer 15

Until underlying cause treated

Used until iron stores replenished and continued for 3 months after Hb back to normal

Question 16

What is the usual cause of megaloblastic anaemia?

Answer 16

B12 or folate deficiency

Question 17

What is macrocytosis?

Answer 17

Increased numbers of large red cells

Question 18

What is the pathology of the red cell in megaloblastic anaemia?

Answer 18

Large red cell with poorly matured nucleus

Question 19

Why does anaemia occur in B12 or folate deficiency?

Answer 19

Causes reduced red cell output as well as abnormal cells as these are required to form proper red blood cells

Question 20

What are the causes of B12 deficiency?

Answer 20

Reduced intake (uncommon)
Malabsorption - problems in stomach or ileum
Chronic pancreatitis

Question 21

What auto-antibodies should be tested for in blood?

Answer 21

Anti-parietal cell antibodies

Anti-intrinsic factor antibodies

Question 22

What are the problems with autoantibody tests in pernicious anaemia?

Answer 22

Anti-intrinsic factor antibodies are specific but not sensitive
Anti-parietal cell antibodies are sensitive but not specific

Question 23

What symptoms specific to B12 deficiency might be seen?

Answer 23

Neurological disturbance:
Peripheral neuropathy
Subacute combined degeneration

Question 24

Why are folate and B12 checked together?

Answer 24

If folate treatment is given when there is underlying B12 deficiency, it could cause subacute combined degeneration of the spinal cord

Question 25

What are the causes of folate deficiency?

Answer 25

Reduced dietary intake (common) Malabsorption Increased demand e.g. pregnancy Drugs e.g. methotrexate, alcohol, anti-convulsants

Question 26

What is the key diagnostic test for folate deficiency?

Answer 26

Reduced red blood cell folate

Question 27

How is folate deficiency treated?

Answer 27

Oral folate supplements

Question 28

What is the underlying cause of anaemia of chronic disease?

Answer 28

Cytokine induced failure of the transfer of iron from reticuloendothelial cells in the bone marrow to normoblasts IL-6 is produced by macrophages, which stimulate production of hepcidin, blocking the absorption of iron from the gut

Question 29

What illness is anaemia of chronic disease associated with?

Answer 29

Chronic infection e.g. TB Chronic inflammation e.g. Crohn's Malignancy

Question 30

Why is NADH important in maintaining efficient oxygen transportation?

Answer 30

Iron in the form Fe3+ means the Hb is oxidised In this state is it not effective at transporting oxygen and so free iron is left to travel in the blood NADH maintains iron in the Fe2+ state and prevents oxidation of haemoglobin

Question 31

What is the treatment for anaemia of chronic disease?

Answer 31

Erythropoetin injections | Regular blood transfusions

Question 32

What are the two main causes of sprurious macrocytosis?

Answer 32

Reticulocytosis | Cold agglutination

Question 33

What is a reticulocyte?

Answer 33

An immature red blood cell that has just left the bone marrow and is larger than the average red blood cell

Question 34

What does deficiency of any of the components of haemoglobin do to the red blood cell affected?

Answer 34

Produces small red blood cells with reduced amounts of haemoglobin

Question 35

What does reticulocytosis indicate?

Answer 35

Indicates compensatory erythropoesis is occurring to replenish numbers of red blood cells,

Question 36

What are the two main causes of reticulocytosis?

Answer 36

Blood loss | Haemolysis

Question 37

Why does cold agglutinin disease appear as macrocytic anaemia?

Answer 37

The analyser gets confused as clumps of ‘agglutinated’ red cells go through and are registered as 1 big cell

Question 38

What is the risk associated with chronic transfusions?

Answer 38

Free iron will begin to circulate in the blood and potentially generate free radicals

Question 39

What is needed to make Hb?

Answer 39

Haem Globin Fe2+ Porphyrin ring

Question 40

What kind of globin is found in adults?

Answer 40

Alpha and beta

Question 41

What does deficiency of any of the components of haemoglobin do to the red blood cell affected?

Answer 41

Produces small red blood cells with reduced amounts of haemoglobin

Question 42

What is thalassaemia?

Answer 42

An autosomal recessive disorder causing abnormal formation of haemoglobin, resulting in a microcytic anaemia

Question 43

Why is iron freely circulating the body toxic?

Answer 43

It can generate free radicals

Question 44

What form is iron stored in when not bound to haemoglobin?

Answer 44

Ferritin

Question 45

What is the risk associated with chronic transfusions?

Answer 45

Free iron will begin to circulate in the blood and potentially generate free radicals

Question 46

What is transferrin?

Answer 46

A transporter molecule with two binding sites for iron

Question 47

When is transferrin saturation reduced?

Answer 47

It reflects supply of iron, therefore reduced in iron deficiency and anaemia of chronic disease