Anaemia

Question 1

Haemoglobin levels in anaemic Px

Answer 1

In F <120

in M <140

Question 2

MCV vs MCH

Answer 2

Mean corpuscular volume - mean cell size

Mean corpuscular Haemoglobin (MCH) Haemoglobin amount per RBC

Question 3

What does MCV tell you?

Answer 3

Microcytic if <80
Normocytic if 80-100
Macrocytic if >100

Question 4

Causes of Microcytic Anaemia

Answer 4

Iron deficiency

Thalassaemia

lead poisoning

Anaemia of chronic disease (More common in normocytic tho)

Question 5

What is the commonest cause of microcytic anaemia

Answer 5

Iron Deficiency

Question 6

What does a blood film look like in iron deficiency anaemia

Answer 6

Hypochromic

RBC look like they have a hole in the middle but they are pale because of low Hb

Question 7

Causes of Iron deficiency anaemia

Answer 7

inadequate intake - vegetarians/vegans

impaired absorption - Coeliac disease, Crohn’s

Chronic blood loss - menstruation, GI malignancy, Hookworm

Question 8

Where is iron absorbed in the body?

Answer 8

Duodenum and upper jejunum

Question 9

Normocytic Anaemia causes?

Answer 9

Anaemia of chronic disease

Acute blood loss

Haemolytic anaemia

Question 10

Macrocytic Anaemia causes?

Answer 10

Folate deficiency
B12 deficiency
Alcohol
liver disease
Hypothyroidism - why? - check TSH
Drugs - phenytoin
Reticulocytosis

Question 11

What does the blood film look like in thalassaemia

Answer 11

Target cells

Question 12

What is reticulocytosis

Answer 12

Increased reticulocytes (immature RBC)

Question 13

What is haemolytic anaemia

Answer 13

it is the anaemia caused by haemolysis

haemolysis can be caused by acquired or inherited causes

Question 14

How does anaemia present

Answer 14

Many are asymptomatic
Lethargy
Dysponoea
Chest pain
Sx of cardiac failure
Sx related to blood loss - Menorrhagia, altered bowel habits, dyspepsia

Question 15

What is dyspepsia?

Answer 15

indigestion

Question 16

75 F seeing GP because of feeling tired and washed out. Lost 1 stone in last 3 Months
What would you ask

Answer 16

Is weight loss intentional?
any pain? abdo pain?
Bleeding from anywhere? vomiting or back passage?
bowel habits?
water works
tell me about your sleep
Swallowing difficulty? did it change since started?

Question 17

what are the ALARM Symptoms

Answer 17

Anaemia
Loss of weight
Anorexia
Recent osnet of progressive symptoms
Malaena/haematamesis
Swallowing difficulty? did it change since started?

Question 18

what is dysphagia

Answer 18

difficulty swallowing

Question 19

what is odynophagia

Answer 19

painful swallowing

Question 20

what is malaena

Answer 20

dark sticky faeces mixed with partly digest food and blood

Question 21

haematemesis

Answer 21

vomiting blood

Question 22

42M in A&E cuz he “turned yellow”, itching and a little confused
Take a history

Answer 22

When did it start
happened before
pain?
bleeding? PR or vomiting
when itchy started?
Alcohol?

Question 23

what to ask about alcohol?

Answer 23

What u drink?
How much in one day
When do u drink

Question 24

22F in GP complaining of being very tired in last 2 months

Take a history

Answer 24

Sleep
travel
work
stress
pain? abdo Sx? cramping?
SOB
cardiac Sx
bleeding? vomiting or PR
periods? heavy?
bowel habits
coeliac?

Question 25

What Sx can B12 and folate deficiency give

Answer 25

Loose stools
intermittent abdo cramping
macrocytic anaemia

Question 26

What Sx occur with increased bilirubin

Answer 26

Yellow appearance

Itching

Question 27

Sideroblastic Anaemia

Answer 27

Microcytic anaemia - think of sideroblastic anaemia when iron Rx is not effective

A bone marrow problem - investigate bone marrow

haemosiderin within mitochondria

Alcoholism

Hereditary