Anaemia

Question 1

What is the definition of anaemia?

Answer 1

A reduced total red blood cell mass

Question 2

What is the main marker used for anaemia?

Answer 2

Haemoglobin concentration

Haematocrit also used

Question 3

What haemoglobin concentration indicates anaemia in men and women?

Answer 3

Men <130g/l

Women <120g/l

Question 4

What method is used to measure haemoglobin concentration?

Answer 4

Spectrophotometric

Question 5

What is haematocrit?

Answer 5

The concentration of whole blood that is red cells

Question 6

When might haemoglobin concentration not be a good marker of anaemia?

Answer 6

Massive haemorrhage

Haemodilution

Question 7

What is the body’s natural response to anaemia?

Answer 7

Reticulocytosis - increase red cell production

Question 8

How will blood film appear in patients undergoing reticulocytosis?

Answer 8

Polychromatic

Question 9

What aspects of red blood cells are measured?

Answer 9

Haemoglobin concentration
Number of red cells
Size of red cells

Question 10

What are the two main pathophysiological causes of anaemia?

Answer 10

Decreased production

Increased loss/destruction of red cells

Question 11

If there is decreased production of red cells, will reticulocyte count be low or high?

Answer 11

Low

Question 12

What are the two main types of decreased production of red cells?

Answer 12

Hypoproliferative (reduced amount)

Maturation abnormality

Question 13

What can cause increased loss/destruction of red cells?

Answer 13

Bleeding

Haemolysis

Question 14

Where are the sites of defect in a maturation abnormality?

Answer 14

Cytoplasm

Nucleus

Question 15

A cytoplasmic defect results in impaired what?

Answer 15

Haemoglobinisation

Question 16

A nucleus defect results in impaired what?

Answer 16

Cell division

Question 17

If mean cell volume is low, there are problems with what?

Answer 17

Haemoglobinisation

Question 18

Problems with cell division results in a low/high/normal MCV

Answer 18

High

Question 19

In cells where there is a problem with haemoglobin, how will the cells appear?

Answer 19

Microcytic (small)

Hypochromic (lacking in colour)

Question 20

What are the two main causes of microcytic anaemias?

Answer 20

Heme deficiency

Globin deficiency

Question 21

Give some causes of heme deficiency

Answer 21

Iron deficiency

Problems with porphyrin synthesis

Question 22

What is it called when you cannot make globin chains?

Answer 22

Thalassaemia

Question 23

What carries iron in the blood?

Answer 23

Transferrin

Question 24

What is iron stored as in the body? Where is it mainly stored?

Answer 24

Ferritin

Liver

Question 25

A combination of what confirms iron deficiency?

Answer 25

Anaemia | Low serum ferritin

Question 26

Give some causes of iron deficiency

Answer 26

Diet Blood loss Malabsorption

Question 27

What is macrocytic anaemia?

Answer 27

An anaemia where the red cells have a larger than normal volume

Question 28

On a blood film, the size of a red blood cell should be the same size as what?

Answer 28

Nucleus of a mature small lymphocyte

Question 29

What are the two main groups of causes of macrocytosis?

Answer 29

Megaloblastic | Non-megaloblastic

Question 30

What is a megaloblast?

Answer 30

An abnormally large nucleated red cell precursor with an immature nucleus

Question 31

Megaloblastic anaemias are characterised by defects in what?

Answer 31

DNA synthesis | Nuclear maturation

Question 32

In megaloblasts, cytoplasmic development and haemoglobin accumulation is normal. True/false?

Answer 32

True

Question 33

Why does anaemia occur even though the red cells are bigger than normal?

Answer 33

Because many more of the red cell precursors undergo apoptosis

Question 34

What are the main causes of megaloblastic anaemia?

Answer 34

Vitamin B12 deficiency | Folate deficiency

Question 35

Why does B12/folate deficiency result in megaloblastic anaemia?

Answer 35

As they are essential co-factors in nuclear maturation

Question 36

The folate cycle is important in what?

Answer 36

Nucleoside synthesis

Question 37

What nucleoside synthesis is the folate cycle particularly important in?

Answer 37

Uridine to thymidine

Question 38

Vitamin B12 is an important part of which cycle?

Answer 38

Methionine cycle

Question 39

Once vitamin B12 enters the stomach in food, it is bound to what?

Answer 39

R-protein

Question 40

What hormone is released by gastric parietal cells?

Answer 40

Intrinsic factor

Question 41

Where does vitamin B12 bind to intrinsic factor?

Answer 41

Duodenum

Question 42

The intrinsic factor-B12 complex binds to which receptors in the ileum?

Answer 42

Cubulin

Question 43

Give some causes of vitamin B12 deficiency

Answer 43

``` Veganism Pernicious anaemia Atrophic gastritis Achlorhydia Coeliac disease Crohn's disease ```

Question 44

What is pernicious anaemia?

Answer 44

An autoimmune condition with destruction of gastric parietal cells

Question 45

Where is folate absorbed?

Answer 45

Jejunum

Question 46

Give some causes of folate deficiency

Answer 46

Inadequate intake Malabsorption Haemolysis Pregnancy

Question 47

What group of people are particularly prone to getting folate deficiency?

Answer 47

Alcoholics

Question 48

Which drug is known to cause folate deficiency?

Answer 48

Phenytoin

Question 49

Give some clinical features of B12/folate deficiency

Answer 49

``` Fatigue Shortness of breath Weight loss/diarrhoea Glossitis Jaundice Developmental problems ```

Question 50

What system tends to be more affected by a deficiency in B12?

Answer 50

Neurological

Question 51

A vitamin B12 deficiency will commonly affect which part of the spinal cord?

Answer 51

Dorsal column

Question 52

What does the blood film of a macrocytic anaemia show?

Answer 52

Hypersegmented neutrophils | Macrovalocytes

Question 53

What antibodies can be measured to diagnose macrocytic anaemia?

Answer 53

Anti-intrinsic factor | Anti-gastric parietal cell

Question 54

What are the main flaws of using auto-antibodies to diagnose macrocytic anaemia?

Answer 54

Anti-GPC has poor specificity | Anti-IF has poor sensitivity

Question 55

How is pernicious anaemia treated?

Answer 55

Vitamin B12 injections for life

Question 56

How is folate deficiency treated?

Answer 56

Folic acid tablets 5mg per day

Question 57

Give some causes of non-megaloblastic macrocytosis

Answer 57

Alcohol Liver disease Hypothyroidism Marrow failure

Question 58

What occurs in spurious macrocytosis?

Answer 58

Volume of mature red cell is normal but MCV is high

Question 59

What are the two main causes of spurious macrocytosis?

Answer 59

Reticulocytosis | Cold-agglutinins

Question 60

How does increased reticulocytosis cause spurious macrocytosis?

Answer 60

As reticulocytes are bigger than mature red cells and are analysed as well for MCV