Anaemia

Question 1

What is the definition of anaemia?

Answer 1

A reduced total red cell mass

Question 2

What will happen to the reticulocyte count in anaemias caused by a decreased production of red blood cells?

Answer 2

Low reticulocyte count

Question 3

What will happen to the reticulocyte count in anaemias caused by an increased loss or destruction of red blood cells?

Answer 3

High reticulocyte count

Question 4

What are the two main examples of anaemia caused by increased loss or destruction of red blood cells?

Answer 4

Bleeding and haemolysis

Question 5

A blood film which is ‘polychromatic’ suggests the presence of what cells?

Answer 5

Reticulocytes

Question 6

What products of red blood cell breakdown may be present in excess in patients with haemolytic anaemia?

Answer 6

Serum unconjugated bilirubin and urinary urobilinogen

Question 7

What type of murmur may be heard in patients with anaemia?

Answer 7

Ejection systolic murmur loudest over the apex

Question 8

What cause of a microcytic, hypochromic anaemia is caused by a deficiency of globin chains, rather than a deficiency of haem?

Answer 8

Thalassaemia

Question 9

What type of anaemia (i.e. micro, normo or macrocytic) is sideroblastic anaemia?

Answer 9

Microcytic anaemia

Question 10

What is the most common cause of microcytic anaemia?

Answer 10

Iron deficiency

Question 11

What happens to the ferritin level in microcytic anaemia caused by iron deficiency?

Answer 11

Low ferritin

Question 12

What happens to the ferritin level in microcytic anaemia not caused by iron deficiency?

Answer 12

High/normal ferritin

Question 13

What happens to the total iron binding capacity in microcytic anaemia caused by iron deficiency?

Answer 13

High total iron binding capacity

Question 14

What happens to the total iron binding capacity in microcytic anaemia not caused by iron deficiency?

Answer 14

Low total iron binding capacity

Question 15

What happens to the % saturation of transferrin in iron deficiency anaemia?

Answer 15

Low % saturation of transferrin

Question 16

What happens to the % saturation of transferrin in anaemia of chronic disease?

Answer 16

Low % saturation of transferrin

Question 17

A blood film showing anisopoikilocytosis, target cells and pencil pokilocytes is suggestive of what diagnosis?

Answer 17

Iron deficiency anaemia

Question 18

What are the three main reasons for being iron deficient, leading to anaemia?

Answer 18

Blood loss, insufficient nutritional intake, reduced absorption

Question 19

What diagnosis should always be considered in men or post-menopausal women with iron deficiency anaemia?

Answer 19

GI blood loss

Question 20

What condition is most likely to cause a deficiency of iron absorbed, leading to anaemia?

Answer 20

Coeliac disease

Question 21

What is the treatment for iron deficiency anaemia?

Answer 21

Oral ferrous sulphate

Question 22

How long should ferrous sulphate be taken for when treating iron deficiency anaemia?

Answer 22

For 3 months after the deficiency has been corrected

Question 23

What are some common side effects of taking oral ferrous sulphate?

Answer 23

Nausea, abdominal pain, altered bowel habit

Question 24

What are the main causes of megaloblastic macrocytic anaemia?

Answer 24

B12 and/or folate deficiency

Question 25

What are the main causes of non-megaloblastic macrocytic anaemia?

Answer 25

Alcohol, liver disease, hypothyroidism, pregnancy

Question 26

What are the main causes of spurious (false) macrocytosis?

Answer 26

Reticulocytosis and cold agglutinins

Question 27

Vitamin B12 travels down the gut bound to what?

Answer 27

Intrinsic factor

Question 28

Where is vitamin B12 absorbed?

Answer 28

Terminal ileum

Question 29

What lifestyle choice can lead to an inadequate intake of of vitamin B12?

Answer 29

Vegan diet

Question 30

What is the most common cause of vitamin B12 deficiency?

Answer 30

Pernicious anaemia

Question 31

Which disease of the bowel is most likely to cause a deficiency of vitamin B12?

Answer 31

Crohn's disease

Question 32

What is the pathophysiology behind pernicious anaemia?

Answer 32

An autoimmune destruction of gastric parietal cells resulting in a deficiency of intrinsic factor

Question 33

What lifestyle choice can lead to an inadequate intake of folate?

Answer 33

Alcoholism

Question 34

What drugs are recognised as a cause of folate deficiency?

Answer 34

Anti-convulsants, particularly phenytoin

Question 35

How long do stores of vitamin B12 last for in the body?

Answer 35

2-4 years

Question 36

How long do stores of folate last for in the body?

Answer 36

4 months

Question 37

What is the daily requirement of vitamin B12?

Answer 37

1.5mcg

Question 38

What is the daily requirement of folate?

Answer 38

200mcg

Question 39

Where is folate absorbed?

Answer 39

Duodenum and jejunum

Question 40

A sore tongue can be a feature of which type of anaemia?

Answer 40

Megaloblastic macrocytic anaemia

Question 41

What neurological problem can vitamin B12 deficiency lead to eventually?

Answer 41

Subacute combined degeneration of the cord

Question 42

What cause of anaemia is most likely to cause neurological and neuropsychiatric features?

Answer 42

Vitamin B12 deficiency

Question 43

Are the neurological consequences which occur as a result of vitamin B12 deficiency reversible?

Answer 43

No

Question 44

A blood film showing macrovalocytes and hypersegmented neutrophils is suggestive of which type of anaemia?

Answer 44

Megaloblastic macrocytic anaemia

Question 45

What antibodies can be tested for if pernicious anaemia is suspected as a diagnosis?

Answer 45

Anti-GPC and anti-IF

Question 46

How is pernicious anaemia treated?

Answer 46

Vitamin B12 injections for life

Question 47

Why should you never give folic acid tablets before treating B12 deficiency, unless the B12 level is known to be normal?

Answer 47

This can precipitate subacute combined degeneration of the cord

Question 48

What type of anaemia (i.e. micro, normo, macrocytic) does aplastic anaemia cause?

Answer 48

Normocytic

Question 49

What is the most common cause of a normocytic anaemia?

Answer 49

Anaemia of chronic disease

Question 50

What happens to the serum iron in anaemia of chronic disease?

Answer 50

Low serum iron

Question 51

What happens to the ferritin level in anaemia of chronic disease?

Answer 51

Normal or increased serum ferritin

Question 52

What is the congenital cause of aplastic anaemia?

Answer 52

Fanconi's anaemia

Question 53

How is Fanconi's anaemia inherited?

Answer 53

Autosomal recessive

Question 54

Which spinal cord tract is affected first by vitamin B12 deficiency?

Answer 54

Dorsal columns

Question 55

If there is no neurological involvement, how is vitamin B12 deficiency treated?

Answer 55

1mg IM injection of vitamin B12 3 times weekly for 2 weeks, then once every 3 months