Anaemia

Question 1

What are the 4 mechanisms of anaemia?

Answer 1

reduced production of red cells/haemoglobin by the bone marrow

reduced survival of red cells in the circulation (haemolysis).

loss of blood from the body

pooling of red cells in a very large spleen.

Question 2

What are the three classifications of anaemia? (size)

Answer 2

Microcytic
Normocytic
Macrocytic

Question 3

What are reticulocytes?

Answer 3

Early red cells

Question 4

What is ferritin?

Answer 4

Cellular store of iron

Question 5

What is a classic form of microcytic anaemia?

Answer 5

Iron deficiency

Question 6

What is ESR (process)?

Answer 6

Rate at which red cells fall in test tube

Question 7

What does ESR stand for?

Answer 7

Erythrocyte sedimentation rate

Question 8

Why do rouleaux develop?

Answer 8

Increased number of plasma proteins with positive charge
Attract red cells
Stacking of coins

Question 9

What is anaemia of chronic disease?

Answer 9

Characterised by pattern of low-normal transferrin
No obvious cause except that the patient is ill
Diagnosis by exclusion

Question 10

What is the issues with measuring

Answer 10

Not very sensitive measure of iron stores

Question 11

What causes low MCV?

Answer 11

Iron deficiency
Alpha/Beta Thalassemia
Anaemia of chronic disease

Question 12

What laboratory tests can be conducted to diagnose microcytic anaemia?

Answer 12

Iron screening

Question 13

What comprises an iron screening

Answer 13

Ferritin
Serum iron
Transferrin
Transferrin saturation
Hb electrophoresis

Question 14

What question should you ask in iron defficency?

Answer 14

Heavy menstrual blood loss
Menopausal and bleeding?
Diet - vegan/vegetarian
GI symptoms: dysphagia
Weight loss
Medication e.g. NSAIDS, asprin

Question 15

What are features of iron deficiency anaemia?

Answer 15

Glossitis
Angular stomatitis
Koilonychia

Question 16

She reports weight loss, what investigations should you carry out?

Answer 16

Investigation for blood in the stool
GI investigations
Coeliac antibody testing

Question 17

What is haemolysis?

Answer 17

Breakdown of red blood cells

Shortened lifespan

Question 18

What are causes of inherited haemolytic anaemia?

Answer 18

Membrane abnormalities
Abnormal Hb
Metabolic pathways

Question 19

Why is MCV raised in haemolytic anaemia?

Answer 19

Reticulocytes are larger

Question 20

What are heinz bodies?

Answer 20

Precipitated oxidised haemoglobin

Question 21

What is the cause of haemolytic anaemia on this case?

Answer 21

G6PD deficiency

Question 22

What are those with a G6PD deficiency told to do?

Answer 22

Avoid oxidant drugs
Don’t eat broad beans
Avoid naphthalene
Be aware that haemolysis can result from infection

Question 23

What is LDH?

Answer 23

Is an intracellular enzyme that is leaked into the plasma when cells breakdown

Question 24

What are spherocytes?

Answer 24

Smaller RBC’s with loss of central pallor

Question 25

What are the two types of haemolytic anaemia?

Answer 25

Inherited | Acquired (normal red cells but environment becomes toxic to the cell)

Question 26

What are the two types of acquired haemolytic anaemia?

Answer 26

Non-immune | Immune mediated

Question 27

What test do you do to look for auto-antibodies?

Answer 27

Direct antiglobulin test | DAT

Question 28

How does DAT work?

Answer 28

Add rabbit antibody that is directed against human immunoglobulin Binds human immunoglobulin together

Question 29

What is AIHA?

Answer 29

Auto immune haemolytic anaemia

Question 30

What causes hereditary spherocytosis?

Answer 30

Due to inherited defect in red cell membrane

Question 31

What are polychromatic macrocytes?

Answer 31

Blue, large cells Due to the presence of ribosomes they pick up blue dye Young cells

Question 32

What is treatment for hereditary spherocytosis?

Answer 32

Folic acid | Splenectomy

Question 33

What is meant by inappropriately normal reticulocytes?

Answer 33

When Hb is so low you would expect reticulocytosis to compenstae

Question 34

What is a neutrophil with many lobes known as?

Answer 34

hyper-segmented neutrophil

Question 35

Why do you always have to check B12 and folic acid blood test?

Answer 35

Present exactly the same on blood films | Need to do both to differentiate

Question 36

What is megaloblastic change?

Answer 36

Nucleocytoplasmic dissociation

Question 37

What can cause megaloblastic change?

Answer 37

Drugs Folate antagonists e.g. methotrexate BM cancer

Question 38

What does B12 require to be absorbed?

Answer 38

Intrinsic factor

Question 39

What is pernicious anaemia?

Answer 39

Destroy cells in stomach | Cannot absorb B12