Anaemia

Question 1

Hb in males

Answer 1

140 + per litre (or 14 decilitres)

Question 2

Hb in females

Answer 2

120 + per litre

Question 3

Normal range for ferritin

Answer 3

10-120

Question 4

How do you work out what type of anaemia it is?

Answer 4

Look at the mean cell volume (not down a microscope)

Question 5

Causes of microcytic anaemia

Answer 5

IDA
ACD/Chronic inflammatory problems
Thalassaemia

Question 6

What do you do to work out which of these three is the cause of microcytic anaemia?

Answer 6

Iron studies
CRP ESR
Electrophoresis

Question 7

IDA

Answer 7

Serum iron low
Transferrin high
Trans saturation
Soluble transferrin receptor
Ferritin

Question 8

ACD

Answer 8

Low serum iron
low transferrin
normal/high ferritin

Question 9

How do you classify normocytic anaemia?

Answer 9

Look at reticulocyte count

Question 10

Causes of normocytic anaemia

Answer 10

Haemorrhage (loss)
Acute haemolysis (breakdown)

Aplastic anaemia

Question 11

How many litres of blood do we have in our body?

Answer 11

5L

Question 12

How much blood do you give when you donate blood?

Answer 12

Half a litre

10% of blood volume

Question 13

What is aplastic anaemia

Answer 13

(bone marrow failure e.g. due to B19 parvovirus)

Question 14

What does the reticulocyte count tell you?

Answer 14

If high:
it’s due to blood loss, break down

OR

low: aplastic anaemia (production problem)

Question 15

What are the signs of haemorrhage?

Answer 15

Tachycardia
Hypotension
Breathless
Reduced GCS
Cold peripheries 

SHOCK

Question 16

Commonest causes of shock in a post op patient

Answer 16

Haemorrhage

Sepsis (note even though we associate fever with infections, in sepsis they are really cold).

Question 17

How do you deal with a patient with SHOCK?

Answer 17

FLUIDS
Are there any active bleeding sites? If so, apply pressure
Two wide bore cannulae
Verbal prescription for 15L oxygen through non rebreathe
500ml bolus of 0.9ml saline solution

then ABCDE approach

Question 18

What fluid would you give?

Answer 18

Hartman’s solution or/Saline solution 0.9%

Question 19

What is the cause of death in haemmorhage?

Answer 19

Myocardial infarction - due to hypoperfusion

Question 20

Why don’t you warm up the patient in shock?

Answer 20

Vasodilation in peripheries would cause a further drop in BP

Question 21

What is A? What do you do?

Answer 21

If they are conscious and talking to you, it’s fine
But if they’re unconscious, shake them to see if they respond
If not, their muscles could relax and their tongue could flop into their airway, so you need to keep their airway open.

Also, put out a:
Peri arrest call
Call an anaesthetist

Question 22

If you’re worried about the airway and you’re worried about the c-spine, what do you do?

Answer 22

Jaw thrust

Can put in guedel

Question 23

If you’re not worried about the c-spine, what do you do?

Answer 23

Head tilt

Chin lift

Question 24

Breathing - what do you check for?

Answer 24

Do ABG (raised lactate would suggest sepsis)
Check for haemothorax
Portable chest x ray
Listen to lungs

Question 25

What would you tell the anaesthetist to get them to come?

Answer 25

This patient is non-responsive and tolerating a guedel

Question 26

What type of bloods do you need to order? what does this depend on?

Answer 26

Female, reproductive age: 2 units of o neg OR Male patient or post reproductive patient: 2 units of O positive AND 4units of their blood type

Question 27

What else do you have to check after an ABC approach?

Answer 27

Check glucose Check active sites of bleeding Rash (septiciemia) Pulsatile masses

Question 28

What are the classifications of macrocytic anaemia?

Answer 28

Megaloblastic | Non-megaloblastic

Question 29

Megaloblastic causes

Answer 29

Folate/B12 deficiency | Methotrexate

Question 30

Non-megaloblastic causes

Answer 30

Alcohol Hypothyroidism Pregnancy Blood film

Question 31

What are the mechanisms of anaemia?

Answer 31

Reduction in production of RBC Blood loss Breakdown

Question 32

What are the mechanisms of anaemia?

Answer 32

Reduction in production of RBC Blood loss Breakdown (intravascular or extravascular)

Question 33

What are the causes of extravascular

Answer 33

Hyposplenism autoimmune haemolytic anaemia Bartenelosis (bartenela infection) Malaria

Question 34

Intravascular causes

Answer 34

HUS DIC TTP

Question 35

What would you see in the blood tests if you have haemolysis?

Answer 35

LDH increased (as it's stored inside RBC) high bilirubin high reticulocytes Reduction in haptoglobin

Question 36

What does haptoglobin do?

Answer 36

(binds to free haemoglobin which is about to be destroyed)

Question 37

Causes of reduction in production

Answer 37

``` BM failure Kidney disease (CKD) Hypothyroidism B12/iron deficiency Chronic inflammatory problems Anaemia of chronic disease ```

Question 38

What is the breakdown product of

Answer 38

Haem splits into bilirubin and iron Haptoglobin takes the haemoglobin before it's even broken down, and takes it to the spleen