Anaemia and Microcytic Anaemia

Question 1

define anaemia

Answer 1

reduced total red cell mass

Question 2

name surrogate markers of anaemia?

Answer 2

haemoglobin conc

haematocrit

Question 3

normal Hb for men?

Answer 3

130-180g/L

Question 4

normal Hb for women?

Answer 4

120-180g/L

Question 5

why do men have higher Hb levels?

Answer 5

more testosterone

Question 6

haematocrit levels are higher in men or women?

Answer 6

men

Question 7

red cell production occurs where?

Answer 7

bone marrow

Question 8

how do you create a Hb solution?

Answer 8

lyse red cells

Question 9

what is haematocrit?

Answer 9

the ratio of the volume of red cells to the total blood volume

Question 10

when would Hb and haematocrit levels not be a good marker of red cell mass and why?

Answer 10

rapid bleeding
if fluids have been given

both cause plasma expansion

Question 11

how does the body respond to anaemia?

Answer 11

increased red cell production

Question 12

red cells that have JUST left the bone marrow are called…

Answer 12

reticulocytes

Question 13

are reticulocytes or RBCs larger?

Answer 13

reticulocytes

Question 14

what colour do reticulocytes stain and why?

Answer 14

purple/blue as they have RNA

Question 15

“polychromatic blood film”

Answer 15

reticulocytes

Question 16

how is haematocrit calculated?

Answer 16

red cell number x red cell volume

Question 17

what is MCV?

Answer 17

size of the red cells (mean cell volume)

Question 18

what blood test looks at cellular morphology (shape)?

Answer 18

blood film

Question 19

when would you do a reticulocyte count?

Answer 19

to assess bone marrow response

Question 20

2 main causes of anaemia?

Answer 20

decreased production

increased loss

Question 21

what is a marker of decreased red cell production?

Answer 21

low reticulocyte count

Question 22

what is a marker of increased red cell loss?

Answer 22

high reticulocyte count

Question 23

causes of low reticulocyte count?

Answer 23

hypoproliferative - reduced erythropoesis

maturation abnormality - ineffective erythropoesis

Question 24

what can make erythropoesis ineffective?

Answer 24

impaired haemoglobinisation

impaired cell division

Question 25

causes of high reticulocyte count?

Answer 25

bleeding | haemolysis

Question 26

if MCV is low and patient is anaemic what could be the cause?

Answer 26

haemoglobinisation problems in the cytoplasm

Question 27

if MCV is high and patient is anaemic what could be the cause?

Answer 27

cell division | got big cells that cant divide

Question 28

iron and porphyrin meet where in the cell to make haem?

Answer 28

mitochondrion

Question 29

appearance of microcytic anaemia cells?

Answer 29

hypochromic - lack of colour from lack of Hb | small

Question 30

haemoglobin synthesis occurs where?

Answer 30

cytoplasm

Question 31

commonest and 2nd most common cause of microcytic anaemia?

Answer 31

iron deficiency | thalassaemia

Question 32

define thalassaemia

Answer 32

cant make globin chain

Question 33

how does anaemia of chronic disease differ from iron deficiency anaemia in terms of iron levels?

Answer 33

normal body iron but lack of available iron

Question 34

its common for porphyrias to cause microcytic anaemia T or F

Answer 34

F

Question 35

what kind of poisoning can cause problems with porphyrin synthesis?

Answer 35

lead

Question 36

microcytic anaemia is caused by...

Answer 36

haemoglobinisation problems

Question 37

macrocytic anaemia is caused by...

Answer 37

cell division problems

Question 38

when fully saturated 1g Hb will bind __ml O2

Answer 38

1.34

Question 39

how can you work out how much iron is in the blood

Answer 39

divide total blood volume by 2

Question 40

storage iron is stored in a molecule called...

Answer 40

ferritin

Question 41

circulating iron is bound to what molecule?

Answer 41

transferrin

Question 42

what organ is iron stored in mainly?

Answer 42

liver

Question 43

how does iron get to red cells?

Answer 43

circulate bound to transferrin transferred to bone marrow macrophages fed to red cell precursors

Question 44

test for functional iron levels

Answer 44

Hb

Question 45

test for transported iron levels?

Answer 45

serum iron OR transferrin

Question 46

test for storage iron?

Answer 46

ferritin levels

Question 47

what does transferrin transport iron from and to?

Answer 47

from macrophages/intestinal cells/hepatocytes to tissues expressing transferrin receptors eg erythroid marrow

Question 48

low ferritin means...

Answer 48

iron deficiency

Question 49

causes of iron deficiency

Answer 49

diet blood loss eg menorrhagia/GI malabsorption

Question 50

men commonly get iron deficiency T or F

Answer 50

F, rare and usually pathological

Question 51

how much iron is lost per month from menstrual blood loss? how is this worked out?

Answer 51

15-20mg | average period blood loss is 30-40ml and to get iron levels you divide blood vol by 2

Question 52

heavy menstrual blood loss is defined as

Answer 52

>60ml blood loss

Question 53

when do epithelial changes such as skin and koilonychia occur in anaemia?

Answer 53

LATE

Question 54

normal MCV values

Answer 54

85-105

Question 55

normal transferrin sat is..

Answer 55

30%

Question 56

what iron supplement is used? dose and frequency?

Answer 56

ferrous fumarate 210mg TDS

Question 57

management plan for man with iron deficiency anaemia and bowel signs

Answer 57

colonoscopy

Question 58

how should iron tablets be taken and why?

Answer 58

with food as it is absorbed very quickly | with orange juice as acidity transports it better

Question 59

other iron preparations?

Answer 59

IV iron

Question 60

risks of IV iron

Answer 60

risk of ROS anaphylaxis diabetes risk

Question 61

how does iron get into the body?

Answer 61

as haem or non-haem iron

Question 62

how much iron is absorbed per week?

Answer 62

7g

Question 63

even if iron isnt raised after initiating supplements, what marker can you check to see if the patient is responding to treatment?

Answer 63

reticulocytes

Question 64

how long should you treat pernicious anaemia?

Answer 64

for life as its an autoimmune condition | give B12 every 3 months

Question 65

3 main SEs of iron supplementation

Answer 65

black stool constipation abdo pain