Anaemia (zero to finals)

Question 1

What is haemoglobin?

Answer 1

A protein found in red blood cells. Haemoglobin is responsible for picking up oxygen in the lungs and transporting it to the body’s cells.

Iron is essential in creating haemoglobin and forms part of it’s structure.

Question 2

What is anaemia?

Answer 2

Defined as a low concentration of haemoglobin in the blood.

This is the consequence of an underlying disease, not a disease itself.

Question 3

What is mean cell volume (MCV)?

Answer 3

Refers to the size of the red blood cells and is highly relevant in anaemic patients.

Question 4

What are the normal haemoglobin and MCV ranges for men and women?

Answer 4

Haemoglobin:
Men: 130-180g/l
Women: 120-165g/l

MCV (mean cell volume):
Men: 80-100 femtolitres
Women: 80-100 femtolitres

Question 5

What are the main 3 categories for anaemia and what are they based on?

Answer 5

Anaemia is divided into 3 main categories based on the MCV:

Microcytic anaemia (low MCV)
Normocytic anaemia (normal MCV)
Macrocytic anaemia (high MCV)

Question 6

The mnemonic for remembering the causes of microcytic anaemia is “TAILS”, what does this stand for?

Answer 6

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

Question 7

What is sideroblastic anaemia?

Answer 7

A disorder where the body produces enough iron but is unable to put it into the haemoglobin.

Question 8

Why does anaemia of chronic disease often occur with chronic kidney disease, how is this treated?

Answer 8

Occurs due to reduced production of erythropoietin by the kidneys, the hormone responsible for stimulating red blood cell production.

Treatment is with erythropoietin.

Question 9

What are the 3A’s and 2H’s for the causes of normocytic anaemia?

Answer 9

A – Acute blood loss
A – Anaemia of chronic disease
A – Aplastic anaemia
H – Haemolytic anaemia
H – Hypothyroidism

Question 10

What are the 2 main types of macrocytic anaemia?

Answer 10

Can be normoblastic or megaloblastic

Question 11

What does megaloblastic anaemia occur as a result of?

Answer 11

Megaloblastic anaemia results from impaired DNA synthesis, preventing the cells from dividing normally.

Rather than dividing, they grow into large, abnormal cells.

Question 12

2 major causes of megaloblastic anaemia?

Answer 12

B12 deficiency

Folate deficiency

Question 13

Main causes of normoblastic macrocytic anaemia?

Answer 13

Alcohol

Reticulocytosis (usually from haemolytic anaemia or blood loss)

Hypothyroidism

Liver disease

Drugs, such as azathioprine

Question 14

What is reticulocytosis?

Answer 14

Reticulocytosis refers to an increased concentration of reticulocytes (immature red blood cells).

This happens when there is a rapid turnover of red blood cells, such as with haemolytic anaemia or blood loss.

Question 15

What are the main generic symptoms of anaemia?

Answer 15

Tiredness

Shortness of breath

Headaches

Dizziness

Palpitations

Worsening of other conditions, such as angina, heart failure or peripheral arterial disease

Question 16

What are some symptoms that are specific to iron-deficiency anaemia?

Answer 16

Pica (dietary cravings for abnormal things, such as dirt or soil)

Hair loss

Question 17

What are generic signs of anaemia?

Answer 17

Pale skin

Conjunctival pallor

Tachycardia

Raised respiratory rate

Question 18

What is koilonychia and what can it indicate?

Answer 18

Koilonychia refers to spoon-shaped nails and can indicate iron deficiency anaemia

Question 19

What is angular cheilitis and what can it indicate?

Answer 19

A common inflammatory skin condition. It affects one or both corners of your mouth and causes irritated, cracked sores.

Angular cheilitis can indicate iron deficiency anaemia

Question 20

What is atrophic glossitis and what can it indicate?

Answer 20

Atrophic glossitis is a smooth tongue due to atrophy of the papillae and can indicate iron deficiency anaemia

Question 21

What can brittle hair and nails be an indication of?

Answer 21

Iron deficiency anaemia

Question 22

What can jaundice be an indication of?

Answer 22

Haemolytic anaemia

Question 23

What can bone disorders be an indication of and why?

Answer 23

Thalassaemia

Ineffective erythropoiesis causes bone marrow expansion.

This causes the bones to widen. This can result in abnormal bone structure, especially in your face and skull.

Bone marrow expansion also makes bones thin and brittle, increasing the chance of broken bones.

Question 24

Oedema, hypertension and excoriations can be an indication of what underlying disease?

Answer 24

Oedema, hypertension and excoriations on the skin can indicate chronic kidney disease

Question 25

What is full blood count used for in anaemia?

Answer 25

Assess MCV and haemoglobin levels

Question 26

What is reticulocyte count used for in anaemia?

Answer 26

Indicates red blood cell production

Question 27

What are liver function tests used for and what could it be raised?

Answer 27

For liver disease and bilirubin (raised in haemolysis/haemolytic anaemia)

Question 28

What can ferritin blood test be used to check for?

Answer 28

Iron

Question 29

What can direct Coombs test assess for?

Answer 29

Autoimmune haemolytic anaemia

Question 30

What are intrinsic factor antibodies used to assess for?

Answer 30

Pernicious anaemia

Question 31

What can haemoglobin electrophoresis test for?

Answer 31

Thalassaemia and sickle cell anaemia

Question 32

What is pernicious anaemia?

Answer 32

Pernicious anaemia is an autoimmune condition involving antibodies against the parietal cells or intrinsic factor

Question 33

If Coombs test is positive, what could it indicate?

Answer 33

Can indicate haemolytic anaemia, which is when the bloodstream doesn't contain enough red blood cells due to premature death.

Question 34

What are the 2 main types of Coombs (antiglobulin tests)?

Answer 34

Direct and indirect Coombs test

Question 35

What is the direct Coombs test?

Answer 35

Detects antibodies or complement proteins that are already bound to the surface of red blood cells.

Question 36

What is the procedure for direct Coombs test?

Answer 36

Blood from the patient is taken, and the red blood cells are washed to remove any unattached antibodies. Antiglobulin reagent (Coombs reagent) is then added to see if it binds to any antibodies or complement proteins already on the patient's red blood cells.

Question 37

What can the direct Coombs test be used for?

Answer 37

Used in diagnosing autoimmune hemolytic anaemia, haemolytic disease of the newborn, and some drug-induced haemolytic anaemias.

Question 38

What is the indirect Coombs test?

Answer 38

Detects antibodies circulating in the plasma that may attack red blood cells in the future.

Question 39

What is the procedure for indirect Coombs test?

Answer 39

Blood from the patient is taken, and the plasma (liquid portion of blood) is separated. This plasma is then mixed with donor red blood cells known to have certain antigens. Antiglobulin (Coombs) reagent is added to see if antibodies in the patient's plasma react with the donor red blood cells.

Question 40

What can the indirect Coombs test be used for?

Answer 40

Used in blood typing, crossmatching for blood transfusions, and detecting antibodies in conditions like Rh incompatibility between a pregnant woman and her foetus.

Question 41

What is the role of gastric parietal cells?

Answer 41

play a role in gastric homeostasis, as well as in the absorption of vitamin B12 (cobalamin) due to the release of intrinsic factor (IF).

Question 42

What are intrinsic factors?

Answer 42

A glycoprotein produced by the parietal cells (oxyntic cells) located at the gastric body and fundus. Intrinsic factor plays a crucial role in the transportation and absorption of the vital micronutrient vitamin B12 (cobalamin, Cbl) by the terminal (distal) ileum

Question 43

Causes of normocytic anaemia (mnemonic ABCD)?

Answer 43

Acute blood loss Bone marrow failure Chronic disease Destruction (haemolysis)

Question 44

Non-megaloblastic causes of macrocytic anaemia (mnemonic HAND LAMP)?

Answer 44

Hypothyroidism Aplastic anaemia Neonates Drugs Liver disease Alcohol Myelodysplasia (cancer where immature blood cells in bone marrow don't mature) Pregnancy

Question 45

Megaloblastic causes of macrocytic anaemia?

Answer 45

B12 deficiency (e.g. pernicious anaemia) Folate deficiency (e.g. dietary insufficiency - leafy green vegetables and beef liver)