Anaemias

Question 1

Sickle cell anaemia symptoms

Answer 1

Structural abnormality of haemoglobin leads to deformed RBC can result in infarction of the microvasculature and restricted blood supply to organs, resulting in severe pain - known as sickle-cell crisis.

Question 2

What is G6PD deficiency?

Answer 2

Most common in males and POC, deficiency of glucose 6-phosphate dehydrogenase, a protein responsible for protecting red cells. An inherited deficiency can lead to development of acute haemolytic anaemia (premature destruction of RBC) when triggered by infection or certain drugs:
- Fluoroquinolones
- Nitrofurantoin
- Quniolones
- Sulfonamides e.g., co-trimox
- aspirin
- chloroquin
- quinine
- sulfonylureas

Question 3

What is asplastic anaemia and how is is treated?

Answer 3

Caused when autoimmune reaction attacks the bone marrow so it cannot produce enough blood cells, leading to weakness and fatigue, as well as clotting issues due to reduced platelets.
Can be reduced by immunosuppressants such as ciclosporin or antithymocyte globulin.

Question 4

What is renal deficiency anaemia and how is it treated?

Answer 4

In renal failure, the kidneys stop producing erythopoietin which usually stimulates erythrocyte production in bone marrow,
Epoetins are recombinant human erythopoietins which can stimulate blood cell production in the bone marrow.

Question 5

What is iron-deficiency anaemia and its treatment?

Answer 5

Reduction in erythrocyte (RBC) production due to low iron stores.
Treated with ferrous salts such as:
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate.
Generally oral treatment but other forms such as ferric carboxymaltose can be given when oral treatment fails or they have malabsorption issues.

Question 6

What is megaloblastic anaemia and how is it treated?

Answer 6

Megaloblastic anaemia causes abnormally large RBC which do not function properly, leading to fatigue, paleness etc.
It is usually caused by vitamin B12 and/or folate deficiency. Treatment consists of:
- IM or PO vitamin B12 replacement (e.g., hydroxycobalamin or cyanocobalamin).
- PO folic acid 5mg OD

Question 7

MHRA warning for vitamin B12

Answer 7

Cyanacobalamin and hydroxycobalamin contain cobalt and can cause allergic reactions in some patients.

Question 8

Which should be treated first, folate or vitamin B12 deficiency?

Answer 8

B12, as treating folic acid deficiency can improve wellbeing and mask underlying B12 deficiency, causing neurological diseases to develop.