Anemia

Question 1

Definition of anemia

Answer 1

WHO:

Anemia is a condition in which the no. of RBCs/ their O2 carrying capacity is insufficient to meet physiologic needs which vary by age, sex, altitude, smoking and pregnancy status

Clinical practice

Hemoglobin below normal reference range for age and sex

Question 2

Traits of RBC

Answer 2

Pink - hemoglobin

No nucleus - fill up w/ more Hb

Biconcave - for gas exchange

Question 3

How long do RBCs circulate in the blood?

Answer 3

120 days

Question 4

How are old RBCs broken down?

Answer 4

Macrophages

Question 5

What are signs of anemia related to?

Answer 5

Lack of O2 in tissues

Question 6

Symptoms of anemia

Answer 6

Fatigue

Weakness

Dyspnea

Palpitations

Dizziness

(only some listed)

Question 7

Signs of anemia

Answer 7

Pallor

Tachycardia

Bounding pulse

Hemic murmur

Cardiac failure

Question 8

When does conjunctival pallor happen?

Answer 8

When Hb < 9

Question 9

When does skin crease pallor happen?

Answer 9

When Hb < 7

Question 10

What are the parameters you look at to check for anemia?

Answer 10

MCV (size)

MCH (colour)

RDW (size distribution - how size of cells vary)

Red cell count

Question 11

What are the 3 main cell lines use in investigations?

Answer 11

Hb

White cell

Platelet

Question 12

How does folate deficiency affect cells?

Answer 12

Big cells

Question 13

How does Fe deficiency affect cells?

Answer 13

Small pale cells

Question 14

What is an easy way to classify anemia?

Answer 14

MCV

Question 15

What does microcytic RBCs indicate?

Answer 15

Issue with ferritin

Low ferritin
- Fe deficiency

Normal/high ferritin
- thalassaemia
- inflammation anemia
- sideroblastic anemia

Question 16

What do normocytic RBCs indicate?

Answer 16

Increased production
- acute bleeding
- haemolysis

Decreased production
- renal anemia
- inflammatory anemia
- marrow disease

Question 17

What do macrocytic RBCs indicate?

Answer 17

Issue with folate/B12

Megaloblastic anemia
- B12/folate deficiency

Non-megaloblastic anemia
- reticulocytosis
- alcohol
- liver disease

Question 18

How is anemia classified if MCV is normal?

Answer 18

By mechanism of anemia (reduced production/ increased destruction or loss)

Question 19

What is observed when there is reduced production of RBCs?

Answer 19

Reduced reticulocytes

Question 20

Eg of anemia due to reduced production?

Answer 20

Haematinic deficiencies
- Fe, B12/folate deficiency

Reduced globin chain
- thalassaemia

Bone marrow failure
- suppression -> inflammation
- infiltration -> malignancy
- defective production -> AA, myelodysplasia

Insufficient EPO

Inability to utilise Fe

Question 21

What is observed when there is increased destruction/loss of RBCs?

Answer 21

Increased reticulocytes

Question 22

Eg of anemia due to increased destruction (hemolysis)

Answer 22

Immune
- AIHA
- CHAD
- PCH

Non-immune
- haemoglobinopathy
- membrane
- enzyme
- mechanical
- infections

Question 23

Eg of anemia due to increased loss (bleeding)

Answer 23

Menorrhagia

Surgery/trauma

GIT

Genitourinary

Question 24

Impt initial work up for anemia after hist/examination

Answer 24

Full blood count (FBC)

MCV

Reticulocyte count

Peripheral blood film

Question 25

What is special about ferritin?

Answer 25

It's an acute phase reactant, increases w/ infection/ inflammation -> high ferritin does not always exclude Fe deficiency

Question 26

Eg of causes of increased Fe requirement

Answer 26

Pregnancy

Question 27

Eg of causes of increased Fe loss

Answer 27

GI bleed Menstruation

Question 28

Eg of causes of decreased Fe intake

Answer 28

Vegetarianism/ veganism Drugs that reduce stomach acidity Lack of balanced diet

Question 29

Possible side effects of Fe supplements

Answer 29

Upset stomach Nausea Diarrhea Faintness Vomiting Dark stools Constipation

Question 30

Why will platelet count increase during Fe deficiency?

Answer 30

No Fe -> hematopoiesis divert to make more platelet as they come from same lineage

Question 31

What causes megaloblastic anemia?

Answer 31

B12/ folate deficiency

Question 32

Clinical presentation of megaloblastic anemia

Answer 32

Gastrointestinal - glossitis Neurology - subacute combined degeneration of spinal cord (B12 deficiency) -> numbness, weakness Psychiatric - personality changes - psychosis - memory loss

Question 33

Causes of B12 deficiency

Answer 33

Mainly due to malabsorption

Question 34

Causes of folate deficiency

Answer 34

Low diet/ increased demands

Question 35

Treatment of B12 deficiency

Answer 35

IM B12 injections - if neurological involvement -> every other day till no further improvement - otherwise -> 6 injections over 2 weeks then monthly Oral B12 tablets - if Hb normalised

Question 36

Treatment of folate deficiency

Answer 36

Oral folate replacement

Question 37

What does spherocytes in PBF suggest?

Answer 37

Anemia is due to immune cause

Question 38

What do bite / blister cells in PBF suggest?

Answer 38

Anemia is due to oxidative hemolysis

Question 39

What do cell fragments in PBF suggest?

Answer 39

Anemia is due to MAHA / mechanical

Question 40

How to know if the anemia is immune-mediated?

Answer 40

Use Direct Coombs test