Anemia (Zana)

Question 1

Functional definition of anemia

Answer 1

a state in which the circulating red-cell mass is insufficient to meet the oxygen requirements of the tissues

Question 2

Usual definition of anemia

Answer 2

a reduction of the haemoglobin concentration, red-cell count, or hematocrit to below normal levels

Question 3

Anemia lab values according to WHO

Answer 3

lower than 13 g/dl (males)
or 12 g/dl (females)

Question 4

Anemia symptoms

Answer 4

fatigue
headaches
faintness
breathlessness
angina of effort
intermitent claudication
palpitations

Question 5

Anemia non-specific signs

Answer 5

pallor
tachycardia
a full pulse
systolic flow murmur
cardiac failure
ankle oedema
rarely papilloedema and retinal haemorrhage in an acute bleed

Question 6

Anemia specific signs (4)

Answer 6

koilonychia – spoon-shape nails seen in iron deficiency anaemia

jaundice – haemolytic anaemia

bone deformities thalassemia major

leg ulcers – sickle cell disease

Question 7

Where is iron absorbed? (2)

Answer 7

duodenum and jejunum

Question 8

Common causes of iron deficiency (4)

Answer 8

Poor intake
Decreased absorption
Increased demands
Blood loss (menstruation and GIT loss are the most common)

Question 9

The average monthly menstrual blood loss is approximately _____ mL or about _____ mg/d

Answer 9

50ml
0.7 mg/d

Question 10

Other causes of iron deficiency

Answer 10

Other uterine bleeding
Blood donation
Chronic hemoglobinuria
Traumatic hemolysis due to prosthetic cardiac valve

Question 11

Changes in severe deficiency (6)

Answer 11

skin and mucosal changes,

including a smooth tongue,

brittle nails, koilonychia

dysphagia (due to esophageal webs)

parotid gland enlargement, splenomegaly and failure to grow

and cheilosis (zvalje)

Question 12

Plummer-Vinson syndrome

Answer 12

is a rare disease characterized by difficulty swallowing, iron-deficiency anemia, glossitis, cheilosis and esophageal webs

Question 13

Differential diagnosis of microcytic anemia (3)

Answer 13

chronic disease anemia
thalassemia
sideroblastic anemia

Question 14

Anemia of chronic disease (4)

Answer 14

normal or increased iron stores in the bone marrow and a normal or elevated ferritin level

serum iron is low

TIBC is normal/low

common causes are chronic infection/inflammation, cancer and liver disease

Question 15

Thalassemia (3)

Answer 15

Deficiency in the synthesis of the globin chains of haemoglobin in addition, the accumulation of abnormal chains within the red cell leads to its early destruction

normal iron, lower MCV, more normal RBC and more abnormal peripheral blood smear

clinically dived into: thalassemia major (severe anemia), intermedia (moderate anemia) and minor (symptomless, heterozygous state)

Question 16

Sideroblastic anemia (4)

Answer 16

congenital (X linked) or acquired (idiopathic or secondary)

heterogeneous group of disorders in which hemoglobin synthesis is reduced because of failure to incorporate heme into protoporphyrin to form hemoglobin

iron accumulates in mitochondria

often due leukemia, chronic alcoholism and lead poisoning

Question 17

Macrocytic anemia

Answer 17

The presence in the bone marrow of erytroblasts with delayed nuclear maturation because of defective DNA synthesis (megaloblasts).

Question 18

Causes of macrocytic anemia (3)

Answer 18

vitamin B12 deficiency
folic acid deficiency
diseritropoetic anaemia

Question 19

Lab results in macrocytic anemia (5)

Answer 19

MCV > 96fl
macrocytes and hypersegmented polymorphs
neutropenia
thrombocytopenia

Question 20

Appearance in pernicious anemia

Answer 20

gray hair, blue eyes, wide cheekbones

mild jaundice

sometimes widespread brown pigmentation

red, smooth tongue

Question 21

Anemic syndrome (4)

Answer 21

Peripheral neuropathy

Mental changes

Digestive syndrome (glossitis, angular stomatitis, hepatosplenomegaly, gastric atrophy, achlorydia)

Other (yellow tint to skin, heart failure, fever)

Question 22

Vitamin B12 deficiency should be differentiated from ________ deficiency

Answer 22

folic acid

Question 23

Difference between B12 deficiency and myelodysplasia (2)

Answer 23

low B12 and elevated methylmalonic acid levels

Question 24

Normocytic anemias (4)

Answer 24

Acute blood loss
Aplastic anaemia
Anaemia of chronic disease
Haemolytic anaemia

Question 25

Aplastic anemia

Answer 25

Aplasia of the bone marrow with peripheral blood pancytopenia (autoimmune suppression of T-cell mediated mechanism)

Congenital: Fanocni’s anemia

Acquired: chemicals, drugs, radiation, hepatitis, tuberculosis, pregnancy, unknown

Pancytopenia.
No abnormal cells seen.
Hypocellular bone marrow

Question 26

Hemolytic anemia

Answer 26

The red cells normally survives about 120 days, but in haemolysis the cell survival times are considerably shortened.

Question 27

Causes of hemolytic anemia

Answer 27

Inherited:
- red cell membrane defect: hereditary spherocytosis hereditary eliptocytosis

haemoglobin abnormalities:
thalassaemia, sickle cell disease

metabolic defects:
glucose 6 phosphate dehydrogenize deficiency
pyruvate kinase deficiency

Acquired: autoimmune, liver disease, infections, hypersplenism etc.

Question 28

Polycythaemia

Answer 28

Is defined as a haemoglobin level greater than 18 g/dL, a red cell count above 6x1012/L. The red cell volume is greater than 36 mL/kg in males and 32 mL/kg in females.