Common Causes of Anaemia and Thrombocytopenia

Question 1

3 common causes of anaemia

Answer 1

Iron, B12, folate deficiencies
Haemolysis
Anaemia of chronic disease

Question 2

2 common causes of thrombocytopenia

Answer 2

Immune thrombocytopenic purpura (ITP)

Thrombocytic Thrombocytopenia Purpura (TTP)

Question 3

When do you get macrocytic anaemia

Answer 3

Larger RBCs than normal, less Hb in the blood

Question 4

Causes of macrocytic anaemia

Answer 4

B12, folate deficiencies
Metabolic abnormalities (thyroid, liver disease)
Marrow damage (alcohol, drugs, marrow disease)
Haemolysis (reticulocytes are bigger than mature RBCs)

Question 5

MCV in macrocytic anaemia

Answer 5

Above normal

Question 6

Normocytic anaemia

Answer 6

A normocytic anemia is defined as an anemia with a mean corpuscular volume (MCV) of 80-100 which is the normal range. However, the hematocrit and hemoglobin is decreased.

Question 7

Causes of normocytic anaemia

Answer 7

Anaemia of chronic disease/inflammatory

Question 8

3 causes of microcytic anaemia

Answer 8

Iron deficiency
Hb disorders
Sometimes chronic disease

Question 9

Describe the iron balance

Answer 9

No excretion, limited absorption
Controlled at the level of the gut mucosa
Most iron is thus recycled
Absorbed in duodenum
Transported by transferrin
Stored in ferritin

Question 10

Lab results of iron deficiency

Answer 10

Microcytic anaemia, small pale RBCs. 
Low MCV
Low MCH
Low ferritin
increased hypochromic cell %

Question 11

3 main causes of iron deficiency

Answer 11

Blood loss
Increased demand (pregnancy, growth)
Decreased intake (diet, malabsorption)

Question 12

Usual iron deficiency treatment

Answer 12

IV iron

Question 13

Megaloblastic anemia caused by vitamin B-12 deficiency

Answer 13

Pernicious anaemia

Question 14

RBCs big and few

Answer 14

Megaloblastic anaemia

Question 15

3 main causes of megaloblastic anaemia

Answer 15

B12 deficiency
Folate deficiency
Alcohol

Question 16

Why does B12 or folate deficiency result in megaloblastic anaemia?

Answer 16

Both involved in DNA synthesis- targets rapidly dividing cells

Question 17

Describe B12 absorption

Answer 17

Gastric parietal cells produce acid and intrinsic factor- binds with vit. B12 and internalised in terminal ilium. Well absorbed and stored for years.

Question 18

3 causes of vit. B12 deficiency

Answer 18

Nutritional-vegans
Gastric problems (gastrectomy, pernicious anaemia)
Small bowel problems- Crohn’s, TB

Question 19

Describe the absorption of folic acid

Answer 19

Absorbed quite well- good diet requied. 4 month body stores.

Question 20

3 main causes of folic acid deficiency

Answer 20

Diet
Malabsorption
Increased usage (pregancy, haemolysis, inflammatory disorders)

Question 21

Autoimmune disease where you have antibodies targeted against parietal cells/intrinsic factor

Answer 21

Pernicious anaemia

Question 22

An example of an effect severe B12 deficiency can have on the myelination of peripheral nerve, reversible

Answer 22

Subacute combined degeneration of the cord (SADC)

Question 23

3 main causes of haemolytic anaemia

Answer 23

Things go wrong on the inside, membrane or outside of the RBC

Question 24

What causes of haemolytic anaemia affect the inside of the RBC

Answer 24

Sickle cell
Enzyme defects (G6PD)

Question 25

Cause of haemolytic anaemia that targets the RBC membrane

Answer 25

Hereditary spherocytosis

Question 26

Cuases of haemolytic anaemia outside of the RBC

Answer 26

Antibodies Drugs/toxins Heart valves Vasculitis (damaged endothelium)

Question 27

Features of anaemia of chronic disease

Answer 27

Normal MCV Decreased RBC production due to abnormal iron metabolism Poor erthropoetin response

Question 28

Describe the pathology of anaemia of chronic disease

Answer 28

Effects are mediated by the release of inflammatory cytokines (particularly IL-6) which affect hepcidin and results in alteration in iron absorption and release from macrophages

Question 29

Diagnosis of anaemia of chronic disease

Answer 29

Normal MCV Raised inflammatory markers Normal/high ferritin and low serum iron

Question 30

Causes of thrombocytopenia

Answer 30

``` Alcohol, drugs Viral infections ITP (Immune thrombocytopenia) Liver disease Coagulation disorders (DIC) ```

Question 31

Low platelet disorder-diagnosis of exclusion

Answer 31

Immune thrombocytopenic purpura

Question 32

How does the presentation of immune thrombocytopenic purpura vary between children and adults?

Answer 32

Children-self limiting, usually no treatment | Adults-chronic or relapsing/remitting

Question 33

Small, non blanching subcutaneous haemorrhages

Answer 33

Petechiae

Question 34

Treatment of immune thrombocytopenic purpura

Answer 34

Steroids Splenectomy (platelets covered with antibiotics are removed in the spleen, without the spleen, no removal and platelet count rises) Immunosuppressives Thrombopoetin-stimulate platelet production

Question 35

Thrombocytopenia and fever, neurological symptoms or haemolysis

Answer 35

Thrombotic thrombocytopenic purpura

Question 36

Hb value for anaemia in men and women

Answer 36

Men-

Question 37

In what circumstances would you get an elevated erythrocyte sedimentation rate?

Answer 37

Increased concentration of immuno-globulins and fibrinogen e.g. in inflammatory and neoplastic conditions