DUMS

Question 1

what is a haem group

Answer 1

iron and flat porphyrin ring

Question 2

erythropoiesis

Answer 2

production of RBCs

Question 3

where are iron stores

Answer 3

liver, spleen, bone marrow

Question 4

how are red cells produced in hypoxia

Answer 4

hypoxia sensed by kidneys > EPO produced which stimulates red cell production

Question 5

site of haematopoeisis

Answer 5

Embryo – yolk sac (week 3 -7) then liver (week 6) then marrow (week 16)
At birth – mostly bone marrow, liver and spleen
Birth to maturity – number of active bone marrow sites decreases
Adult – skull, ribs, sternum, pelvis, proximal ends of femur (axial skeleton)

Question 6

monocyte

Answer 6

large single nucleus
faintly saining granules
becomes macrophage

Question 7

what does an eosinophil look like

Answer 7

bi-lobed nucleus
bright orange/red granules

Question 8

what does a neutrophil look like

Answer 8

segmented nucleus
neutral staining granules
(acute inflammation)

Question 9

basophil

Answer 9

large deep purple granules obscuring nucleus

Question 10

normal haemoglobin

Answer 10

males: 130–180 g/L
females: 120–160 g/L

Question 11

when could you see target cells in blood film

Answer 11

iron deficiency anaemia
hyposplenism
thalassaemia
sickle cell
liver disease

Question 12

causes of microcytic anaemia

Answer 12

TAILS
thalassaemia
anaemia of chronic disease
iron deficiency
lead poisoning
sideroblastic anaemia

Question 13

why does microcytic anaemia happen

Answer 13

because you are missing the building blocks to make Hb
however the nuclear machinery still works so the cell is still dividing but the it produces smaller cells (and paler)

Question 14

types of haem deficiency

Answer 14

lack of iron erythropoiesis
- iron deficiency
- anaemia of chronic disease
problems with porphyrin ring synthesis
- lead poisoning
- congenital sideroblastic anaemia (X-linked)
globin deficiency
- thalassaemia

Question 15

transferrin

Answer 15

transfer iron

Question 16

ferritin

Answer 16

stores iron

Question 17

low ferritin

Answer 17

suggest iron deficiency

Question 18

causes of iron deficiency

Answer 18

loss of iron (blood loss: menorrhagia, GI tumour, ulcers, NSAIDs)
malabsorption: coeliac or crohns
lack in diet

Question 19

where is iron absorbed

Answer 19

proximal small bowel (duodenum and proximal jejunum)

Question 20

what control iron absorption

Answer 20

hepcidin (produced in the liver)

Question 21

causes of true macrocytic anaemia

Answer 21

megaloblastic (impaired DNA) or non-megaloblastic

Question 22

what does a megaloblastic red blood cell look like

Answer 22

larger than normal RC precursor with immature nucleus

Question 23

causes of megaloblastic

Answer 23

B12 deficiency
folate deficiency

Question 24

how does megaloblastic anaemia happen

Answer 24

DNA damage affects cells ability to divide
Hb production carries on as normal

Question 25

where do you get B12 and how long can you store it

Answer 25

animal products stores for 2-4 years

Question 26

causes of B12 deficiency

Answer 26

low dietary intake pernicious anaemia gastrectomy and congenital def of intrinsic factor

Question 27

what is pernicious anaemia

Answer 27

autoimmune condition causing destruction of gastric parietal cells resulting in intrinsic factor deficiency with B12 malabsorption in the ileum

Question 28

why can pernicious anaemia patients appear mildly jaundiced

Answer 28

intramedullary haemolysis

Question 29

testing for pernicious anaemia

Answer 29

auto-antibodies - intrinsic factor antibody (first line) - gastric parietal cell antibody

Question 30

presentation of pernicious

Answer 30

peripheral neuropathy with numbness or paraesthesia loss of vibration or proprioception visual changes mood or cognitive changes

Question 31

management of pernicious anaemia

Answer 31

1Mg hydroxocobalamin 3x a week then every 3 months

Question 32

what food contains folate and where is it absorbed

Answer 32

found in plant food and absorbed in jejunum

Question 33

causes of folate deficiency

Answer 33

diet (alcoholics) malabsorption (coeliac, crohns) excess utilisation- pregnancy, malignancy, exfoliating dermatitis, haemolysis drugs (anticonvulsants)

Question 34

causes of non-megaloblastic macrocytosis

Answer 34

alcohol excess liver disease hypothyroidism (may not be associated with anaemia) marrow failure (myelodysplasia, myeloma, anaplastic anaemia)

Question 35

indications for a blood transfusion

Answer 35

symptomatic anaemia where Hb <70

Question 36

examples of false macrocytosis

Answer 36

reticulocytosis in response to acute blood loss or red cell breakdown- reticulocytes are bigger than mature red cells cold-agglutinins- cause RBCs to clump at temperatures lower than core body temp