Haem

Question 1

Define microcytic anaemia

Answer 1

Anaemia associated with a decreased MCV
Microcytic (MCV <80 fL).

Haemoglobin (Hb) level <120 g/L in females and <140 g/L in males

Question 2

Explain the aetiology / risk factors of microcytic anaemia

Answer 2

Iron-deficiency:
- Blood loss
Anaemia of chronic disease:
- Usually normocytic, but can be microcytic
Thalassaemia
Sideroblastic anaemia:
- Abnormal haem synthesis
Lead poisoning:
- Globin and haem synthesis interference

Question 3

Summarise the epidemiology of microcytic anaemia

Answer 3

most common cause is iron deficiency anaemia

Question 4

Recognise the presenting symptoms of microcytic anaemia

Answer 4

Anaemia: lethargy, tiredness, dyspnoea, pallor, weakness

Lead poisoning: anorexia, nausea, vomiting, abdominal pain

Question 5

Recognise the signs of microcytic anaemia on physical examination

Answer 5

Anaemia: pallor, brittle nails and hair, conjunctival pallor
Tachycardia in severe cases?
Glossitis, cheilitis
Lead poisoning: blue gum line, peripheral nerve lesions, encephalopathy

Question 6

Identify appropriate investigations for microcytic anaemia and interpret the results

Answer 6

Bloods: FBC, serum iron, iron-binding capacity, serum ferritin, serum lead
Blood film:
- Iron-deficiency: microcytic, hypochromic, anisocytosis, poikilocytosis
- Sideroblastic anaemia: dimorphic blood film
- Lead poisoning: basophilic stripping
If >40/menopausal women:
- Upper GI endoscopy, colonoscopy

Question 7

Generate a management plan for microcytic anaemia

Answer 7

Iron deficiency: iron supplements, consider parenteral if doesn’t work
Sideroblastic anaemia: treat cause (drugs), pyridoxine in inherited forms
Lead poisoning: remove source of poison, dimercaprol

Question 8

Identify the possible complications of microcytic anaemia and its management

Answer 8

High-output cardiac failure, complications of cause

Question 9

Summarise the prognosis for patients with microcytic anaemia

Answer 9

Depends on underlying cause

Question 10

Define macrocytic anaemia

Answer 10

Anaemiais defined as Hb <120 g/L in females and <140 g/L in males
Macrocytic (MCV >100 fL)

Question 11

Explain the aetiology / risk factors of macrocytic anaemia

Answer 11

Megaloblastic:
• B12 deficiency (Crohn’s, metformin, omeprazole)
• Folate deficiency (alcoholics, phenytoin)
• Drugs: methotrexate
Non-megaloblastic:
• Alcohol excess, liver disease

Question 12

Summarise the epidemiology of macrocytic anaemia

Answer 12

More common in elderly and females

Question 13

Recognise the signs of macrocytic anaemia on physical examination

Answer 13

Anaemia: pallor, tachycardia
Pernicious anaemia: lemon-tinted skin, glossitis, weight loss
B12 deficiency: peripheral neuropathy, ataxia

Question 14

Recognise the presenting symptoms of macrocytic anaemia

Answer 14

Anaemia: tiredness, lethargy, dyspnoea

Family history of autoimmune disease

Question 15

Identify appropriate investigations for macrocytic anaemia and interpret the results

Answer 15

Blood: FBC, LFTs, ESR, TFTs, B12, folate
Blood film: large erythrocytes
Schilling’s: radiolabelled B12 measured in urine

Question 16

Generate a management plan for macrocytic anaemia

Answer 16

Pernicious anaemia: IV hydroxycobalamin

Folate deficiency: oral folic acid (treat B12 deficiency first, folate can worsen neuropathy)

Question 17

Identify the possible complications of macrocytic anaemia and its management

Answer 17

Risk of gastric cancer, pregnancy + folate deficiency predisposes to spinal cord abnormalities

Question 18

Summarise the prognosis for patients with macrocytic anaemia

Answer 18

Majority are treatable

Question 19

Define normocytic anaemia

Answer 19

Anaemia associated with a normal MCV

Anaemiais defined as Hb <120 g/L in females and <140 g/L in males
Normocytic (MCV 80-100 fL

Question 20

Explain the aetiology / risk factors of normocytic anaemia

Answer 20

Loss of blood cells: 
	• Blood loss (peptic ulcers, oesophageal varices, trauma)
	• Hypersplenism (RBCs pool in the spleen)
	• Haemolytic disorders 
Reduced blood cell formation: 
	• Myelopathies 
	• Renal failure (secondary)
Plasma expansion: 
Pregnancy/overhydration

Question 21

Summarise the epidemiology of normocytic anaemia

Answer 21

Most common anaemia

Question 22

Recognise the presenting symptoms of normocytic anaemia

Answer 22

Anaemia: pallor, fatigue, dyspnoea

Anorexia, headache, bowel disturbances

Question 23

Recognise the signs of normocytic anaemia on physical examination

Answer 23

Koilonychia (iron deficiency), pallor, glossitis, tachycardia, wide pulse pressure, systolic ejection murmur

Question 24

Identify appropriate investigations for normocytic anaemia and interpret the results

Answer 24

Bloods: FBC, U&Es, eGFR, clotting screen

Pregnancy test

Question 25

Generate a management plan for normocytic anaemia

Answer 25

Treat underlying cause | Erythropoietin administration

Question 26

Identify the possible complications of normocytic anaemia and its management

Answer 26

Fatigue

Question 27

Summarise the prognosis for patients with normocytic anaemia

Answer 27

Dependant on cause

Question 28

Define aplastic anaemia

Answer 28

Diminished haematopoietic precursors in the bone marrow, and a deficiency of all blood cells (pancytopaenia)

Question 29

Explain the aetiology / risk factors of aplastic anaemia

Answer 29

Idiopathic (>40%): destruction due to autoimmune mechanisms Acquired: drugs (chloramphenicol, gold), chemicals, radiation Inherited: Fanconi’s anaemia

Question 30

Summarise the epidemiology of aplastic anaemia

Answer 30

Rare, 2-4:1,000,000

Question 31

Recognise the presenting symptoms of aplastic anaemia

Answer 31

Slow or rapid onset | Anaemia: lethargy, tiredness, dyspnoea Thrombocytopaenia: easy bruising, bleeding gums Leukopenia: increased infections

Question 32

Recognise the signs of aplastic anaemia on physical examination

Answer 32

Anaemia: pallor Thrombocytopaenia: bruises, petechiae Leukopenia: multiple infections

Question 33

Identify appropriate investigations for aplastic anaemia and interpret the results

Answer 33

Bloods: FBC (everything lowered, normal MCV) Blood film: exclude leukaemia Bone marrow trephine biopsy: for diagnosis and exclusion Criteria for severe aplastic anaemia (AA) - Marrow with <25% normal cellularity - Neutrophils <0.5 x 109/L - Platelets <20 x 109/L - Reticulocytes <40 x 109/L

Question 34

Define haemolytic anaemia

Answer 34

Shortened erythrocyte life span, due to premature breakdown (<120 days), with anaemia

Question 35

Explain the aetiology / risk factors of haemolytic anaemia

Answer 35

``` Hereditary: - Membrane defects - Metabolism defects - Haemoglobinopathies (sickle cell, thalassaemia) Acquired: - Autoimmune - Isoimmune (transfusion reactions) - Drugs (penicillin) - Trauma - Infection (malaria) - Paroxysmal nocturnal haemoglobinuria ```

Question 36

Summarise the epidemiology of haemolytic anaemia

Answer 36

Common