HAEMATOLOGY

Question 1

what is the most common cause of microcytic anaemia?

Answer 1

iron deficiency

Question 2

give 2 physiological causes of iron deficiency anaemia

Answer 2

increased demand

decreased absorption

Question 3

give 2 pathological causes of iron deficiency anaemia

Answer 3

blood loss

malignancy

Question 4

give 1 lifestyle cause of iron deficiency anaemia

Answer 4

poor diet

Question 5

give a sign you might see on the hands of someone with iron deficiency anaemia

Answer 5

kiolonychia

Question 6

give a sign you might see on the face of someone with iron deficiency anaemia

Answer 6

angular stomatitis

Glossitis

Question 7

what is plummer vinson syndrome?

Answer 7

dysphagia and glossitis w iron deficiency anaemia

Question 8

what specific blood tests might you suggest for iron deficiency anaemia?

Answer 8

ferritin
iron
iron binding

Question 9

give 2 differential diagnoses for iron deficiency anemia

Answer 9

thalassaemia
sideroblastic anaemia
anaemia of chronic disease

Question 10

what type of iron is better absorbed in the body?

Answer 10

haem iron (as opposed to non-haem)

Question 11

give 4 normal physiological instances where iron in lost in the body(0.5-1mg/day)

Answer 11

faeces
sweat
urine
menstruation

Question 12

when does demand for iron increase in life?

Answer 12

growth

pregnancy

Question 13

give 4 types of macrocytic anaemia

Answer 13

megaloblastic
non-megaloblastic
pernicious (B12 deficiency)
folate deficiency

Question 14

give 3 causes of megaloblastic anaemia

Answer 14

vitamin B12 deficiency/abnormal metabolism
folic acid deficiency
DNA defects

Question 15

give 2 causes of DNA defects in megaloblastic anaemia

Answer 15

congenital

drug related - azathioprine

Question 16

what kind of condition is pernicious anaemia?

Answer 16

autoimmune

Question 17

what is the mechanism for pernicious anaemia?

Answer 17

loss of parietal cells, loss of intrinsic factor, malabsorption of B12

Question 18

what group are most likely to get pernicious anaemia?

a) black, female, overweight
b) black, female, elderly
c) white, male, overweight
d) white, female, elderly

Answer 18

d) white female elderly

Question 19

give 3 iatrogenic causes of folate deficiency

Answer 19

methotrexate
trimethoprim
phenytoin

Question 20

Excess of what can cause folate deficiency?

Answer 20

alcohol

Question 21

give 4 causes of non-megaloblastic anaemia

Answer 21

alcohol excess
liver disease
hypothyroidism
drugs (azathioprine)

Question 22

in which type of macrocytic anaemia might you see neurological changes?

Answer 22

B12 deficiency

Question 23

name 3 neurological changes that might occur with B12 deficiency

Answer 23

optic atrophy
dementia
hallucinations
polyneuropathy

Question 24

what is the pathophysiology of megaloblastic anaemia?

Answer 24

delayed nuclear maturation of RBCs in bone marrow - large immature nuclei

Question 25

what is the pathophysiology of non-megaloblastic anaemia?

Answer 25

increased lipid deposit in red blood cell membrane

Question 26

what is aplastic/fanconi's anaemia?

Answer 26

non megaloblastic, bone marrow failure

Question 27

what is non-megaloblastic polycythaemia? | What is the cause?

Answer 27

erythrocytosis increased red cell count & haemoglobin Cause is renal cell carcinoma

Question 28

what is the specific defect in polycythaemia vera?

Answer 28

JAK2 mutation - stem cell disorder

Question 29

what age group is most prone to polycythaemia vera? a) infants b) young adults c) middle aged d) over 60

Answer 29

d) over 60

Question 30

Give 4 neurological symptoms of polycythaemia vera

Answer 30

vertigo tinnitus visual disturbances Depression

Question 31

what locomotor condition can occur in polycythaemia vera?

Answer 31

gout

Question 32

how can alcohol cause macrocytic anaemia

Answer 32

increases mean cell volume and is toxic on erythropoiesis

Question 33

what types of macrocytic anaemia can alcohol cause

Answer 33

megaloblastic and non megaloblastic

Question 34

which blood tests would you use to distinguish between different types of macrocytic anaemia?

Answer 34

to differentiate between B12 and folate

Question 35

what will the blood results of B12 and folate look like in non-megaloblastic anaemia?

Answer 35

normal

Question 36

what drug is given to treat B12 deficiency?

Answer 36

hydroxocobalamin

Question 37

what drug is used to treat folate anaemia?

Answer 37

folic acid

Question 38

where can folate be naturally found?

Answer 38

raw green vegetables

Question 39

what drugs are given to treat pernicious anaemia

Answer 39

corticosteroids and hydroxocobalamin IM

Question 40

give a treatment for aplastic anaemia

Answer 40

bone marrow transplant

Question 41

What is the most common type of anaemia in pregnancy?

Answer 41

Iron deficiency anaemia

Question 42

Why do pre-menopausal females get IDA?

Answer 42

Heavy menstrual bleed and pregnancy

Question 43

What is the most common cause of IDA in post menopausal females and males?

Answer 43

Blood loss from GI tract

Question 44

What are general physical symptoms of iron deficiency anaemia?

Answer 44

``` Fatigue Syncope SOB Headache Angina Pallor ```

Question 45

What are the risk factors to IDA?

Answer 45

heavy periods | blood loss/bleeding

Question 46

What are DD of iron deficiency anaemia?

Answer 46

Thalassaemia, sideroblastic anaemia and anaemia of chronic disease

Question 47

What is sideroblastic anaemia?

Answer 47

Bone marrow produces ringed sideroblastic cells rather than health RBC

Question 48

What are the treatments for IDA?

Answer 48

Oral iron --> ferrous suphate | Severe IDA= paraenteral iron

Question 49

what sort of infection can cause IDA?

Answer 49

Hook worm infection ( ask about travel)

Question 50

What four drugs can increase the likely hood of IDA?

Answer 50

Clopidogrel NSAIDS SSRIs Corticosteriods

Question 51

What is megoblastic anaemia?

Answer 51

Anaemia caused by large RBC in the bone marrow with a immature nuclei caused by a defective DNA synthesis

Question 52

What is the most common cause of megoblastic anaemia?

Answer 52

Pernicious anaemia

Question 53

How is B12 absorbed?

Answer 53

Combines with IF that are produced by the parietal cells in the stomach. IF-B12 complex then attached to IF receptors in distal ilium and is absorbed

Question 54

What physical state makes you prone to folate deficiency and therefore megoblastic anaemia?

Answer 54

Pregnancy and lactation | Increase age

Question 55

Where in the body is folate absorbed and how long can it be stored for?

Answer 55

Upper part of the small intestine and stored for up to 4 months

Question 56

What excessive action can cause folate and vitamin B12 deficiency?

Answer 56

Excessive urination

Question 57

What conditions can cause a person to excessively urinate and therefore have folate deficiency?

Answer 57

Acute liver disease (alcoholics), congestive heart failure and chronic dialysis

Question 58

Give examples of conditions where you need increase amount of folate causing folate deficiency?

Answer 58

Malignancy Blood disorders: Thalassaemia and sick cell disease Infection: Malaria, Chrons and TB Poor absorption : ceoliac disease

Question 59

What is non megoblastic anaemia?

Answer 59

It is a mature large RBC with a normal DNA | Less common

Question 60

Except for neuo changes what are the other signs and symptoms of macrocystic anaemia?

Answer 60

``` Lethargy, Fatigue Fainting Jaundice Glossitis and angular stomatitis Pallour Bleeding SOB Angina Headache. ```

Question 61

Do you get any neuro problems with folate deficiency?

Answer 61

Mild depression

Question 62

If you have both B12 and folate deficiency which one would you treat first?

Answer 62

B12

Question 63

How do you test that vitamin B12 is due to pernicious anaemia?

Answer 63

Check Serum for anti IF antibodies