haematology - anaemia

Question 1

Hb values if anaemic

Answer 1

M: <135 g/L

F: <115g/L

Question 2

general causes of anaemia

Answer 2

↓ RBC production
↑ RBC loss
↑ plasma volume

Question 3

general symptoms of anaemia

Answer 3

fatigue
dyspnoea
faintness
palpitations
headache
tinnitus
anorexia

Question 4

general signs of anaemia

Answer 4

pallor
hyper dynamic circulation (tachycardia)
flow murmurs (HF)

Question 5

high MCV suggests

Answer 5

↓ RBC production

Question 6

low MCV suggests

Answer 6

normal RBC count but low content

eg. iron deficiency, thalassaemia

Question 7

causes of microcytic anaemia (FAST)

Answer 7

Fe deficiency
anaemia of chronic disease
sideroblastic anaemia
thalassaemia

Question 8

causes of normocytic anaemia

Answer 8

acute blood loss
haemolysis

anaemia of chronic disease
bone marrow failure
renal failure

hypothyroidism
pregnancy

Question 9

causes of microcytic anaemia (FT MR. ABC)

Answer 9

fetus (pregnancy)
thyroid (hypo)
myelodysplastic syndromes
reticulocytosis
antifolates
B12/folate deficiency
cirrhosis

Question 10

signs of IDA

Answer 10

koilonychia
atrophic glossitis
angular chelosis
post-cricoid webs (PV syndrome)
brittle hair and mails

Question 11

IDA blood film

Answer 11

microcytic
hypochromic
anisocytosis
poikilocytosis
pencil cells

Question 12

IDA classification

Answer 12

blood loss - GI bleed

intravascular haemolysis - chronic Hb loss

↑ use - pregnancy/lactation, child growth

↓ intake - diet, prematurity

↓ absorption - coeliac, post gastric surgery

Question 13

treatment of IDA

Answer 13

treat cause
oral ferrous sulphate
IV Fe if severe symptomatic anaemia

Question 14

treatment of IDA in sepsis/severe infection

Answer 14

transfusion

• Fe will not absorb well
• Fe can fuel sepsis

Question 15

side effects of oral Fe

Answer 15

nausea
abdominal discomfort
diarrhoea/constipation
black stools

Question 16

anaemia of chronic disease is

Answer 16

cytokine driven inhibition of RBC production

Question 17

inflammatory markers involved in anaemia of chronic disease

Answer 17

IFNs
TNF
IL1

IL6
LPS

Question 18

role of IFNs, TNF, and IL1 in anaemia of chronic disease

Answer 18

reduce EPO receptor production and EPO synthesis by kidneys

Question 19

role of IL6 and LPS in anaemia of chronic disease

Answer 19

stimulates liver to make hepcidin
inhibition of transferrin
decreased iron absorption from gut
iron accumulation in macrophages

Question 20

ferritin in anaemia of chronic disease

Answer 20

high

Fe held in macrophage to deprive invading bacteria

Question 21

anaemia of chronic disease in renal failure is

Answer 21

not cytokine driven

due to EPO deficiency

Question 22

sideroblastic anaemia

Answer 22

ineffective erythropoiesis

• iron loading haemosiderosis
• endocrine, liver, and cardiac damage

Question 23

diagnosis of sideroblastic anaemia

Answer 23

ring sideroblasts seen in marrow

erythroid precursors with iron deposited in mitochondria in a ring around nucleus

Question 24

causes of sideroblastic anaemia

Answer 24

myelodysplastic disorders
myleoproliferative disease
chemotherapy
irradiation
alcohol excess
lead excess
anti-TB drugs

Question 25

treatment of sideroblastic anaemia

Answer 25

remove cause | pyridine (vit B6 - promotes RBC production)

Question 26

iron, TIBC and ferritin in IDA

Answer 26

iron - low TIBC - high ferritin - low

Question 27

iron, TIBC and ferritin in anaemia of chronic disease

Answer 27

iron - low TIBC - low ferritin - high

Question 28

iron, TIBC and ferritin in chronic haemolysis

Answer 28

iron - high TIBC - low ferritin - high

Question 29

iron, TIBC and ferritin in haemochromatosis

Answer 29

iron - high TIBC - low/normal ferritin - high

Question 30

iron, TIBC and ferritin in pregnancy

Answer 30

iron - high TIBC - high ferritin - normal

Question 31

iron, TIBC and ferritin in sideroblastic anaemia

Answer 31

iron - high TIBC - normal ferritin - high

Question 32

transferrin saturation

Answer 32

serum Fe/TIBC | <20% indicated iron deficiency

Question 33

when checking ferritin also check

Answer 33

CRP | ferritin is acute phase protein increased with inflammation

Question 34

investigations for pancytopenia

Answer 34

``` B12/folate/iron abdominal examination reticulocyte count blood film myeloma screen parvovirus PCR in immunosuppressed medication review bone marrow biopsy ```

Question 35

low reticulocyte suggests

Answer 35

bone marrow failure syndromes

Question 36

pancytopenia blood smear

Answer 36

look for: blasts hairy cell leukaemia features dysplastic changes - myelodysplasia