Haematology - Anaemia

Question 1

what are the blood features of aplastic anaemia?

Answer 1

pancytopenia
no abnormal cells
(hypo cellular marrow)

Question 2

causes of aplastic anaemia?

Answer 2

drugs (chloramphenicol/NSAIDs)
idiopathic
autoimmune disease
viral (post hep)

Question 3

features of aplastic anaemia?

Answer 3

infections
fatigue
SOB
tachycardia
bruising 
bleeding
pallor

Question 4

Ix and results in aplastic anaemia?

Answer 4

FBC (pancytopenia)
reticulocyte count (low)
bone marrow biopsy (hypocellular)

hepatitis test
LFTs
B12 and folate

Question 5

Tx for aplastic anaemia?

Answer 5

monitor
steroids
immunosuppression

Question 6

what happens in haemolytic anaemia?

Answer 6

increased RBC destruction
exceeds bone marrows capacity for production
premature RBCs released into circulation

Question 7

what features can be seen in haemolytic anaemia?

Answer 7

organomegaly
jaundice
no stool/urine changes

Question 8

where can red cells be destroyed? what are the consequences of each?

Answer 8

extravascular -> taken up by liver/spleen causing organomegaly

intravascular -> destroyed in circulation causing

haemoglobinaemia (Hb in circulation)
haemoglobinuria (pink urine)
haemosiderinuria (coca cola urine)

Question 9

what location of RBC destruction if more dangerous? why?

Answer 9

intravascular

abnormal waste products created

Question 10

what hereditary conditions can cause haemolytic anaemia?

Answer 10

G6PDD
sickle cell
thalassaemias
hereditary spherocytosis

Question 11

Ix for haemolytic anaemia? results?

Answer 11

Hb (low)
FBC 
reticylocytes (high)
blood film (Heinz bodies, red cell fragments)
Coombs test (+ve suggest immune cause)

Question 12

Tx for haemolytic anaemia?

Answer 12

Tx cause
steroids
plasmaphoresis

Question 13

what happens in microcytic anaemia?

Answer 13

shortage of globins/haem to make up Hb
cells are microcytic and hypochromic
cell does not get bigger

Question 14

features of microcytic anaemia?

Answer 14

angular stomatitis
koilonychia
pica
fatigue
hair loss
glossitis
restless legs
SOB

Question 15

causes of iron deficiency anaemia?

Answer 15

menorrhagia
veggie
GI blood loss
malabsorption

Question 16

what happens in anaemia of chronic disease?

Answer 16

inflam causes hepcidic to be upregulated

iron doesnt leave macrophages due to this

not enough iron to supply marrow -> microcytic hypochromic anaemia

Question 17

Ix for iron deficiency anaemia? results?

Answer 17

transferrin (circulating iron)
ferritin (stores)
Hb (low)
MCV (low)

Question 18

Ix for anaemia of chronic disease? results?

Answer 18

transferring (reduced)
serum iron (low)
ferritin (stores - normal/high)

Question 19

Tx for iron deficiency anaemia?

Answer 19

ferrous sulphate
ascorbic acid
RBC transfusion

Question 20

Tx for anaemia of chronic disease?

Answer 20

treat condition
transfusion
EPO
ferrous sulphate

Question 21

what happens in macrocytic anaemia?

Answer 21

megaloblast is a RBC precursor that hasn’t lost its nucleus and failed to get smaller before release into circulation

Question 22

what are the causes of macrocytic anaemia?

Answer 22

megaloblastic = defect in DNA synthesis/nuclear maturation:
B12 deficiency
folate deficiency

non megaloblastic:
alcohol
liver disease
marrow failure

spurious = size of RBC normal but MCV high:
acute blood loss

Question 23

where is folate absorbed?

Answer 23

jejunum

Question 24

where is B12 absorbed?

Answer 24

terminal ileum while bound to IF (released by parietal cells)

Question 25

what happens in pernicious anaemia?

Answer 25

autoantibodies against IF/gastric parietal cells

Question 26

features of macrocytic anaemia?

Answer 26

``` wt loss diarrhoea sore tongue jaundice stomatitis chelitis pallor of conjunctiva ```

Question 27

features of B12 deficiency?

Answer 27

dementia peripheral neuropathy dorsal column abnormalities

Question 28

what dorsal column abnormalities result in B12 deficiency? why?

Answer 28

loss of fine touch, vibration and proprioception subacute combined degeneration of the cord

Question 29

Ix for macrocytic anaemia? result?

Answer 29

``` Hb (low) MCV (high) blood film (macrovalocytes and hyperseg neutrophils) B12 and folate anti gastric parietal cell Ab anti intrinsic factor Ab ```

Question 30

Tx for macrocytic anaemia?

Answer 30

hydroxycobalamin injections 5mg folic acid RBC transfusion

Question 31

what is the inheritance of sickle cell?

Answer 31

autosomal recessive

Question 32

what is the pathology of sickle cell mutation?

Answer 32

HbS is created due to defect in B chains of Hb made of 2alpha and 2betaS polymerises in low oxygen

Question 33

what is normal HbA made of?

Answer 33

2 alpha | 2 beta

Question 34

features of sickle cell? what happens to those with trait?

Answer 34

painful lungs, spleen, digits, bone marrow hyposplenism traits only in severe stress/illness

Question 35

Ix for sickle cell?

Answer 35

FBC blood film HPLC

Question 36

Tx for sickle cell crisis?

Answer 36

``` opiates oxygen hydrate rest transfusion ```

Question 37

Tx for sickle cell?

Answer 37

penicillin vaccination | hydroxycarbamide/hydroxyurea

Question 38

what are acquired IMMUNE causes of haemolytic anaemia?

Answer 38

warm/cold | transfusion reactions

Question 39

what are acquired NON IMMUNE causes of haemolytic anaemia?

Answer 39

TTP DIC prosthetic heart valves malaria

Question 40

out of warm and cold haemolytic anaemia, where does haemolysis occur?

Answer 40

warm - extravascular | cold - intravascular

Question 41

causes of a normocytic anaemia?

Answer 41

``` CKD haemolytic anaemias anaemia of chronic disease aplastic anaemia blood loss ```

Question 42

in chronic alcoholism, what happens to bloods?

Answer 42

megaloblastic anaemia (high MCV) thrombocytopenia hypoalbuminaemia hyponatraemia