IC7

Question 1

What to check for low MCV?

Answer 1

Serum ferritin

Question 2

Low serum ferritin hints at which type of anaemia?

Answer 2

Iron-deficiency anaemia

Question 3

What to test if serum ferritin is high/normal?

Answer 3

TIBC

Question 4

Type of anaemia: High/normal serum ferritin, low TIBC

Answer 4

Anaemia of chronic disease

Question 5

Cause of High/normal serum ferritin, high/normal TIBC

Answer 5

Suspect lead intoxication, thalassemia or sideroblastic anaemia

Question 6

What to check for high MCV?

Answer 6

Folate and B12 level

Question 7

Significance of normal folate and normal B12

Answer 7

Consider
- hepatic disease
- drug-induced anaemia
- hypothyroidism
- reticulocytosis

Question 8

What to measure if Hb is low, to determine cause of anaemia?

Answer 8

MCV

Question 9

What to measure if normal MCV?

Answer 9

Reticulocyte count

Question 10

Cause of anaemia: Normal MCV, high reticulocyte

Answer 10

Haemolysis, acute blood loss, splenic sequestration

Question 11

Side effect for too much iron

Answer 11

GI side effects e.g. constipation

Question 12

Examples of anaemia of chronic disease

Answer 12

CKD, IBD, rheumatoid arthritis

Question 13

Anaemia of chronic disease is also known as anaemia of ____

Answer 13

inflammation

Question 14

Two types of microcytic anaemia

Answer 14

1) Iron-deficiency anaemia
2) Anaemia of inflammation

Question 15

Vegetarian obtain minimal ___ from diet

Answer 15

Vitamin 12 (usually found in meat)

Question 16

Role of intrinsic factors

Answer 16

Absorb vit B12

Question 17

Cobalamin is also known as ____

Answer 17

Vit B12

Question 18

Treatment for pernicious anaemia

Answer 18

Parenteral (IM or SQ) vitamin B12:
1) 1000 𝝻g daily for 1 week followed by
2) 1000 𝝻g weekly for 4 weeks followed by 3) 1000 𝝻g monthly for life

Question 19

Treatment for Vit B12 (excluding pernicious anaemia)

Answer 19

Oral vit B12: 1000 𝝻g or 2000 𝝻g daily

Question 20

Cause of pernicious anaemia

Answer 20

Autoimmune condition - presence of autoantibodies to intrinsic factor

Question 21

Folate is also known as ____

Answer 21

Vit B9

Question 22

Treatment for folate deficiency

Answer 22

1 mg/d of folate for 1 to 4 months or until hematologic recovery is achieved.

Question 23

Vitamin B12, 1000 𝝻g orally given daily, is absorbed by ____, not relying on the action of _____

Answer 23

mass action; intrinsic factor

Question 24

Vit B12 / folate deficiency anaemia is also known as _____

Answer 24

Megaloblastic anaemia

Question 25

Diagnosis of aplastic anaemia

Answer 25

Presence of any 2:
1) WBC count ≤ 3,500 cells/mm3 (3.5 × 10^9/L)
2) Platelet count ≤ 55,000 cells/mm3 (55 × 10^9/L)
3) Haemoglobin value ≤ 10 g/dL (100 g/L; 6.21 mmol/L) + reticulocyte count ≤ 30,000 cells/mm3 (30 × 10^9/L)

Question 26

Goal of therapy: aplastic anaemia

Answer 26

Improve peripheral blood counts, limit the requirement for transfusions, and minimize the risk for infections.

Question 27

Infection in aplastic anaemia: when to give prophylactic antibiotics/ antifungals?

Answer 27

when neutrophil counts are below 500 cells/mm3 (0.5 × 109/L)

Question 28

Definition of neutropenia

Answer 28

Absolute neutrophil count (ANC) < 1500/𝝁L

Question 29

Definition of agranulocytosis

Answer 29

Absence of granulocytes (ie, ANC of zero), although the term is often used loosely to indicate severe degrees of neutropenia (ie, ANC <100, <200 or even <500/microL)

Question 30

Drugs causing agranulocytosis

Answer 30

Beta lactams, methimazole, sulfonamide, propylthiouracil, clozapine

Question 31

Agranulocytosis: can offending agent be restarted?

Answer 31

Not recommended, but can consider restarting penicillin at lower dose (after the neutropenia has resolved without any recurrence of drug-induced agranulocytosis)

Question 32

Drugs unsafe in G6PD deficiency

Answer 32

• FQ (-xacin)
• SU e.g. glipizide
• primaquine, tafenoquine

Question 33

Chemical/food unsafe in G6PD deficiency

Answer 33

• Fava beans
• Henna compounds
• Naphthalene (moth ball, lavatory deodorant)

Question 34

Is chloroquine/ hydroxychloroquine safe in G6PD deficiency?

Answer 34

Yes

Question 35

Definition of thrombocytopenia

Answer 35

Platelet count ≤ 100,000 cells/mm3 (100 × 109/L) or > 50% reduction from baseline values