introduction to anaemia

Question 1

what is anaemia?

Answer 1

reduced total red cell mass

Question 2

what is a surrogate marker of anaemia?

Answer 2

hemoglobin concentration

haematocrit

Question 3

what level of Hb is considered anaemia in adult males?

Answer 3

Hb<130g/L

Question 4

what level of Hb is considered anaemia in Adult females?

Answer 4

Hb <120g/L

Question 5

where does red cell production take place?

Answer 5

in the bone marrow

Question 6

measuring hemoglobin concentration using a spectrophotometric method involves ———- the red cells to create Hb solution
Stabilise the Hb molecules ———
Measure the optical density (OD) at ———-

Answer 6

1. lyse
2. cyan-metHb
3. 540nm

Question 7

what is Beer’s law?

Answer 7

OD proportional to the concentration

Question 8

wat is calculated against a known reference standard cyan-metHb concentration solution?

Answer 8

Hb concentration

Question 9

Hb concentration is calculated against known reference of?

Answer 9

standard cyan-metHb concentration solution

Question 10

how to measure hematocrit?

Answer 10

it is a ratio/percentage of the whole blood that is red cells if the sample was left to settle

Question 11

how do modern machines measure hematocrit?

Answer 11

by adding the calculated volume of the red cells it counts

Question 12

in what situations are Hb/Hct not good markers of anaemia?

Answer 12

Rapid bleeds

Haemadilution

Question 13

wat are the two pathophysiological classifications of anaemia?

Answer 13

decreased production

increased loss or destruction of red cells

Question 14

when there is decreased production what is the reticulocyte count?

Answer 14

low reticulocyte count because you are not producing enough cells

Question 15

when there is increased loss or destruction of red cells the reticulocyte count is?

Answer 15

increased because you are producing more cells to compensate the loss

Question 16

hypo proliferative problems?

Answer 16

reduced amount of erythropoiesis , amount of production is a problem

Question 17

maturation abnormalities?

Answer 17

present but ineffective erythropoiesis

Question 18

cytoplasmic defects?

Answer 18

impaired haemoglobinisation

Question 19

nucleus defects?

Answer 19

impaired cell division

Question 20

what two states cause in increased loss or destruction of red cells?

Answer 20

bleeding

haemolysis

Question 21

what is the difference between bleeding and hemolysis?

Answer 21

in bleeding no bilirubin present

Question 22

why is there bilirubin present in hemolysis?

Answer 22

increase of breakdown products

Question 23

if MCV iss low (microcytic) consider problems with?

Answer 23

haemoglobinisation

Question 24

if MCV is hight (macrocyclic) consider problems with?

Answer 24

maturation

Question 25

if MCV is normal consider problems with?

Answer 25

hypo proliferation

Question 26

where is HB synthesized?

Answer 26

cytoplasm

Question 27

to make Hb you need?

Answer 27

globins | Haem : porphyrin ring, Iron (Fe2+)

Question 28

causes of microcytic anaemia?

Answer 28

commonest iron deficiency (low body iron)

Question 29

what is the second commonest cause of microcytic anaemia?

Answer 29

thalassemia which is when there is a globin deficiency

Question 30

shortage of globins and ham result in?

Answer 30

small red cells with a los Hb content

Question 31

in microcytic anaemia the cells are--------and ---------

Answer 31

microcytic and hypo chromic )small and lack in color)

Question 32

some causes of microcytic anaemia of chronic disease occur because?

Answer 32

normal body iron but lack of available iron - most normocytic

Question 33

very rare reasons of microcytic anaemia?

Answer 33

problems with porphyrin synthesis - lead poisoning, pyroxidine responsive anemias

Question 34

another rare cause of microcytic anaemia?

Answer 34

congenital sideroblastic anaemia

Question 35

what amount of iron is absorbed everyday?

Answer 35

1mg/day

Question 36

what is the actual circulating iron in plasma?

Answer 36

4mg of iron in the pool

Question 37

most of the iron in the body is as?

Answer 37

Hb

Question 38

iron is stored in the body as?

Answer 38

ferritin

Question 39

different in post-menopausal women and men is that?

Answer 39

don't lose much blood, so can't cope with loss of blood that well

Question 40

when hemoglobin is fully saturated?

Answer 40

1gHb will bind 1.34mlO2

Question 41

transferrin

Answer 41

picks up from storage area and takes it to tissues where it is required

Question 42

transferrin saturation

Answer 42

is the amount of available iron

Question 43

ferritin?

Answer 43

is a large intracellular protein

Question 44

spherical protein stores up to?

Answer 44

4000 ferric ions

Question 45

ferritin is also an ----------- --------- reactive protein?

Answer 45

acute phase,

Question 46

what is serum ferritin a measure of?

Answer 46

indirect measure of storage iron

Question 47

low ferritin means?

Answer 47

iron deficiency

Question 48

high ferritin?

Answer 48

could be falsely high

Question 49

iron deficiency can be confirmed by a combination of?

Answer 49

anaemia (decreased functional iron) and reduced storage iron (low serum ferritin)

Question 50

iron is absorbed from?

Answer 50

the proximal small bowel

Question 51

what two conditions cause insufficient absorption of of iron?

Answer 51

coeliac disease | achlorhydria

Question 52

red meat iron is absorbed much?

Answer 52

faster

Question 53

examples of relative deficiency of iron?

Answer 53

women of childbearing age and children

Question 54

what are examples of absolute deficiency of iron?

Answer 54

vegetarian diets

Question 55

causes of chronic blood loss? (5)

Answer 55

``` Menorrhagia Gastrointestinal -Tumours -Ulcers -Non-steroidal anti-inflammatory agents Haematuria ```

Question 56

what is average menstrual blood loss per month?

Answer 56

30-40ml/month = 15-20mg/month of iron

Question 57

what is the average daily intake of iron?

Answer 57

1mg/day

Question 58

heavy menstrual blood loss is?

Answer 58

>60ml ie. >30mg iron/month

Question 59

what are the sequential consequences of negative iron balance?

Answer 59

1. Exhaustion of iron stores 2. Iron deficient erythropoiesis - Falling red cell MCV 3. Microcytic Anaemia 4. Epithelial changes - skin - koilonychia

Question 60

what is occult blood loss?

Answer 60

A small volume gastrointestinal blood loss can occur without any symptoms or signs of bleeding

Question 61

what can occult blood loss cause?

Answer 61

This can outstrip the maximum dietary iron absorption of iron and result in anaemia iron absorption can be increased by iron supplements

Question 62

iron deficiency anaemia is a -------- not a --------

Answer 62

symptom not diagnosis

Question 63

what may relieve iron deficiency without treating the underlying problem?

Answer 63

iron replacement therapy

Question 64

what may be curative of iron deficiency anaemia?

Answer 64

early GI surgery of tumors

Question 65

what is the body's natural response to anaemia?

Answer 65

increased red cell production- reticulocytes

Question 66

what are reticulocytes?

Answer 66

red cells that have just left the bone marrow

Question 67

what is the size of reticulocytes?

Answer 67

larger than average red cells

Question 68

what is different amount reticule cites?

Answer 68

still have remnants of protein making machinery (RNA)

Question 69

what color do reticulocytes stain?

Answer 69

purple/deeper red as a consequence

Question 70

how does the blood film appear for reticulocytes?

Answer 70

polychromatic

Question 71

how long does up regulation of reticulocyte production by the bone marrow take in response to anaemia?

Answer 71

a few days

Question 72

what can automated analyses tell us about red cells?

Answer 72

Physical principles – e.g. cell size and light-scattering properties

Question 73

what is the advantage of using automated analysers?

Answer 73

rapid and reproducible

Question 74

what are measured red cell indices?

Answer 74

The haemoglobin concentration The number of red cells (concentration)‏ The size of the red cells. (Mean Cell Volume or MCV)‏

Question 75

what are the calculated indices of red cell indices?

Answer 75

Haematocrit Mean cell haemoglobin Mean cell haemoglobin concentration

Question 76

what can blood films show?

Answer 76

look at acellular morphology

Question 77

what can reticulocyte count show?

Answer 77

asses marrow response