L03: Anaemia

Question 1

What is the definition of anaemia

Answer 1

A reduction in haemoglobin

Question 2

What does the range for low haemoglobin depend on

Answer 2

Age
Gender
Pregnancy 
Altitude 
Different labs

Question 3

What is in the blood

Answer 3

Plasma proteins 
Electrolytes
Hormones
Nutrients 
Platelets
White cells 
Red cells

Question 4

What are the cell features of red cells

Answer 4

Biconcave

No nucleus

Question 5

What is the key role of red cells

Answer 5

Oxygen and carbon dioxide transport

Question 6

Where does erthropoiesis take place

Answer 6

In the bone marrow

Question 7

What happens during bleed

Answer 7

Erythropoiesis increases and sometimes reticulocytes can become releases (reticulocytosis)

Question 8

What is haemoglobin made of

Answer 8

4 polpypeptide chain

1 haem for each polypeptide chain

Question 9

How many oxygen molecules bind to haemoglobin

Answer 9

4

Question 10

What are the types of haemoglobin

Answer 10

HbA
HbA2
HbF
HbS

Question 11

What is affinity

Answer 11

The ability to hold onto oxygen

Question 12

What does haemoglobin affinity depend on

Answer 12

Body area
Ph 
Temperature 
Co2
2.3DPG
Haemoglobin type

Question 13

What are the symptoms of anaemia

Answer 13

Nausea
Breathlessness
Palpitations due to heart working harder to get oxygen round the body
Angina (heart pain)

Question 14

What are the signs of anaemia

Answer 14

Pallor 
Tachycardia 
Bounding pulse 
Flow murmur 
Signs of heart failure 
Conjunctiva- pale inside of eye 
Koilonychia - spooning of nails
Angular stomatitis - sores at the angle of the mouth

Question 15

What are the 3 main causes of anaemia

Answer 15

1) reduced production
2) increased destruction
3) poor function of haemoglobin

Question 16

Why is it not enough to to diagnose anaemia

Answer 16

Anaemia indicates an underlying disease

Question 17

How can reduced production occur to give anaemia

Answer 17

Deficiency in:
iron : due to dilatory, malabsorption, chronic blood loss
B12 & folate: due to pernicious anaemia, increased alcohol, using too much B12& folate

Reduced production due to bone marrow:
Aplastic anaemia
Myeloma
Myelodysplasia

Displacement in bone marrow:
Leukaemia

Chronic disease:
Renal failure : due to lack of erythropoietin
Myeloma
Chronic inflammatory disease

Question 18

How can destruction occurs to give anaemia

Answer 18

Haemolysis (break down of red blood cells)
Large spleen (macrophages can take out red cells)
Bleeding (lose red cells quickly)

Question 19

How can you get poor function to give anaemia

Answer 19

Red blood cell membrane defect:
Hereditary spherocytosis

Haemoglobin defect:
Sickle cell anaemia
Thalassemia

Red blood cell enzyme defect:
G6DP defiency

Question 20

Why is iron important in RBC

Answer 20

Essential for haemoglobin production

Question 21

Why is folate and b12 important in RBC

Answer 21

Turns uracil into thymidine for dna building

Question 22

What is hereditatory spherocytosis

Answer 22

A defect in the red blood cell cytoskeleton means the RBC cannot pass through narrow vessels. RBC becomes damages and therefore quickly removed by macrophages.

Question 23

What is the shape of RBC in hereditary spherocytosis

Answer 23

Sphere instead of biconcave

Question 24

What is thalassaemia

Answer 24

Defect in alpha or beta globin gene resulting in abnormal form of haemoglobin

Question 25

What is sickle cell anaemia

Answer 25

Defect of hb beta globin gene which changes the shape of haemoglobin

Question 26

What can sickle cell anaemia lead to

Answer 26

Obstructed capillaries leading to spleen damage

Question 27

How do we investigate anaemia

Answer 27

``` Take full history Full blood count Blood film Ferritin, b12 and folate levels Liver and kidney functions Haemolysis screen ```

Question 28

How do we use hb and mean cell volume (MCV) to diagnose anaemia

Answer 28

Low hb and low MCV= iron deficiency anaemia, thalassemia, sickle cell anaemia Low hb and normal MCV- chronic disease, acute blood loss, bone marrow failure Low hb and high MCV- B12& folate deficiency anaemia, alcohol, haemolytic anaemia

Question 29

What is mcv

Answer 29

Mean cells volume i.e size of cell

Question 30

Where does Vitamin b12 get absorbed in the body

Answer 30

Terminal ileum

Question 31

What factor does vitamin b12 need to become absorbed in the terminal ileum

Answer 31

Intrinsic factor

Question 32

Where are intrinsic factors made

Answer 32

In the stomach from the parietal cells

Question 33

What can stop the production of intrinsic factor form the stomach

Answer 33

Pernicious anaemia

Question 34

If we have enough pernicious anaemia and B12 from the diet what can stop the absorption

Answer 34

Crohn’s disease which affects the small intestine and stops absorption of vitamin B12

Question 35

If the stomach and small intestine are working well what can another cause be to haver b12 deficiency

Answer 35

Vegan diet because B12 is in animal products

Question 36

What are the sources of folate in the diet

Answer 36

Vegetables

Question 37

Where is folate absorbed

Answer 37

Small intestine

Question 38

Therefore what can stop the absorption of folate in the body

Answer 38

Small intestine disease such as coeliac disease

Question 39

What are the causes of iron deficiency

Answer 39

Blood loss A lack of iron in diet Inability to absorb Pregnancy

Question 40

What does the blood loss in iron deficiency anaemia involve

Answer 40

Menstrual loss Slow chronic loss such as peptic ulcer, cancer Gastrointestinal bleeding

Question 41

Where does iron get absorbed in the body if consumed in the diet

Answer 41

Small intestine so intestinal disorder can give iron deficiency Or if small intestine as been bypassed or removed

Question 42

What levels do we look at to confirm low iron

Answer 42

Ferritin levels