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Question 1

what is Anaemia?

and what clinical consequence does it have?

Answer 1

when the Haemoglobin level falls below defined levels.

Insufficient o2 delivery

Question 2

what are the causes of anaemia ?

Answer 2

A decrease: in RBCs
Haemoglobin content
and altered haemoglobin content doesn’t carry sufficient o2

Question 3

What are the symptoms?

Answer 3

Koilonychias-spoon shaped finger nails 
Lethargy 
Shortness of breath 
Palpitations
Headaches 
Non-specific

Question 4

what are the signs?

Answer 4

Pale conjunctivae
Tachypnoea-breathing
Tachycardia-heart rate

Question 5

What are the 5 main broad causes?

Answer 5

Bleeding 
Deficiency in Fe, B12, folic acid 
Haemolytic 
Bone marrow dysfunction
poor o2 saturation

Question 6

3 other minor causes?

Answer 6

Diet
Increased requirements-Pregnancy
Poor O2 utilisation

Question 7

Which 3 categories can help classify anaemia?

Answer 7

Size of the red blood cells
Acute/ chronic
other underlying aetiology

Question 8

What can cause Fe deficiency?

Answer 8

Bleeding
nutrition
Increased requirements

Question 9

What diagnostic tests can be done to confirm suspicions?

Answer 9

Serum Ferritin-storage form of Fe
Serum Fe- Labile as reflects recent intake of iron
Serum Transferrin-Carrier molecule for Fe, Homeostatically goes up if Fe deficient.
% Transferrin saturation- Sensitive
Blood film-quick and easy

Question 10

what do we measure in the category of size of red blood cell?

Answer 10

Mean Corpuscular volume

Question 11

what describes the 3 size states of red blood cells and any info on them?

Answer 11

Microcytic -small:
Fe deficiency 
Thalassaemia indicator
Macrocytic-large:
B12 and folate deficiency 
Myelodysplasia
Normocytic-normal

Question 12

What does myelodysplasia mean?

Answer 12

Group of disorders caused by poorly formed cells

Question 13

what is a reticulocyte count?

Answer 13

Represents RBC production rate by bone marrow

Question 14

What 2 reasons would the count be low?

Answer 14

1) bone marrow is infiltrated

2) Precursor deficiencies

Question 15

What 2 reasons would cause the count to be high

Answer 15

Haemolysis

chronic bleeding

Question 16

what if they are in normal range but are anaemic

Answer 16

Bone marrow is not responding appropriately

Question 17

How is it measured

Answer 17

Flow cytometry- count nucleic acid

Question 18

What ae the 4 features of the blood film diagnosis?

Answer 18

Hypochromia- Pale red blood cells
Microcytosis- Small rbcs
Pencil cells-cigar shaped
Target- cells with dark centres

Question 19

what 3 things classify is megaloblastic anaemia

Answer 19

when Macrocytic cells are above 100
B12 and Folate deficiency
Insufficient Reticulocyte precursors for cell division

Question 20

What does B12 and Folate contribute to making

Answer 20

DNA Nucleotides

Question 21

Info on B12 Deficiency

Answer 21

Dietary 
Malabsorption 
Crohns disease 
pernicious anaemia:
-autoimmune 
-Intrinsic factor

Question 22

what is crohns disease?

Answer 22

Inflammatory bowels disease affecting lining

Question 23

Folate deficiency?

Answer 23

Dietatry 
Malabsorption
Excess utilisation:-pregnancy
Alcohol 
Drugs

Question 24

Causes of chronic anaemia

Answer 24

Chronic:
-Inflammation
-Infection
Autoimmune
Rheumatoid arthritis
Cancer

Question 25

3 Main causes of chronic anaemia

Answer 25

1) Poor utilisation of Fe in body: stuck in macrophages of reticuloendothelial system and so can't be mobilised by erythroblasts 2) Dysregulation of Fe homeostasis - decreased transferrin - Increased hepodin 3) Impaired proliferation of erythroid progenitors -Fe unavailable -n response to erythroprotein

Question 26

Information on sickle cell anaemia?(3)

Answer 26

Point mutation in Beta globin gene causing Hbs Autosomal recessive Forms long spiky filamentous strand which is insoluble at low o2 tensions, leading to crisis

Question 27

Effects of sickle cell anaemia

Answer 27

low blood o2 levels Vaso-occlusive Ischemia-pain

Question 28

Managing SCA

Answer 28

Hydration | transfusion

Question 29

What is Thalassaemia & Clinical features detection

Answer 29

``` When there is insufficient Hb produce Due to altered gene expression Bones misshapen enlarged spleen liver and heart Blood film ```

Question 30

What are the 3 causes of bone marrow infiltration

Answer 30

``` Leukaemia: Bone marrow failure Lymphoma: Lymphadenopathy Weight Loss Myeloma: Anaemia Hyperkalaemia Renal failure ```

Question 31

where to take a bone marrow biopsy/aspiration

Answer 31

iliac crest

Question 32

Management of acute anaemia (1)

Answer 32

Transfusion

Question 33

Management of chronic anaemia

Answer 33

Fe Supplement-oral Folic acid -oral B12- injections Erythroprotein in patients with kidney failure

Question 34

Why avoid long term transfusion for patients with chronic anaemia

Answer 34

Fe overload | May cause alloimmunity and antibody production against it

Question 35

Symptoms of acute anaemia

Answer 35

Melena-dark stools | Hematemesis-vomiting