Lecture 2 - Overview of Anaemias

Question 1

What is anaemia?

Answer 1

Reduced haemoglobin level in relation to age, sex, and physiological state

NZ adult reference ranges: 115–155 g/L (female), 130–175 g/L (male)

Question 2

What are the severity classifications of anaemia based on haemoglobin levels?

Answer 2

• Mild: > ~100 g/L
• Moderate: 70 - 100 g/L
• Severe: < 70 g/L

Question 3

What are common clinical features of mild anaemia?

Answer 3

• Often none
• Weakness
• Fatigue
• Shortness of breath
• Heart racing or palpitations
• Feeling cold

Question 4

What signs might indicate severe anaemia during clinical examination?

Answer 4

• Pallor (paleness) of mucous membranes
• Increased pulse rate
• Myocardial ischaemia in ECG/exercise test

Question 5

What are the classifications of anaemia based on blood count?

Answer 5

• Normal
• Anaemia
• Polycythaemia

Question 6

What are the types of cells in anaemia classification?

Answer 6

• Microcytic
• Normocytic
• Macrocytic

Question 7

What are the aetiological causes of anaemia?

Answer 7

• Increased loss or destruction
• Impaired red cell production

Question 8

What is the reticulocyte count?

Answer 8

Count of young red cells (1-2 days old) in the blood, indicating marrow production

Question 9

What causes microcytic anaemias?

Answer 9

• Iron deficiency
• Thalassaemias
• Anaemias of inflammation

Question 10

What is the most common cause of anaemia?

Answer 10

Iron deficiency

Question 11

What is the best test for iron stores?

Answer 11

Ferritin

Question 12

What characterizes thalassaemias?

Answer 12

Reduced production of either α or β globin chain of haemoglobin

Question 13

What is anaemia of inflammation?

Answer 13

A type of anaemia caused by reduced iron availability and sequestering of iron stores

Question 14

What is the role of hepcidin in anaemia of inflammation?

Answer 14

Hepcidin reduces release of iron from stores and blocks intestinal absorption

Question 15

What are some causes of anaemia of inflammation?

Answer 15

• Rheumatoid arthritis
• Inflammatory bowel disease
• Severe chronic infections

Question 16

True or False: Anaemia of inflammation responds to iron therapy.

Answer 16

False

Question 17

What does C-reactive protein indicate?

Answer 17

A protein produced in response to inflammation; used as a diagnostic test

Question 18

What happens to serum iron during inflammation?

Answer 18

Serum iron levels decrease, reducing availability to erythroblasts

Question 19

Fill in the blank: Anaemia is classified by _______ and aetiology.

Answer 19

morphology

Question 20

What is the relationship between iron deficiency anaemia and red blood cell characteristics?

Answer 20

Small, pale red cells with low MCV and low MCH

Question 21

What are some features of anaemia of inflammation?

Answer 21

• Neutrophil and platelet counts may be elevated
• C-reactive protein raised

Question 22

What are the common symptoms of severe anaemia?

Answer 22

• Angina
• Claudication
• Confusion from inadequate oxygen delivery

Question 23

What is the role of centration in the immune system?

Answer 23

Part of the natural immune mechanisms

Question 24

What is a common diagnostic test used to detect inflammation?

Answer 24

Centration

Question 25

What level of centration is observed in acute severe bacterial infections?

Answer 25

Very high level

Question 26

How does centration change in viral infections?

Answer 26

Only a mild increase

Question 27

In which conditions is centration elevated?

Answer 27

* Arthritis * Crohn disease * Some cancers * Acute tissue injury

Question 28

What is the implication of the phrase 'Evidence based medicine?'

Answer 28

Be a skeptic

Question 29

Who conducted research on students' interaction and ability to recall lecture content?

Answer 29

Bligh DA, 2000

Question 30

What did Jack Adams find regarding attention to manual skills after a brief rest?

Answer 30

Marked improvement

Question 31

What is the significance of a rest period in teaching methods?

Answer 31

Strong case for short breaks and changes in teaching method

Question 32

What deficiency is associated with macrocytic anaemias?

Answer 32

* Folic acid * Vitamin B12

Question 33

What does 'megaloblastic anaemia' describe?

Answer 33

Appearance of erythroblasts in the marrow

Question 34

What is a rare cause of folate deficiency?

Answer 34

Fortification

Question 35

What is the most common cause of vitamin B12 deficiency?

Answer 35

Autoimmune destruction of stomach cells

Question 36

What are some non-megaloblastic causes of macrocytic anaemias?

Answer 36

* Liver disease/alcohol * Haemolytic anaemias * Increased red cell production

Question 37

What happens to reticulocytes in response to blood loss?

Answer 37

Increased production

Question 38

What is the typical reticulocyte size compared to mature red cells?

Answer 38

20-30% larger

Question 39

What is the normal reticulocyte count range?

Answer 39

20-100x10^9/L (1-2%)

Question 40

What can lead to macrocytosis?

Answer 40

Very high reticulocyte count

Question 41

What are common causes of normocytic anaemias?

Answer 41

* Anaemia of renal failure * Acute blood loss * Bone marrow disease * Anaemia of inflammation

Question 42

What is the effect of bleeding on blood volume and blood pressure?

Answer 42

Causes reduced blood volume and falls blood pressure

Question 43

What does the term 'pancytopenia' refer to?

Answer 43

Low levels of all major marrow cell types

Question 44

What is a major consequence of chemotherapy on the marrow?

Answer 44

Pancytopenia

Question 45

What is the effect of reduced erythropoietin (EPO) from diseased kidneys?

Answer 45

Leads to anaemia of renal disease

Question 46

What are some risks associated with EPO abuse by athletes?

Answer 46

* Dangerous increase in Hb * Increased blood viscosity * Risk for clots

Question 47

What can cause severe anaemia due to reduced red cell survival?

Answer 47

Haemolysis

Question 48

What is polychromasia in the context of reticulocytes?

Answer 48

RNA appears blue in stained blood film

Question 49

What are examples of haemolytic anaemias?

Answer 49

* Malaria * Autoimmune * Hereditary spherocytosis

Question 50

What tests are used to diagnose haemolysis?

Answer 50

* Blood count * Blood film examination * Reticulocyte count * Bilirubin levels * Haptoglobin levels

Question 51

What happens to haptoglobin levels during haemolysis?

Answer 51

Very low levels due to being used up

Question 52

What is the consequence of non-functioning marrow?

Answer 52

Low levels of haemoglobin, platelets, and neutrophils

Question 53

What should you do after self-studying cases?

Answer 53

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