M103 T2 Symposia

Question 1

What are the two main causes of microcytic anaemia?

Answer 1

Fe deficiency – acquired

Thalassaemia – inherited

Question 2

What causes acquired microcytic anaemia?

Answer 2

Chronic bleeding (GI tract, Menstrual)
Low ferritin
Low Fe, high transferrin, low transferrin saturation

Question 3

What causes inherited microcytic anaemia?

Answer 3

alpha, beta (quantitative 𝛼/𝛽 imbalance)

normal ferritin, abnormal Hb electrophoresis/HPLC

Question 4

What are the three main causes of macrocytic anaemia?

Answer 4

Lack of B12 (dairy) or folate (fruit/veg)
B12 deficiency – autoimmune pernicious anaemia
Folate deficiency – many causes

Question 5

What can cause autoimmune pernicious anaemia?

Answer 5

B12 deficiency due to lack of intrinsic factor – inadequate absorption
Other causes (vegan, gastric surgery, Crohn’s)

Question 6

What are some of the causes of a folate deficiency?

Answer 6

dietary lack (tea and toast diet); alcohol
malabsorption (coeliac); excess utilisation; pregnancy

Question 7

What are the two main causes of normocytic anaemia?

Answer 7

Anaemia of chronic disease

Renal failure

Question 8

What feature of a blood sample indicates normocytic anaemia as opposed to any other anaemia?

Answer 8

the presence of normal-sized red blood cells

Question 9

What are some of the causes of anaemia of chronic disease?

Answer 9

Iron trapped inside macrophages
Cancer, inflammation, rheumatoid arthritis
Normal/raised ferritin, normal/low transferrin
Raised hepcidin (and inflammatory proteins)

Question 10

What are some of the causes of renal failure leading to normocytic anaemia?

Answer 10

Lack of erythropoietin (low serum Epo level)

Red cell hormone produced by kidney

Question 11

How is renal failure that has lead to normocytic anaemia treated?

Answer 11

with recombinant erythropoietin (weekly sc injection)

Question 12

What are the two types of bone marrow failure?

Answer 12

congenital

acquired

Question 13

What causes acquired bone marrow failure?

Answer 13

Marrow is empty (aplastic anaemia)
Marrow is full (infiltration e.g. leukaemia)
Marrow is not working (e.g. dysplasia)

Question 14

What are the main features of bone marrow failure?

Answer 14

Not making enough red cells
Reticulocyte count is low
Haematinics are normal

Question 15

What is excess consumption mainly caused by?

Answer 15

haemolysis - inherited or aquired

Question 16

What is the function of a bone marrow biopsy?

Answer 16

shows all precursor cells

will diagnose patients with bone marrow failure conditions

Question 17

What causes acquired haemolysis?

Answer 17

Immune (antibodies)

Non-immune (direct damage)

Question 18

What causes inherited haemolysis?

Answer 18

Membrane problems
Haemoglobin problems
Metabolic problems

Question 19

What are the three main causes of inherited RBC problems?

Answer 19

Membrane problems
Haemoglobinopathy
Metabolic

Question 20

What causes the membrane problems that lead to inherited RBC problems?

Answer 20

Red cells are spherical, not biconcave

Splenectomy can help (may need cholecystectomy for gallstones also)

Question 21

What are two examples of haemoglobinopathy that lead to inherited RBC problems?

Answer 21

sickle cell disease (wrong type of Hb)

thalassaemia (not enough Hb)

Question 22

What causes the metabolic problems that lead to inherited RBC problems?

Answer 22

X-linked recessive, males, Afro-Caribbean

Question 23

What is an example of a metabolic problem that leads to inherited RBC problems?

Answer 23

G6PD deficiency

Question 24

How must patients change their lifestyles to prevent / reduce the effect of metabolic problems that lead to inherited RBC problems?

Answer 24

must avoid fava beans, legumes, certain antimalarials and antibiotics

Question 25

What is an example of a membrane problem that leads to inherited RBC problems?

Answer 25

hereditary spherocytosis

Question 26

What are the two types of genes you can get for β thalassaemia?

Answer 26

``` Thalassaemia trait (single defective gene - carrier) Thalassaemia major (both genes defective - severe) thalassemia intermedia (both genes defective - milder) ```

Question 27

How does Thalassaemia major appear in peoples' lives?

Answer 27

Babies born with two defective beta hemoglobin genes usually are healthy at birth but develop signs and symptoms within the first two years of life

Question 28

What are the effects of Thalassaemia major?

Answer 28

problems of iron-overload | organ failure

Question 29

How is Thalassaemia major treated?

Answer 29

will need to have regular blood transfusions to treat anaemia takes a few hours each time

Question 30

What are the two main types of acquired red cell problems?

Answer 30

``` Immune mediated (spherocytes) Non-immune (red cell fragments) ```

Question 31

What are the two types of immune haemolysis?

Answer 31

autoimmune haemolysis | alloimmune haemolysis

Question 32

What events can lead to non immune haemolysis?

Answer 32

the installation of mechanical heart valves patients with DIC (very sick patients - sepsis, metastatic cancer) MAHA (microangiopathic haemolytic anaemia)

Question 33

What are the two forms of autoimmune haemolysis?

Answer 33

warm - regulated by IgG antibodies | cold - regulated by IgM antibodies

Question 34

What can alloimmune haemolysis be caused by?

Answer 34

a reaction by the immune system against rbc transfusions | babies with haemolytic disease of the newborn due to resis disease

Question 35

What does non immune haemolysis caused by?

Answer 35

fragmentation of the rbcs

Question 36

What other names is rhesus disease known by?

Answer 36

haemolytic disease | disease of the foetus and newborn (HDFN)

Question 37

What are the effects of rhesus disease on the mother and the baby?

Answer 37

it doesn't harm the mother | can cause the baby to become anaemic and develop jaundice

Question 38

How is haemolysis diagnosed?

Answer 38

take a history to find out if it is inherited haemolysis screen excessive bleeding (menstrual, internal from trauma etc) sequestered bleeding (e.g splenic sequestration)

Question 39

What are the stages of a haemolysis screening?

Answer 39

start with a Direct anti-globulin test (DAT or Coomb’s test) check the bilirubin level to check for jaundice check the blood film for spherocytes or rbc fragments check the LDH level as it increases in haemolysis check the reticulocyte count as it increases in haemolysis check the haptoglobin level – levels go down in serum check for haemoglobinuria

Question 40

How does Coomb's test screen for haemolysis?

Answer 40

it detects antibodies that are stuck to the surface of the red blood cells

Question 41

How do you check for haemoglobinuria?

Answer 41

involves free Hb in urine urine will be a dark colour a urine dipstick will show urobilinogen (colourless)

Question 42

What does urobilinogen in the urine mean?

Answer 42

normal urine will contain some urobilinogen however if there is little or no urobilinogen in urine, it can mean the liver isn't working correctly a higher than normal level can indicate haemoglobinuria

Question 43

What is a resultant condition from anaemia?

Answer 43

can result in tissue hypoxia

Question 44

What are the symptoms of anaemia?

Answer 44

Tiredness Breathlessness Pallor

Question 45

What is the equation for ejection fraction?

Answer 45

EF (%) = (SV / EDV) x100

Question 46

What are the main three types of Acute Coronary Syndrome?

Answer 46

STEMI (most serious) NSTEMI unstable angina (least serious)

Question 47

What are the symptoms of coronary artery spasm?

Answer 47

chest tightness or pain caused by tightening of a heart artery arm or jaw pain

Question 48

Under what circumstances might the symptoms of coronary artery spasm present?

Answer 48

cold weather, exercise or stress

Question 49

What happens if an NSTEMI isn't treated?

Answer 49

it can progress to serious heart damage or STEMI

Question 50

What happens if an NSTEMI or unstable angina isn't treated?

Answer 50

it can progress to serious heart damage or STEMI

Question 51

What are the two ways in which cardioversion can be achieved?

Answer 51

by sending electric shocks to the heart through electrodes placed on the chest (most common) medications

Question 52

What diseases are associated with the SCN5A protein coding gene?

Answer 52

Long Qt Syndrome 3 | Sudden Infant Death Syndrome

Question 53

Where is a transvenous ICD routed?

Answer 53

inserted into the subclavian vein into the tricuspid valve, into the right ventricle