Nutritional Anaemias

Question 1

causes of iron deficiency anaemia

Answer 1

• decreased intake
• decreased absorption
• increased loss

Question 2

expected lab results from Fe-deficiency anaemia

Answer 2

• low Hb
• raised platelet count
• reduced MCV, MCH, MCHC
• reduced serum iron, raised TIBC
• reduced ferritin
• marrow iron stain
• raised soluble transferrin receptors

Question 3

management of Fe-deficiency anaemia

Answer 3

• investigate and treat the underlying cause
• iron replacement to
• • correct anaemia
• • replenish iron stores

Question 4

differential diagnosis of a microcytic anaemia

Answer 4

• iron-deficiency anaemia
• anaemia of chronic disease
• thalassemia trait

Question 5

causes of B12 deficiency

Answer 5

• reduced intake
• reduced absorption
• increased loss

Question 6

what is pernicious anaemia?

Answer 6

autoimmune condition where there is a lack of intrinsic factor production, causing a macrocytic anaemia of B12 deficiency

Question 7

expected lab results from megaloblastic anaemia

Answer 7

• raised MCV
• reduced reticulocyte count
• reduced leucocyte and/or platelet count
• bone marrow: erythroid hyperplasia, abnormal erythroblasts, giant metamyelocytes
• raised bilirubin and LDH
• reduced vitamin B12
• reduced folate

Question 8

what is Schilling’s test?

Answer 8

a patient is given IM vitamin B12 to check whether they can absorb B12; if positive, the radioactive B12 would be all in the faeces

Question 9

which are the stages of Schilling’s test?

Answer 9

• Part I: B12 given alone to diagnose the B12 deficiency
• Part II: B12 is taken with IF to check whether there is a malabsorption of B12
• Part III: B12 is taken with antibiotics to check whether B12 malabsorption is caused by a bacterial overgrowth

Question 10

management of pernicious anaemia

Answer 10

lifelong IM B12

Question 11

management of normal megaloblastic anaemia

Answer 11

• B12 IM
• oral folate for 4m
• monitor response by reticulocyte count

Question 12

which deficiency causes neurological damage?

Answer 12

B12

Question 13

which populations would require folate prophylaxis?

Answer 13

• pregnant
• haemolytic anaemia
• dialysis

Question 14

differential diagnosis of macrocytic anaemia

Answer 14

• myelodysplastic syndrome
• reticulocytosis
• red cell agglutinates
• neonates
• hypothyroidism
• alcoholism
• liver disease
• aplastic anaemia
• drug induced