Red blood cells 2

Question 1

What is normal haemoglobin for males aged 12-70?

Answer 1

140-180

Question 2

What is normal haemoglobin for males >70 years?

Answer 2

116-156

Question 3

What is normal haemoglobin for females aged 12-70?

Answer 3

120-160

Question 4

What is normal haemoglobin for females >70 years?

Answer 4

108-143

Question 5

What are general anaemia features?

Answer 5

Tiredness
Pallor
Breathlessness
Ankle swelling
Dizziness
Chest pain

Question 6

What factors affect anaemia symptoms?

Answer 6

Age
Speed of onset
Haemoglobin level

Question 7

What symptoms will anaemic patients get if underlying cause is bleeding?

Answer 7

Menorrhagia
Dyspepsia
Post rectal bleeding

Question 8

What symptoms will anaemic patients get if the underlying cause is malabsorption?

Answer 8

Diarrhoea

Weight loss

Question 9

What is it called when patient doesn’t produce red cells?

Answer 9

Aplastic anaemia

Question 10

What are 3 general areas anaemia can happen?

Answer 10

Bone marrow - cell production
Red cell during life
Cell destruction

Question 11

How do we get a morphological description of red cells?

Answer 11

Mean cell haemoglobin

Mean cell volume

Question 12

How can cells be described morphologically?

Answer 12

Hypochromic - low haemoglobin
Microcytic - small cells
Normochromic
Normocytic
Macrocytic

Question 13

What are the 3 broad types of anaemia?

Answer 13

Hypochromic microcytic anaemia
Normochromic normocytic anaemia
Macrocytic anaemia

Question 14

What investigation should be done intitially?

Answer 14

Red cell indices - MCV, MCH

Blood film

Question 15

What investigation should be done if hypochromic microcytic anaemia?

Answer 15

Serum ferritin

Question 16

What investigation should be done if normochromic normocytic anaemia?

Answer 16

Reticulocyte count

Question 17

What investigation should be done if macrocytic anaemia?

Answer 17

B12/folate

Bone marrow

Question 18

What would you see in a reticulocyte count of someone with dysfunctioning bone marrow?

Answer 18

Low reticulocyte count

Question 19

What happens if serum ferritin is normal or increased in hypochormic microcytic anaemia?

Answer 19

Tahlassaemia

Secondary anaemia

Question 20

What happens to ferritin in inflammation and why is this important?

Answer 20

Increases - can mask iron deficiency anaemia in conditions such as rheumatoid arthritis

Question 21

What is common on history of iron deficiency anaemia?

Answer 21

Dyspepsia/GI bleeding
Other bleeding - menorrhagia
Low iron in diet
Increased requirement ie pregnancy

Question 22

What are clinical features of iron deficiency?

Answer 22

Koilonychia
Atrophic tongue
Angular stomatitis
Hypochromitic microcytic cells

Question 23

What are causes of iron deficiency?

Answer 23

GI blood loss
Menorrhagia
Malabsorption

Question 24

How is iron deficiency managed?

Answer 24

Oral iron usually sufficient
IV iron if intolerant of oral
Blood transfusion rarely indicated
Correct the cause

Question 25

What are causes of increases reticulocyte count?

Answer 25

Acute blood loss | Haemolysis

Question 26

What are causes of low reticular count?

Answer 26

Secondary anaemia Hypoplasia Marrow infiltration

Question 27

What is secondary anaemia?

Answer 27

Anaemia of chronic disease

Question 28

What is haemolytic anaemia?

Answer 28

Accelerated red cell destruction to the point it can't be compensated by bone marrow reticular cell production

Question 29

What does the direct antiglobulin test do?

Answer 29

Detects presence of complement fixed on red cell

Question 30

How does antiglobulin test happen?

Answer 30

Put anti-antibody-antibodies into blood, if antibodies present on antigens of blood blood will clump

Question 31

What does it mean if someone has haemolytic anaemia with a positive direct antiglobulin test?

Answer 31

It is immune mediated

Question 32

What investigations should be done if you suspect patient is haemolysing?

Answer 32

``` FBC Reticulocyte count - raised Blood film Serum billirubin Serum haptoglobin ```

Question 33

What are causes of folate deficiency?

Answer 33

Dietary Increased requirements GI pathology ie coeliac disease

Question 34

What are physical features of macrocytic anaemia

Answer 34

Lemon-yellow tinge Bilirubin, LDH Red cells friable

Question 35

How is folate deficiency treated?

Answer 35

Oral folate replacement | Ensure B12 normal if neuropathic symptoms

Question 36

What are other causes of macrocytosis?

Answer 36

``` Alcohol Drugs - methotrexate, antiretrovirals, hydroxycarbamide Disordered liver function Hypothyroidism Myelodysplasia ```