Red Cells 2

Question 1

What factors cause variability in Hb normal range?

Answer 1

Age
Sex
Ethnicity
Time of day/analysis

Question 2

Clinical features of anaemia?

Answer 2

Tiredness
Pallor
Breathlessness
Swollen ankles
Dizziness
Chest pain
May also see: Bleeding, malabsorption, jaundice, splenomegaly

Question 3

What are the general symptoms of malabsorption?

Answer 3

Diarrhoea

Weight loss

Question 4

What are the causes of anaemia?

Answer 4

Bone marrow abnormality
Red cell abnormality
Destruction/loss

Question 5

What are the main indices of anaemia diagnosis?

Answer 5

MCH - meal cell haemoglobin

MCV - mean cell volume

Question 6

What are the 3 descriptions of RBC?

Answer 6

Hypochromic microcytic
Normochromic normocytic
Macrocytic

Question 7

What is the commonest cause of hypochromic microcytic anaemia? What should you check?

Answer 7

Iron deficiency

Check: serum ferritin

Question 8

What should be checked in normocytic/normochromic anaemia?

Answer 8

Reticulocyte count (immature RBC)

Question 9

When is reticulocyte count low in anaemia?

Answer 9

Suppressed bone marrow activity

Question 10

When is reticulocyte high?

Answer 10

Haemolytic anaemia - bone marrow activity increased

Question 11

What should be checked in macrocytic anaemia?

Answer 11

B12
Folate
Bone marrow

Question 12

Hypochromic microcytic anaemia with low serum ferritin means what?

Answer 12

Iron deficiency

Question 13

Hypochromic microcytic anaemia with normal/increased serum ferritin?

Answer 13

Thalassaemia
Secondary anaemia
(sideroblastic anaemia)

Question 14

How can ferritin vary in inflammation?

Answer 14

Ferritin is an acute reactant, it will increase in normal inflammation

Question 15

Outline the pathway of iron metabolism?

Answer 15

Bound by mucosal ferritin
-or-
Transported across basement membrane by ferroportin

Bound to transferrin in plasma
Stored as ferritin

Question 16

What is the role of Hepcidin?

Answer 16

Made in liver
Regulate Iron storage
Made in response to ↑iron levels, inflammation
Blocks ferroportin

Question 17

What is the role of ferroportin?

Answer 17

Regulates the passage of iron across membranes (uptake)

Question 18

What stimulates the synthesis of hepsidin?

Answer 18

Inflammation

↑ Iron levels

Question 19

What are the causes of iron deficiency anaemia?

Answer 19

GI bleed
Other bleed
Diet
Increased requirement (pregnancy) 
Malabosorption (gastrectomy, coeliac, carcinoma)

Question 20

What are the physical signs on examination of Fe deficiency?

Answer 20

Tongue atrophy
Angular cheilitis
Koilonychia

Question 21

How is iron deficiency managed?

Answer 21

Correct deficiency

Correct the cause

Question 22

What is the cause of Normochromic normocytic anaemia with increased reticulocyte count?

Answer 22

Acute blood loss

Haemolysis

Question 23

What is the cause of Normochromic normocytic anaemia with Normal/low reticulocyte count?

Answer 23

Secondary anaemia++

Hypoplasia

Question 24

How does Secondary anaemia present?

Answer 24

70% Normochromic normocytic

30% hypo/micro

Question 25

What are the causes of secondary anaemia?

Answer 25

(chronic disease) Defective iron utilisation Infection, inflammation, malignancy

Question 26

What the classes of haemolytic anaemia?

Answer 26

Congenital Acquired Immune- Extravascular Non-immune- Intravascular

Question 27

How does the Direct antiglobulin test work?

Answer 27

Detect antibody or complement on red cell membrane | Implies immune basis for haemolysis

Question 28

DAGT positive Haemolytic anaemia suggests what?

Answer 28

Immune mediated Haemolytic anaemia

Question 29

DAGT negative Haemolytic anaemia suggests what?

Answer 29

Non-immune mediated haemolytic anaemia

Question 30

What are the main types of immune Haemolytic anaemia?

Answer 30

``` Warm autoantibody Cold autoantibody (only in cold) Alloantibody ```

Question 31

What are the causes of alloantibody immune haemolytic anaemia?

Answer 31

Transfusion reaction

Question 32

What investigations should be used in suspected haemolytic anaemia?

Answer 32

``` FBC Reticulocyte count (will be increased) Blood film (sphero/schistocytes, fragments?) Serum bilirubin Haptoglobin Coomb's/DAGT ```

Question 33

How is haemolytic anaemia managed?

Answer 33

Folic acid Correct cause Consider transfusion

Question 34

How is Macrocytic anaemia diagnosed?

Answer 34

B12/folate assay | Blood film/bone marrow

Question 35

What is megaloblastic anaemia?

Answer 35

Macrocyctic anaemia caused by B12 or Folate deficiency

Question 36

What is non-megaloblastic anaemia?

Answer 36

Macrocytic anaemia NOT caused by B12/Folate deficiency

Question 37

What is the cause of non-megaloblastic anaemia?

Answer 37

Myelodysplasia Marrow infiltration Drugs

Question 38

How does B12/Folate deficiency present?

Answer 38

Anaemia | Peripheral neuropathy

Question 39

What causes B12 deficiency?

Answer 39

``` Pernicious anaemia (AntiB vs IF) Gastric/ileal disease ```

Question 40

What causes folate deficiency?

Answer 40

Diet Haemolysis GI pathology

Question 41

How does Megaloblastic anaemia present?

Answer 41

"lemon yellow" tinge Elevated bilirubin, LDH Red cells friable ?Neurological symptoms (Peripheral neuropathy)

Question 42

What is the cause of Pernicious anaemia?

Answer 42

Autoantibodies vs Intrinsic factor -or- gastric parietal cells

Question 43

How is megaloblastic anaemia treated?

Answer 43

Replace vitamins (both until assay returns)