Red cells 3 (anaemia)

Question 1

Factors influencing the normal range for haemoglobin

Answer 1

• Age
• Sex
• Ethnicity
• Time of day sample is taken
• Time to analysis

Question 2

Normal haemglobin range for males

Answer 2

• 12-70 = 140-180

- >70 = 116-156

Question 3

Normal haemoglobin range for females

Answer 3

• 12-70 = 120-160

- >70 = 108-146

Question 4

Clinical features of anaemia due to reduced O2 delivery to tissues

Answer 4

• Tiredness/pallor
• Breathlessness
• Ankle oedema
• Dizziness
• Chest pain

Question 5

Clinical features of anaemia related to underlying cause

Answer 5

-Evidence of bleeding
Menorrhagia, PR bleeding, Dyspepsia

-Symptoms of malabsorption
Diarrhoea, Weight loss

• Jaundice
• Splenomegaly/Lymphadenopathy

Question 6

What causes destruction/loss of blood leading to anaemia

Answer 6

• Haemorrhage (blood loss)
• Haemolysis
• Hypersplenism (overactive spleen)

Question 7

What problems with RBCs themselves can lead to anaemia

Answer 7

• Membrane
• Haemoglobing
• Enzymes

Question 8

What is MCV + MCH

Answer 8

• MCV = Mean Cell Volume (size)
• MCH = Mean Cell Haemoglobin
• Can give morphological discription of anaemia

Question 9

3 types of anaemia

Answer 9

• Hypochromic Microcytic Anaemia
• Normochromic Normocytic Anaemia
• Macrocytic Anaemia

Question 10

What investigations are used to distinguish between types of anaemia

Answer 10

• Red cell indices

- Blood film

Question 11

What investigation is done when Hypochromic Microcytic anaemia is diagnosed

Answer 11

Serum ferritin

Question 12

What investigation is done when Normochromic Normocytic anaemia is diagnosed

Answer 12

Reticulocyte count

Question 13

What investigation is done when Macrocytic anaemia is diagnosed

Answer 13

• Serum B12 + Folate assay

- ?Bone marrow biospy?

Question 14

If serum ferritin is high or low in Hypochromic Microcytic anaemia what is the cause

Answer 14

• Low = Iron deficiency

- High = Thalassaemia/Secondary anaemia/?sideroblastic anaemia?

Question 15

How does Iron move around the blood

Answer 15

• In haemoglobin

- Bound to Transferrin

Question 16

How is iron stored in most cells

Answer 16

Ferritin

Question 17

How is iron transported from enterocytes + macrophages

Answer 17

Ferroportin

Question 18

What is hepcidin and where is it made

Answer 18

• Synthesised in Hepatocytes
• Responds to inflammation (and increased Fe levels)
• Blocks ferroportin, so reduces intestinal Fe absorption

Question 19

What do high + low levels of hepcidin cause

Answer 19

• High = Anaemia

- Low = Haemochromatosis

Question 20

What is ferroportin

Answer 20

• Transmembrane portein

- Transports iron from inside a cell to outside (i.e. out of gut cells into blood)

Question 21

Commonest cause of anaemia worldwide

Answer 21

Iron deficiency anaemia

DISCRIPTION, NOT A DIAGNOSIS, MUST ESTABLISH A CAUSE

Question 22

Hx for iron deficiency anaemia

Answer 22

• Dyspepsia, GI bleeding
• Other bleeding, e.g. menorrhagia
• Diet (N.B. children + elderly)
• Increased requirement e.g. pregnancy

Question 23

Signs of iron deficiency

Answer 23

• Koilonychia
• Angular stomatitis
• Atrophic tongue (smooth + glossy can be tender/painful)

Question 24

Causes of iron deficiency anaemia

Answer 24

• GI blood loss (worms)
• Menorrhagia
• Malabsorption (Gastrectomy, coeliac disease)

Question 25

Management of iron deficiency anaemia

Answer 25

Correct cause - Diet - Ulcer therapy - Surgery if bleeding - ?COC pill if menorrhagia? Correct anaemia - Oral iron supplement ussually adequate - Possible need of transfusion

Question 26

If reticulocyte count is high or low in Normochromic Normocytic anaemia what is the cause

Answer 26

- High = Acute blood loss or Haemolysis | - Low = Secondary anaemia, hypoplasia, marrow infiltration

Question 27

Causes of haemolytic anaemia

Answer 27

Congenital - Hereditary spherocytosis (HS) - G6PD deficiency Acquired -Auto-immune haemolytic anaemia (extravascular) Intravascular (also acquired) - Mechanical (artificial valve) - Severe infection - Drugs

Question 28

2 ways of categorising acquired haemolytic anaemia

Answer 28

- Immune (mostly extravascular) | - Non-mmune (mostly intravascular)

Question 29

How to test for auto-immune haemolytic anaemia

Answer 29

- Direct antiglobin test - Casuses agglutination in vitro (if -ve suggests the haemolytic anaemia is not immune mediated)

Question 30

What is seen on a blood film in intravascular haemolysis

Answer 30

Shcistocytes (red cell fragments)

Question 31

Management of haemolytic anaemia

Answer 31

-Folic acid (support marrow function) Correct cause -Immunosupression if autoimmune (?Prednisolone?)(treat trigger CLL, lymphoma) -Remove site of destruction (splenectomy) -Treat sepsis, leaky prosthetic valce, malignancy etc -Consider transfusion

Question 32

Describe secondary anaemia

Answer 32

- "Anaemia of chronic disease" - 70% normochromic normocytic, 30% hypochromic microcytic - Defective iron utilisation - Identifiable underlying disease (infection, inflammation, malignancy)

Question 33

If there is megaloblastic changes or no megaloblastic changes in bone marrow in Macrocytic anaemia what is the cause

Answer 33

- Megaloblastic change = B12 + Folate deficiency | - Non-megaloblastic = Marrow infiltration, Myelodysplasia, Drugs

Question 34

Causes of B12 deficiency

Answer 34

- Pernicious anaemia | - Gastric/ileal disease

Question 35

Causes of folate deficiency

Answer 35

- GI disease (coeliac disease) - Increased requirement (haemolysis) - Dietary

Question 36

What happens to the skin in megaloblastic anaemia

Answer 36

Lemon yellow tinge

Question 37

What causes pernicious anaemia

Answer 37

Antibodies against intrinsic factor (auto-immune)

Question 38

Rx for megaloblastic anaemia

Answer 38

Replace vitamin - B12 deficiency = B12 IM injection, loading dose then 3 monthly maintenance - Folate deficiency = Oral folate replacement