01 - Anaemia

Question 1

What gives you Macrocytic anaemia

Answer 1

Folate and B12 deficiencies (megaloblastic)
Alcoholism

Rarely in COPD

Question 2

Some causes of normocytic ? Name at least 3

Answer 2

Chronic disease
Aplastic anaemia
Sickle Cell Disease
Pregnancy
Fluid Overload
Bleeds
B2 and B6 deficiencies
Renal failure

Question 3

Causes of microcytic anaemia ? Name 2

Answer 3

Iron deficiency anaemia
Thalassemia
Sideroblastic anaemia
Lead poisoning

Question 4

General Sx of anaemia

Answer 4

Tiredness
Shortness of breath
Pallor
Confusion
Angina (may progress to MI)

Question 5

Type of anaemia in Iron deficiency?

Causes?

Answer 5

Microcytic

menses, worms, malignancy, ulcers, malaria, chronic blood loss (ie NSAIDs, menorrhagia), dietary insufficiency, bowel disease, pregnancy

Question 6

Signs of FeDeficiency anaemia
Mx?
Rich iron foods?

Answer 6

glossitis, mouth ulcers, spoon shaped nails (kolionychia)

improve intake (iron supplements: iron sulphate), correct causes, lifestyle changes

red meat, brown rice, pulses and beans, eggs, tofu, nuts and seeds, green leafy veg.

Question 7

what does iron bind to in blood? What happens to levels in Fe deficiency/ pregnancy?

Answer 7

transferrin

raised

Question 8

What protein stores and releases Iron? what else is it?

Answer 8

Ferritin (Directly correlates with level of iron in blood)

Acute phase protein

Question 9

What is TIBC? Change in Fe Deficient anaemia ?

Answer 9

total iron binding capacity.
Based on binding capacity of transferrin.
Raised in Iron def anaemia.

Question 10

Name 2 diseases that can be picked up on a blood film?

Answer 10

Malaria
Spherocytosis

(Good at detecting blood parasites and RBC abnormalities)

Question 11

What is haematocrit ?
Low when?
High when?
Usual value compared to Hb?

Answer 11

Proportion of blood volume occupied by RBCs

Low in anemia

High in dehydration and polycythemia plus any conditions producing long term hypoxia (ie, sleep apnoea and COPD)

Usually 3 times haemoglobin

Question 12

Anaemia in Folate (b9) / B12 deficiency?

Folate deficiency in pregnancy ->?
Cause? Medications that cause?

Answer 12

megaloblastic

Neural tube Eg. Spina bifida

Insufficient intake
Trimethoprim, methotrexate, some anticonvulsants / contraceptives

Question 13

What sequelae can you get in b12 deficiency? Common cause?

Answer 13

neuropsychological
(depression, confusion, parasthesiae)

pernicious anaemia

Question 14

Cause of pernicious anaemia?

Answer 14

Lack of intrinsic factor

Most commonly due to an autoimmune attack on the cells that create it in the stomach.
-> Not absorbed in terminal ileum

Question 15

Triad in pernicious ?

Answer 15

Anaemia, GI, Neuro

Question 16

Causes of intrinsic factor deficiency?

Answer 16

Atrophic gastritis
Excessive PPI
Bowel resection
IBD

Question 17

What is atrophic gastritis

Answer 17

autoimmune attack on the parietal cells of the stomach, which produce intrinsic factor (co-transport protein of B12)

Question 18

Where is iron principally absorbed?
reduced by?
increased by?

Answer 18

Principally absorbed in duodenum.

Reduced by coeliac disease, IBD and surgical resection.
PPI therapy.
dairy products

Increased by Vitamin C

Question 19

Additional Sx of haemolytic anaemias

Answer 19

Jaundice

Question 20

Egs of inherited haemolytic anaemias?

Acquired ?.

Answer 20

Inherited: sickle cell disease, spherocytosis, thalassemia, G6Pd deficiency

Acquired: heart valves, malaria, autoimmune, lead poisoning, drugs

Question 21

What is the direct coombs test for?

Answer 21

Detects antibodies binding to RBCs

-> Autoimmune

Question 22

Sx of bone marrow failure?
Cause?
Associations?

Answer 22

Bleeding, bruising and infection.

Accquired or inherited. Chemotherapy, leukaemia, benzenes, radiation,

aplastic anaemia and Fanconi anaemia

Question 23

What is aplastic anaemia ?
Causes?
What happens?
Mx?

Answer 23

Damage to bone marrow and haematopoietic stem cells.

pancytopenia: thrombocytopenia, anaemia and leukopenia.
Caused by exposure to radiation, chemicals drugs. May also be congenital and autoimmune.

Stem cells slowly replaced by fat.

Treat underlying cause, consider bone marrow transplant.

Question 24

Genetics of sickle cell?
Most common from where?
Cause of crisis? Mx?

Answer 24

Point mutation -> gluatamic acid replaced by valine
-> Sulphur bridge bond & distortion

west africa

Cold, infections, hypoxia

Supportive - O2 and analgesia

Question 25

Risk with blood transfusions for thalassaemia? Mx of this?

common location from?

Answer 25

haemochromatosis (also possible with iron supplements)
-> Cardiac problems, splenomegaly, infection, bone deformities

Iron chelation therapy

mediteranian

Bone marrow transplant only cure

Question 26

Mx thrombocytopenia?
Coagulation deficiency?
DIC ?
vWF

Important to do after transfusion?

Answer 26

platelets
FFP
Cryoprecipitate

monitor for signs of reaction and illness