Acquired anaemia

Question 1

What is the normal haemoglobin for males?

Answer 1

12-70= 140-180
>70= 116-156

Question 2

What is the normal haemoglobin for females?

Answer 2

12-70= 120-160
>70= 108-143

Question 3

What factors influence normal haemoglobin levels?

Answer 3

Age
Sex
Ethnicity
Time of day
Time to analysis

Question 4

What controls iron absorption?

Answer 4

Hepcidin

Question 5

What is the role of hepcidin?

Answer 5

Internalise iron transporters to prevent absorption

Question 6

When and where is hepcidin produced?

Answer 6

In the liver, when liver storage of iron if full

Question 7

What are the general features of anaemia?

Answer 7

Tiredness
Pallor
Breathlessness
Swelling of ankles
Dizziness
Chest pain

Question 8

What signs can be present in anaemia related to the cause?

Answer 8

Evidence of bleeding- menorrhagia, blood in stool
Malabsorption- weight loss, diarrhoea
Jaundice
Splenomegaly
Lymphadenopathy

Question 9

What ar the 3 categories of causes of acquired anaemia?

Answer 9

Hypochromic microcytic
Normochromic normocytic
Macrocytic

Question 10

What are the hypo chromic microcytic causes of anaemia?

Answer 10

Iron deficiency
Thalassaemia
Secondary anaemia

Question 11

How can causes of hypo chromic microcytic anaemia be differentiated?

Answer 11

Ferritin
Low ferritin= iron deficiency
Normal or high= thalassaemia, secondary anaemia

Question 12

What are the causes of iron deficiency anaemia?

Answer 12

Bleeding- most common
Diet- malabsorption
Increased requirement- pregnancy

Question 13

What is the treatment of iron deficiency anaemia?

Answer 13

Oral iron- IV if intolerant
Blood transfusion rarely
Correct cause

Question 14

What are the causes of normochromic normocytic anaemia?

Answer 14

Bone marrow problem
Acute blood loss
Haemolysis

Question 15

How can the causes of normochromic normocytic anaemia be differentiated?

Answer 15

Reticulocyte count
Low= bone marrow
High= acute blood loss, haemolysis

Question 16

What is haemolytic anaemia?

Answer 16

Accelerated re cell destruction

Compensated by bone marrow

Question 17

What are the causes of haemolytic anaemia?

Answer 17

Congenital
Acquired
-extravascular
---Autoimmune haemolytic anaemia
-intravascular
---Severe infection/DIC
---Pre-eclampsia

Question 18

What investigations are done for haemolytic anaemia?

Answer 18

Direct antiglobulin test

Detects antibody or complement on red cell membrane

Question 19

What does the result of a direct anti globulin test tell us?

Answer 19

\+= immune mediated
-= non immune

Question 20

What s the treatment of haemolytic anaemia?

Answer 20

Folic acid
Treat cause
-immune- steroids, trigger
-remove site of red cell destruction
Consider transfusion

Question 21

What are the causes of macrocytic anaemia?

Answer 21

B12 deficiency
Folate deficiency
Myelodysplasia
Marrow infiltration
Drugs and alcohol

Question 22

How can the causes of macrocytic anaemia be differentiated?

Answer 22

B12/folate assay
Megaloblastic= B12/folate
Non megaloblastic= myelodysplasia, marrow infiltration, drugs and alcohol

Question 23

What ar the causes of B12 deficiency?

Answer 23

Pernicious anaemia- most common cause, autoimmune

Gastric/ileal disease

Question 24

What are the causes of folate deficiency?

Answer 24

Dietary
Increased requirement- e.g. haemolysis
GI pathology

Question 25

What are the clinical features of megaloblastic anaemia?

Answer 25

Lemon yellow tinge

Question 26

What is the treatment of megaloblastic anaemia?

Answer 26

B12 IM injection every 3 months

Oral folate