acquired anaemias

Question 1

test used to assess morphology of RBC?

Answer 1

blood film

Question 2

3 groups that can be assessed from blood film

Answer 2

hypochromic microcytic

normchromic normocytic

macrocytic

Question 3

hypochromic microcytic - next test?

results?

Answer 3

serum ferritin

• low: iron deficiency
• normal/high: thalassemia or secondary anaemia

Question 4

iron deficiency anaemia

causes?

Answer 4

blood loss - GI bleed, menorrhagia

GI malabsorption
GI malignancy - iron deficient anaemia in the elderly - presume colon cancer

Question 5

physiology of iron in the body

Answer 5

absorbed in the duodenum

transported via transferin

stored with ferritin

Question 6

signs of iron def anaemia

Answer 6

koilonychia
atrophic tongue
angular cheilitis

Question 7

blood results for iron deficient anaemia

Answer 7

low MCV
low ferritin
low transferin
low serum iron

Question 8

iron deficient anaemia PC that requires ODG

Answer 8

Male with no diet problems

Question 9

tx for iron deficient anaemia

Answer 9

mild: oral iron
chronic: IV iron
if cardiac symptoms - transfusion

Question 10

normocytic and normochromic blood film means?

test?

Answer 10

just a reduced number
normal MCV, MCH

reticulocyte count

Question 11

causes of normocytic normochromic anaemia?

Answer 11

high RCC - haemolytic or blood loss

normal or low RCC - secondary anaemia of chronic disease - DM, CKD

Question 12

test for macrocytic blood film?

Answer 12

very big cells
increased MCV

test folate/B12

Question 13

megaloblastic microcytic anaemia cause?

Answer 13

folate or b12 deficiency

Question 14

non megaloblastic macrocytic

Answer 14

marrow infiltration
myelodysplasia
drugs

Question 15

if normocytic normochromic anaemia - haemolytic - next test?

Answer 15

DAGT

Question 16

DAGT stands for and does what?

Answer 16

Direct AntiGlobulin Test

assess if haemolysis is autoimmune or not

Question 17

if pt is haemolysising what tests will you run?

Answer 17

• FBC, RCC, blood film
• serum conjugated bilirubin
• serum haptoglobulin

Question 18

positive DAGT - means

Answer 18

extravascular autoimmune haemolysis - within reticuloendothelial system

Question 19

3 different Abs causing autoimmune haemolysis

Answer 19

1. warm auto-Ab; spherocytes
2. cold auto-ab: infections
3. allo-Ab: TRANSFUSION REACTION

Question 20

Megaloblastic macrocytic anaemia?

Answer 20

b12 or folate deficiency likely

large erythroblasts due to defective DNA synthesis

Question 21

more likely b12 or folate deficiency?

Answer 21

folate - as stores run out faster than b12

Question 22

folate source, absorbed where?

Answer 22

green vegetables

small intestine

Question 23

causes of folate deficiency

Answer 23

diet 
GI malabsorption - coeliac 
GI malignancy 
increased requirements (pregnancy, haemolysis) 
folate antagonists: methotrexate

Question 24

vitamin B12 deficiency - physiology and causes:

Answer 24

absorbed and bound to intrinsic factor in the stomach and absorbed as a complex in the terminal ileum

causes: pernicious anaemia
malabsorption

Question 25

PC of b12/folate def?

Answer 25

YELLOW TINGE

elevated bilirubin due to fragile, easily friable RBCs

Question 26

testing for pernicious anaemia?

tx

Answer 26

auto Abs for intrinsic factor

IM B12 - unable to absorb

Question 27

non megaloblastic causes of macrocytic anaemia

Answer 27

alcohol
drugs
methotrexate
hypothyroidism