Acquired Anaemias

Question 1

do males or females have a higher Hb?

Answer 1

males have higher due to androgens

Question 2

state some clinical features of anaemia ?

Answer 2

tiredness
pallor
SOB
swelling of ankles 
dizziness
chest pain

Question 3

state three things that can cause acquired anaemia?

Answer 3

bleeding
malabsorption
splenomegaly

Question 4

what does MCV stand for?

Answer 4

mean cell volume

Question 5

what does MCH stand for?

Answer 5

mean cell haemoglobin

Question 6

what are the three morphological types of anaemia?

Answer 6

hypo chromic microcytic
normochromic normocytic
macrocytic

Question 7

what test should be used for hypo chromic microcytic to determine the cause?

Answer 7

serum ferritin

Question 8

what test should be used for normochromic normocytic to determine the cause?

Answer 8

reticulocyte count

Question 9

what test should be used for macrocytic to determine the cause?

Answer 9

B12/folate

Bone marrow

Question 10

what is the commonest cause of anaemia?

Answer 10

iron deficiency

Question 11

state some signs of hypo chromic microcytic anaemia?

Answer 11

atrophic tongue
koilonychias
angular cheilitis

Question 12

state some causes of hypo chromic microcytic anaemia/

Answer 12

GI bleed
menorrhagia
gastrectomy
coeliac disease

Question 13

what would low serum ferritin suggest for microcytic anaemia?

Answer 13

iron deficiency

Question 14

what would a normal or increased serum ferritin with microcytic anaemia suggest?

Answer 14

thalassaemia or secondary anaemia

Question 15

what causes secondary anaemia ?

Answer 15

chronic inflammation

Question 16

what does a high reticulocyte count suggest?

Answer 16

high reticulocyte count suggests good production of RBCs

Question 17

what is the commonest cause of macrocytic anaemia?

Answer 17

B12/folate deficiency

Question 18

state some causes of macrocytic anaemia?

Answer 18

B12/folate deficiency 
alcohol
drugs (methotrexate, anti-retrovirals)
hypothyroidism 
disordered liver function

Question 19

what are the two types of macrocytic anaemia?

Answer 19

megaloblastic

non-megaloblastic

Question 20

what type of macrocytic anaemia is caused by B12/folate deficiency ?

Answer 20

megaloblastic

Question 21

state two symptoms of megaloblastic anaemia?

Answer 21

lemon yellow tinge

neuropathy

Question 22

what is the treatment for megaloblastic anaemia?

Answer 22

replace the deficiency

Question 23

state some causes of non-megaloblastic anaemia?

Answer 23

bone marrow infiltration

myelodysplasia

Question 24

what characteristic of the red cell does the MCV determine ?

Answer 24

size of the cell

Question 25

what characteristic of the red cell does the MCH determine ?

Answer 25

the colour of the cell | - pale or dark

Question 26

what protein is responsible for transporting iron out of duodenal cells into circulation and moving iron from the circulation into hepatocytes?

Answer 26

feroportin

Question 27

what enzyme controls the actions of feroportin?

Answer 27

hepcidin

Question 28

when is hepcidin made?

Answer 28

hepcidin is produced in response to inflammation

Question 29

what affect does hepcidin have on iron levels in duodenal cells and hepatocyte cells?

Answer 29

reduces duodenal iron absorption | mobilise iron from reticuloendothelial cells

Question 30

does increase of hepcidin increase or decrease RBC production?

Answer 30

high hepcidin reduces RBC production since less iron is available

Question 31

what is iron transported as in plasma?

Answer 31

transferrin

Question 32

what is iron stored in cells as?

Answer 32

ferritin

Question 33

what affect on ferroportin does hepcidin have?

Answer 33

hepcidin decreases the actions of ferroportin

Question 34

what is the name of the reaction which break down red cells?

Answer 34

haemolysis

Question 35

what is the management of iron deficient anaemia?

Answer 35

correct diet ulcer therapy surgery if bleeding replace iron

Question 36

what would an increased reticulocyte count suggest

Answer 36

suggest there is a greater RBC production and hence may suggest there is acute blood loss or increased haemolysi and the body is trying to compensate

Question 37

state two places where haemolysis can occur?

Answer 37

intravascular | extravascular

Question 38

what is intravascular anaemia?

Answer 38

RBCs lyse in the circulation releasing hemoglobin into the plasma

Question 39

what is extravascular anaemia?

Answer 39

RBCs are phagocytized by macrophages in the spleen and liver. Extravascular hemolysis is characterized by spherocytes.

Question 40

what does haptoglobin bind to?

Answer 40

free Hb

Question 41

what are the levels of haptoglobin like for intravascular haemolytic anaemia?

Answer 41

low because a lot of it has bound to free Hb

Question 42

what type of condition causes extravascular haemolytic anaemia?

Answer 42

autoimmune

Question 43

what test should be done for extravascular haemolytic anaemia?

Answer 43

direct anti globulin test (DAGT)

Question 44

what does the DAGT test detect?

Answer 44

DAGT binds to antibodies on the red cells which suggests autoimmune disease since the body is making antibodies to their own cells

Question 45

what question should be asked to the patient with a positive DAGT ?

Answer 45

have they had a blood transfusion recently? | any other autoimmune diseases?

Question 46

what does the histology of autoimmune (extravascular) haemolytic anaemia look like?

Answer 46

spherocytes | agglutination in cold AIHA

Question 47

why does the red cells clump (agglutinate) together in extravascular haemolytic anemia

Answer 47

IgM antibody causes the cells to clump together since it has receptors on its surface for the cells - only clump in the cold

Question 48

state some causes of intravascular haemolytic anaemia?

Answer 48

injury severe infection drugs

Question 49

what are fragments of RBCs called?

Answer 49

schistocytes

Question 50

what tests should be done for intravascular haemolytic anaemia ?

Answer 50

bilirubin (high) LDH (high) serum haptoglobin (low) check urine for haemosiderin/urobilinogen

Question 51

what is the management of intravascular haemolytic anaemia?

Answer 51

support marrow function with folic acid remove site of red cell destruction (splenectomy) treat underlying cause consider transfusion

Question 52

state some causes of B12 deficiency ?

Answer 52

pernicious anaemia | gastric/ileal disease

Question 53

what causes pernicious anaemia?

Answer 53

autoimmune disease against intrinsic factor

Question 54

state some causes of folate deficiency ?

Answer 54

dietary increased requirements (haemolysis) coeliac disease

Question 55

what is another name for DAGT test? (direct anti globulin test)

Answer 55

coombs test

Question 56

secondary anaemia is caused mostly by what type of anaemia?

Answer 56

normochromic normocytic

Question 57

where is B12 absorbed in the body?

Answer 57

distal ilium

Question 58

how is pernicious anaemia diagnosed?

Answer 58

presence of antibodies against intrinsic factor