Anaemia

Question 1

What is anaemia and what causes it?

Answer 1

1. Low haemoglobin concentration

2. Low RBC mass, increased plasma volume, reduced production/increased loss of RBCs.

Question 2

What are the symptoms of anaemia?

Answer 2

Fatigue, dyspnoea, faintness, palpitations, headache, tinnitus, anorexia.

Question 3

What are the signs of anaemia?

Answer 3

Pallor, tachycardia, murmurs, cardiomegaly.

Question 4

What are the causes of anaemia with low MCV?

Answer 4

Iron deficiency anaemia (most common), thalassaemia, anaemia of chronic disease.

Question 5

What are the causes of anaemia with normal MCV?

Answer 5

Acute blood loss, anaemia of chronic disease, bone marrow failure, chronic renal failure, pregnancy.

Question 6

What are the causes of anaemia with high MCV?

Answer 6

B12 or folate deficiency (most common), liver disease/alcohol excess, cytotoxic drugs, myelodysplastic syndrome, hypothyroidism.

Question 7

When is a blood transfusion indicated in anaemia?

Answer 7

If Hb <70g/L

Question 8

What are vitamin B12, folate, and iron needed for in RBC formation?

Answer 8

1. Vitamin B12 and folate - DNA synthesis

2. Iron - haemoglobin synthesis

Question 9

What are the steps of iron metabolism in the body?

Answer 9

1. Absorbed into duodenum
2. Absorption regulated by hepcidin which binds to ferroportin, preventing iron entering enterocyte.
3. Once iron enters plasma it binds to transferrin.
4. It is moved to the bone marrow to make RBC.
5. Excess iron stored as ferritin

Question 10

What are the features of an iron study?

Answer 10

Serum iron, transferrin, transferrin saturation, ferritin, soluble transferrin receptor.

Question 11

What do these iron study results indicate?
Serum iron - low
Transferrin - high
Transferrin saturation - low
Ferritin - low
Soluble transferrin receptor - high

Answer 11

Iron deficiency

Question 12

What do these iron study results indicate?
Serum iron - low
Transferrin - low
Transferrin saturation - low
Ferritin - normal
Soluble transferrin receptor - normal

Answer 12

Anaemia of chronic disease

Question 13

What do these iron study results indicate?
Serum iron - low
Transferrin - low
Transferrin saturation - low
Ferritin - high
Soluble transferrin receptor - normal

Answer 13

Acute phase reaction

Question 14

What do these iron study results indicate?
Serum iron - high
Transferrin - normal/low
Transferrin saturation - high
Ferritin - high
Soluble transferrin receptor - low

Answer 14

Iron overload