Anaemia

Question 1

what type of anaemia is iron deficiency?

Answer 1

microcytic (low MCV)

hypochromatic (low MCHC)

Question 2

most common cause of iron deficiency anaemia?

Answer 2

blood loss

• menstruation
• GI bleed (often malignancy)

Question 3

what type of anaemia is B12/folate deficiency?

Answer 3

macrocytic

megaloblastic

Question 4

whats the difference between macrocytic and megaloblastic?

Answer 4

macrocytic = high MCV
megaloblastic = high/normal MCHC

Question 5

what is MCHC?

Answer 5

measure of concentration of haemoglobin within a blood cell?

so is normal in B12/folate deficiency as its nuclear maturation thats affected not Hb??

Question 6

what to megaloblastic RBCs look like on blood film?

Answer 6

hypersegmented neutrophils

Question 7

what can cause B12/folate deficiency?

Answer 7

pernicious anaemia (B12)
malbsorption (B12 or folate)

Question 8

how does B12/folate deficiency result in anaemia?

Answer 8

B12 and folate needed for DNA synthesis

deficiency results in large erythroblasts with immature nuclei (megaloblasts)

Question 9

features of aplastic anaemia on blood tests?

Answer 9

pancytopaenia (low RBCs, WBCs and platelets)

low Hb

Question 10

bone marrow features of aplastic anaemia?

Answer 10

hypocellular bone marrow with no abnormal cells

Question 11

what can cause aplastic anaemia?

Answer 11

bone marrow failure of any cause really

eg - idiopathic, drugs, viral illness, inherited forms such as fanconi anaemia

Question 12

most common anaemia in alcoholics?

Answer 12

B12/folate (macrocytic megaloblastic)

Question 13

most common anaemia in otherwise well people who drink a lot of alcohol?

Answer 13

macrocytic non-megaloblastic

Question 14

what can cause non-megaloblastic macrocytic anaemia?

Answer 14

macocytosis in excess alcohol drinkers
hypothyroidism
hepatic disease
haemolytic anaemia
myelodysplastic syndrome
drugs
asplenia

Question 15

features of autoimmune haemolytic anaemia on blood tests?

Answer 15

normocytic (normal MCV)
normochromatic (normal MCHC)
low Hb
unconjugated hyperbilirubinaemia

Question 16

what features on blood film indicate haemolysis (eg in autoimmune haemolytic anaemia)?

Answer 16

spherocytes
high reticulocyte count
(also high unconjugated bilirubin but not really seen on blood film)

Question 17

how can autoimmune haemolytic anaemia be diagnosed?

Answer 17

direct antiglobulin test (direct coombs test) - shows auto-antibodies on surface of RBCs if positive

Question 18

what is fanconi’s anaemia?

Answer 18

increased chromosomal breakage, rearrangements and deletions due to defective DNA repair

Question 19

who is fanconi’s anaemia more common in?

Answer 19

people of ashkenazi jewish descent

Question 20

physical features of fanconi’s anaemia?

Answer 20

abnormal/absent thumbs
kidney malformations
microcephaly
hypogonadism
high foetal Hb

Question 21

features of fanconi’s anaemia on blood film?

Answer 21

aplastic anaemia

pancytopaenia

Question 22

in which conditions can anaemia of chronic disease occur?

Answer 22

active malignancy

chronic conditions such as diabetes or RA

Question 23

blood features of anaemia of chronic disease?

Answer 23

can be normocytic or microcytic
high ferritin
reduced total iron binding capacity
low Hb (but rarely below 8)

Question 24

anaemia of chronic disease is basically the same as what other anaemia and how can they be separated?

Answer 24

basically same as iron deficiency

differentiated by presence of high ferritin and low TIBC in anaemia of chronic disease

Question 25

why is ferritin high in anaemia of chronic disease?

Answer 25

secondary to underlying inflammatory process

Question 26

how is anaemia of chronic disease diagnosed?

Answer 26

presence of chronic inflammatory disease and anaemia | blood features

Question 27

how is anaemia of chronic disease managed?

Answer 27

treat underlying disorder monitor Hb blood transfusion in severe cases

Question 28

what is hereditary spherocytosis?

Answer 28

condition where the RBCs are sphere shaped making them fragile and easily destroyed most common inherited haemolytic anaemia in north europe

Question 29

how is hereditary spherocytosis inherited?

Answer 29

AD

Question 30

how does hereditary spherocytosis present?

Answer 30

``` jaundice (unconjugated bilirubin in all haemolytic anaemias) anaemia gallstones splenomegaly can have episodes of haemolytic crisis ```

Question 31

what can cause haemolytic crisis in hereditary spherocytosis and what happens?

Answer 31

can be triggered by infection | causes more severe haemolysis, anaemia and jaundice

Question 32

what is an aplastic crisis in hereditary spherocytosis?

Answer 32

where patients develop increased haemolysis, anaemia and jaundice without the normal bone marrow response of creating new RBCs (ie no reticulocytosis)

Question 33

what often triggers aplastic crisis in hereditary spherocytosis?

Answer 33

parovirus infection (aplastic crisis after parovirus infection = buzzword for hereditary spherocytosis)

Question 34

how is hereditary spherocytosis diagnosed?

Answer 34

``` fam history clinical features spherocytes on blood film raised MCHC (megaloblastic?) reticulocytes can be raised due to rapid turnover of RBCs ```

Question 35

how is hereditary spherocytosis managed?

Answer 35

folate supplementation splenectomy (stops destruction of fragile RBCs as they pass through the spleen?) removal of gallbladder (if gallstones are a problem) transfusions may be needed during acute crises