Anaemia

Question 1

What is anaemia?

Answer 1

Low RBC
<115 in females
<135 in males

Question 2

What are the symptoms?

Answer 2

Fatigue
SoB
Dizziness
Headaches
Palpitations
Worsening of other conditions e.g. HF
Fe specific
-pica= desire to eat abnormal things e.g. dirt
-hair loss

Question 3

What are the signs?

Answer 3

Pallor
Tachycardia
Tachypnoea
Koilonchyia- spoon nails Fe deficient 
Angular chellitis- redness around mouth edges- Fe deficient
Atrophic glossitis- smooth tongue- Fe deficient 
Bone deformities- thalassaemia
Jaundice- haemolytic anaemia
Leg ulcers- sickle cell

Question 4

What are causes of microcytic anaemia?

Answer 4

MCV <80

Fe deficiency

• heavy periods
• decreased intake
• increased demand- pregnancy
• decreased absorption

Chronic inflammatory disease
Thalassaemia
Lead poisoning

Question 5

What are causes of normocytic anaemia?

Answer 5

Acute blood loss
Hypothyroidism
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia

Question 6

What are causes of macrocytic anaemia?

Answer 6

MCV>100

Megaloblastic

• B12 deficiency
• -poor intake
• -Small bowel disease- Crohns
• -impaired absorption- pernicious anaemia
• Folate deficiency
• -alcohol excess
• -poor diet
• -drugs- methotrexate and trimethoprim
• -malabsorption- coeliacs

Normoblastic

• alcohol excess
• hypothyroidism
• drugs- azathioprine
• reticulocytosis

Question 7

What investigations are needed?

Answer 7

Bloods

• FBC
• Fe studies
• B12
• Folate
• TFTs
• LFTs
• Intrinsic factor and parietal cell antibodies

Blood film

Bone marrow biopsy if uncertain

OGD for gastric cause

Question 8

What is the management of microcytic?

Answer 8

Fe replacement
Ferrous sulphate 200mg tds- can drop down to bd if needed
SE- constipation, black stools and cramping

Ferrous gluconate if not tolerated

Continue once Hb normal for 3 months

Question 9

What is the management of macrocytic?

Answer 9

B12

• injections every other day for 2 wks
• then injections every 2-3 months
• if dietary cause then injections twice a year OR daily tables in between meals

Folate

• folic acid 5mg od
• normally in combination with B12

Question 10

What is the physiology of B12 and folate absorption?

Answer 10

B12 absorbed in terminal ileum and folate in jejunum

B12 acts as co enzyme for activation of folate

Lack of B12 absorption or ingestions leads to lack of folate which is important for DNA synthesis

Leads to production of abnormal RBC which are large and are destroyed

Question 11

What is pernicious anaemia?

Answer 11

Antibodies produced against parietal cells or intrinsic factor which is vital for B12 absorption

Causes decrease in B12 absorption

Leads to neurological symptoms

• peripheral neuropathy
• vision loss
• pins and needles
• loss of vibration sense

Treat with B12 injections followed by folate replacement if needed

DO NOT give folate replacement first as can cause subacute combined degeneration of the cord

• presents with paraesthesia, progressive weakness and ataxia
• can lead to paraplegia