Anaemia

Question 1

What is the MAIN basis for a diagnosis of anaemia

Answer 1

A reduction in haemoglobin

Question 2

What are 3 essential vitamins/minerals needed for erythropoiesis?

Answer 2

Folate, vitamin B12, iron

Question 3

A man over 50 has anaemia. What is your number one cause for concern?

Answer 3

He may have bowel cancer

Question 4

The MCV on the blood film is lower than average. What term is used to describe the red blood cells?

Answer 4

Microcytic

Question 5

What is the main cause for microcytic RBC?

Answer 5

Iron deficiency

Question 6

The MCV on the blood film is higher than normal. What term is used to describe these RBC?

Answer 6

Macrocytic

Question 7

What is the main cause of macrocytic cells?

Answer 7

B12/Folate deficiency

Question 8

What is the term used to describe a normal MCV of a blood film?

Answer 8

Normocytic

Question 9

What do normocytic RBC tell you about the cause of the anaemia?

Answer 9

It is more than likely not caused by a vitamin/ mineral deficiency

Question 10

What does it mean if the blood film says RBC are normochromic?

Answer 10

The RBC are normal colour.

Question 11

What does it tell you about the RBC is they are hypochromic?

Answer 11

There isn’t a lot of colour to them

Question 12

What does it indicate if RBC are hypochromic?

Answer 12

There is probably an iron deficiency

Question 13

What is the serum ferritin on the blood film?

Answer 13

A measure of the iron stored in the liver. Although it is measured from the blood

Question 14

What is transferrin?

Answer 14

Protein which Transport iron around the body

Question 15

What does a low transferrin saturation indicate?

Answer 15

Iron deficiency

Question 16

What could it indicate if blast cells are present in the blood?

Answer 16

A leukaemia.

Question 17

Why are blast cells often present in the blood in patients with leukaemia?

Answer 17

Stem cells are producing too many white blood cells and they do not have time to mature properly.

Question 18

In patients with leukaemia, will RBC and PLT counts be normal?

Answer 18

No. They will be low

Question 19

What test could you use to diagnose leukaemia ?

Answer 19

Take a bone marrow sample

Question 20

Why do people with leukaemia bruise easily?

Answer 20

Low platelet count

Question 21

What is the PATHOPHYSIOLOGY of pernicious anaemia?

Answer 21

• The immune system attacks cells that make a protein called intrinsic factor
• intrinsic factor is needed to absorb B12
• anaemia due to lack of B12

Question 22

Is pernicious anaemia an acquired disease?

Answer 22

No. It is autoimmune

Question 23

What treatment would you give to somebody with pernicious anaemia?

Answer 23

Vitamin B12 injections

Question 24

Why would someone with pernicious anaemia present with ions and needles in extremities?

Answer 24

Vitamin B12 is needed to make the myelin sheath in the PNS

Question 25

What is the cause of haemolytic anaemia?

Answer 25

RBC are destroyed faster than they are Made

Question 26

What is anaemia ?

Answer 26

Concentration of HGB in the blood is too low

Question 27

What kind of anaemia would be suspected if RBCs were hypochromic ?

Answer 27

Iron deficiency anaemia

Question 28

What can cause iron deficiency anaemia

Answer 28

- bad diet - malabsorption due to coeliac disease/ gastrectomy - chronic blood loss e.g ulcers, cancer - menstruation

Question 29

What kind of drugs commonly cause ulcers in the GIT?

Answer 29

NSAIDs

Question 30

What does ferritin do?

Answer 30

Stores iron

Question 31

Why are B12 and folate necessary for dna synthesis

Answer 31

Needed to synthesis thymine

Question 32

Why are vegans susceptible to B12 deficiency?

Answer 32

B12 is only found in animal sources

Question 33

What can cause a deficiency in B12 ?

Answer 33

- bad diet - pernicious anaemia - periods of rapid growth e.g children and pregnant women

Question 34

Reticulocyte count is low. What could this indicate?

Answer 34

Leukaemia

Question 35

What is aplastic anaemia

Answer 35

Body stops producing RBCs

Question 36

What are some causes of aplastic anaemia?

Answer 36

- chemotherapy - exposure to toxic substances - infections eg parvovirus - chronic kidney disease ( no EPO )

Question 37

What is haemolysis ?

Answer 37

Premature destruction of RBCs

Question 38

What are some causes of haemolysis ?

Answer 38

- haemoglobinopathies - red cell membrane abnormalities

Question 39

What causes hereditary spherocytosis

Answer 39

A deficiency in cell membrane protein spectrin

Question 40

Why does hereditary spherocytosis cause haemolysis ?

Answer 40

No spectrin Reduction in surface area of cell membrane Cells take on a spherical shape Cells can’t squeeze through sinusoids in spleen Cells are destroyed

Question 41

Reticulocyte count is increased? What could this indicate?

Answer 41

Haemolysis

Question 42

What is splenomelagy ?

Answer 42

Enlarged spleen

Question 43

What are the symptoms of hereditary spherocytosis

Answer 43

Anaemia Splenoomelagy

Question 44

What causes sickle cell anaemia ?

Answer 44

Single base change in B subunit of HGB GAG -> GTG GLU -> VAL In deoxyhaemoglobin Val6 interacts with Phe85 and Val88 on adjacent B subunits This causes cells to take on a sickle shape

Question 45

Why does sickle cell anaemia flare up when tissues are hypoxic ?

Answer 45

In oxyhaemoglobin, Phe85 and Val88 are on the interior so val6 can’t interact with them

Question 46

What will the FBC of someone with sickle cell anaemia look like?

Answer 46

- RBC and HGB down - everything else is normal

Question 47

Symptoms of sickle cell anaemia ?

Answer 47

- pain in spleen (left abdomen) - pain and fever - sickle cell crisis - organ damage - severe infection