Anaemia

Question 1

What are young RBCs called which have a nucleus

Answer 1

Erythroblasts

Question 2

What is enucleation and when does it occur

Answer 2

Erythrocyte getting rid of nucleus before leaving bone marrow

Question 3

What helps keep iron in the ferrous Fe2+ form

Answer 3

Ascorbic acid

Question 4

What are folic acid and vitamin B12 used for

Answer 4

In production of the nucleotide base thymine
Essential for production of DNA during erythropoiesis

Question 5

What does the presence of reticulocytes suggest

Answer 5

Bone marrow is active in producing RBCs
Plenty of Iron , folate and vitamin B12 available for erythropoiesis

Question 6

What is anaemia? What values diagnose it in males vs females?

Answer 6

Decreased haemoglobin concentration

Females : below 11.5g/dL
Males : below 13.5 g/dL

Question 7

Name three types of anaemia

Answer 7

Iron deficiency anaemia (microcytic anemia)
Normochromic normocytic anaemia
Macrocytic anaemia

Question 8

What is anisocytosis?

Answer 8

variation in RBC size

Question 9

What is poikilocytosis

Answer 9

variation in RBC shape

Question 10

What is iron deficiency anaemia also known as

Answer 10

Microcytic (hypochromic) anaemia

Question 11

What is a common feature of iron deficiency anaemia

Answer 11

Increased platelet count

Question 12

What is ferritin

Answer 12

Protein in which iron is bound in liver

Question 13

What are the physical signs of leukaemia

Answer 13

Expansions of the abdomen - extramedullary haematopoiesis causes splenomegaly and hepatomegaly

Splenomegaly - enlarged spleen
Hepatomegaly - englarged liver

Question 14

What is leukaemia?

Answer 14

A cancer of white blood cells/leukocytes.
Young abnormal WBCs are spilling out of bone marrow

Question 15

Why does leukaemia result in increased likelihood for infections

Answer 15

WBCs produced are of one clone and therefore unable to respond to a range of infections

Question 16

Why do leukaemia patients bruise easily?

Answer 16

Low platelet count

Question 17

What is normocytic normochromic anemia?

Answer 17

RBC’s are normal in size and Hb content, but are too few in number (lack of EPO)
Anaemia caused by another underlying condition

Question 18

Microcytic anaemia

Answer 18

Iron deficiency

Question 19

Causes of macrocytic anaemia

Answer 19

Dietary deficiency of B12 and folate (folic acid)
Pernicious anaemia: autoimmune disease, B12 is not absorbed.

Question 20

Diagnosis?

Answer 20

Microcytic anaemia

Question 21

Causes of microcytic anaemia

Answer 21

Iron deficiency can be caused by:
- dietary deficiency of iron (vegetarian diet)
- malabsorption (gastrectomy, coeliac disease)
- chronic blood loss (menstruation, ulceration of stomach or duodenum, colonic carcinoma, hookworm and schistosomiasis)

Question 22

Serum ferritin and transferrin saturation importance in an iron deficiency patient?

Answer 22

• Most of iron is bound up in a protein in the liver called ferritin
• A Transferrin Saturation of less than 20% suggests iron deficiency anaemia (iron circulates in the blood attached to a plasma protein called transferrin)
• There is an increased rate of cell division of the red cell precursor cells in an iron-deficient environment leading to the individual cells to be smaller (microcytic anaemia)

Question 23

Diagnosis?

Answer 23

Normochromic normocytic anaemia, very high WBC and low PLT indicates acute myeloid leukaemia.

Question 24

Diagnosis?

Answer 24

Macrocytic anaemia

Question 25

Why would a patient with macrocytic anaemia experience pins + needles?

Answer 25

- Vitamin B12 is used in the maintenance of myelin sheaths in the nervous system - Therefore, deficiency of Vitamin B12 can lead to dysfunction of the nervous system including peripheral nerves and the spinal cord

Question 26

Sickle cell disease genetics

Answer 26

- Single base mutation on the gene responsible for the production of β-globin chain ---> replacement of glutamic acid (glutamate) with Valine - High altitudes: amount of O2 in the air is reduced ---> amount of O2 bound to RBCs is reduced = hypoxemia - Abnormal B-globin chains in the Hb molecules within RBC interact with each other and polymerise to form a rigid structure within the cytoplasm ---> deformation of the entire cell ---> sickle-shaped - Sickle shaped cells = unable to pass through the sinusoids in the spleen ---> engorged with blood ---> stretches capusle ---> pain in left upper part of abdomen

Question 27

If haemolysis is the cause of anaemia what type of RBC will be prominent?

Answer 27

Increased reticulocyte count

Question 28

Hereditary Spherocytosis

Answer 28

- Caused by a deficiency of Spectrin (membrane protein) ---> loss of surface area of RBC membrane ---> forces the cell to take on a spherical shape - Spherocytes unable to squeeze through the sinus in the spleen ---> prematurely trapped and broken down - Increased rate of haemolysis can cause jaundice and anaemia - Splenomegaly = common feature

Question 29

What nutrients are essential for the production of RBCs (erythropoiesis)?

Answer 29

Iron, Vitamin B12 and folate

Question 30

Anaemia occurs when there's either: (4 things)

Answer 30

- Decreased rate of production of RBCs - Increased rate of destruction of RBCs (haemolysis) - Loss of RBCs due to blood loss - Impaired production of RBC due to a lack of one of the nutrients needed for their production

Question 31

Why are there few reticulocytes in a patient who has leukaemia?

Answer 31

All the bone marrow is involved in production of abnormal and useless WBCs ---> little space for erythropoiesis ---> reticulocyte count is reduced

Question 32

What hormone stimulates production of RBCs? Disease of which organs causes decreased production of this hormone?

Answer 32

- Erythropoietin (EPO) - Chronic kidney disease (cause by diabetes for instance)

Question 33

Other cause of a normochromic normocytic anaemia?

Answer 33

Renal failure

Question 34

If HGB low and MCV low

Answer 34

Microcytic anaemia (iron deficiency)

Question 35

If HGB low and MCV high

Answer 35

Macrocytic anaemia (low B12 and folate)

Question 36

If HGB low and MCV normal

Answer 36

Normocytic anemia (low EPO)