Anaemia

Question 1

What is erythropoiesis controlled by?

Answer 1

Erythropoietin secretion by kidneys

Question 2

What nutrients are needed for erythropoiesis?

Answer 2

Iron
Vitamin B12
Folic acid

Question 3

What is a major source of iron?

Answer 3

Red meat
Gastric and ascorbic acid keeps it in the Fe++ form so aids in absorption

Question 4

What are the sources of Vitamin B12?

Answer 4

Liver
Fish
Eggs

Question 5

What are sources of folate?

Answer 5

Liver
Yeast extract
Green leafy vegetables

Question 6

What name is given to young RBCs?

Answer 6

Erythroblasts

Question 7

Why are reticulocytes called this?

Answer 7

Still retain some ribosomes which produce a reticular when treated with special stains

Question 8

What does the presence of reticulocytes suggest?

Answer 8

Bone marrow is active producing RBCs
Plenty of nutrients available for erythropoiesis

Question 9

Where do old RBCs get sequestered and broken down?

Answer 9

Become entrapped in sinusoids of spleen

Question 10

How is haemoglobin broken down?

Answer 10

Globin is degraded to amino acids and returned to general amino acid poll of the body
Haem is broken releasing iron to transferrin from which it can be recycled to bone marrow for new erythroblasts
Porphyrin ring is converted to bilirubin

Question 11

What is the path and result of bilirubin in the body?

Answer 11

Transported to the liver bound to albumin
Taken up by the liver and conjugated with glucuronic acid
Excreted from liver into biliary system
Gives urine its yellow colour and faeces its dark colour

Question 12

What is anaemia?

Answer 12

Decreased haemoglobin concentration below the normal range for that age and sex

Question 13

When does anaemia occur?

Answer 13

Decreased rate of production of RBCs
Increased rate of destruction of RBCs
Loss of RBCs due to bleeding
Impaired production of RBC due to lack of one nutrient needed for the production

Question 14

How can the type of anaemia be determined from the FBC?

Answer 14

Red cell indices:
Mean cell volume
Mean cell haemoglobin concentration
Mean cell haemoglobin

Question 15

What is the most common form of anaemia?

Answer 15

Iron deficiency(microcytic) anaemia

Question 16

What is a common feature of microcytic anaemia?

Answer 16

Increased platelet count

Question 17

What are likely causes of iron deficiency anaemia?

Answer 17

Chronic Blood Loss
Malabsorption
Dietary Deficiency of iron

Question 18

What may cause chronic blood loss?

Answer 18

Menstruation
Ulceration of stomach or duodenum (NSAIDS)
Colonic Carcinoma
Hookworm and schistosomiasis in developing countries

Question 19

What may cause malabsorption?

Answer 19

Gastrectomy
Coeliac disease

Question 20

What does transferrin do?

Answer 20

Plasma protein that iron attaches to to circulate in the blood

Question 21

When are blast cells present in blood circulation?

Answer 21

Leukaemia

Question 22

Why would a patient with leukaemia be at increased risk of infections?

Answer 22

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

Question 23

What procedure is used to confirm diagnosis of leukaemia?

Answer 23

Bone marrow biopsy - presence of abnormal blast cells suggest leukaemia

Question 24

What is aplastic anaemia caused by?

Answer 24

Chemotherapy
Infections
Exposure to toxic chemicals

Question 25

What hormone stimulates production of RBCs?

Answer 25

Erythropoietin

Question 26

What are causes of normochromic normocytic anaemia?

Answer 26

Renal failure
Leukaemia

Question 27

What form of anaemia causes Paraesthesia and extreme fatigue?

Answer 27

macrocytic anaemia

Question 28

What are the causes of vitamin B12 deficiency?

Answer 28

Pernicious anaemia
Dietary deficiency

Question 29

What is pernicious anaemia?

Answer 29

Autoimmune disease
Immune system attacks cells in the stomach that produce Intrinsic factor
Intrinsic factor is essential for absorption of vitamin B12 in the ileum

Question 30

Why does pernicious anaemia cause paraesthesia?

Answer 30

Vitamin b12 is used in the maintenance of myelin sheaths

Question 31

What demographic is at a greater risk for sickle cell anaemia?

Answer 31

Those of African heritage

Question 32

What form of haemoglobin does a patient with sickle cell disease have?

Answer 32

Haemoglobin S
Beta-globin chain production affected

Question 33

How does sickle cell anaemia occur?

Answer 33

E replaced with V in mutation
The abnormal beta chains within haemoglobin molecules polymerise to form a rigid structure deforming the cell into a sickle-shape

Question 34

When may sickle cell trait manifest itself?

Answer 34

Exceptional circumstances such as climbing at high altitudes

Question 35

Where would an individual with sickle cell feel pain and why?

Answer 35

Upper left quadrant of abdomen
Sickle cells unable to pass through the sinusoids of the spleen causing it to become engorged which stretches the capsule causing pain

Question 36

What does the irregular shape of RBCs cause in response to minor stress for those with sickle cell disease?

Answer 36

Block capillaries causing painful sickle crises, jaundice, anaemia
Systemic response with tachycardia, sweating and fever

Question 37

What places in the body are affected by sickle cell disease in adults and children?

Answer 37

Children - bones of hands and feet
Adults - humerus, femur, ribs, vertebrae, pelvis

Question 38

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

Answer 38

Increase in reticulocyte count

Question 39

What is a similar disease to sickle cell disease that may also cause anaemia?

Answer 39

Hereditary spherocytosis

Question 40

How is hereditary spherocytosis caused?

Answer 40

Deficiency of spectrin, membrane protein

Question 41

What chronic diseases is anaemia associated with?

Answer 41

Infections
Inflammatory conditions such as rheumatoid arthritis
Cancer