Anaemia

Question 1

What are common symptoms of anaemia?

Answer 1

Shortness of breath😮‍💨; weakness; cardiac failure

Question 2

What are some clinical manifestations of anaemia?

Answer 2

pallor; congestive cardiac failure; tachycardia

Question 3

Name the three classifications of anaemia

Answer 3

Microcytic hypochromic; Normocytic normochromic; Macrocytic

Question 4

Features of microcytic hypochromic anaemia

Answer 4

Iron deficiency; Thalassaemia; In some cases sideroblastic and anaemia of chronic anaemia

Question 5

Features of Normocytic normochromic anaemia

Answer 5

haemolytic anaemias; After acute blood loss; Renal disease

Question 6

Features of macrocytic anaemia

Answer 6

Megaloblastic: B12 or folate deficiency; Non-megaloblastic: alcohol or liver disease

Question 7

Explain the process of iron absorption

Answer 7

Iron, best absorbed in the ferrous form, in the duodenum and jejenum ,is transported in plasma, bound to transferrin, to tissues with transferrin receptors, where it’s stored bound to ferritin.

Question 8

Where is iron stored?

Answer 8

In tissues bound to ferritin

Question 9

Reasons to increased iron absorption

Answer 9

Haem iron; Acids; Iron deficiency; Increased erythropoiesis; Pregnancy🤰; Hereditary haemochromotosis

Question 10

Reasons for decreased iron absorption

Answer 10

Inorganic iron; Ferric form; Alkalis; Iron excess; Infection

Question 11

Symptoms of iron deficiency

Answer 11

Glossitis; Koilonychia; Unusual cravings

Question 12

Causes of iron deficiency

Answer 12

Decreased supply
Malabsorption
Chronic blood loss
GIT
Uterine
Self-inflicted blood loss
Increased demand -> Pregnancy

Question 13

Laboratory findings in iron deficiency

Answer 13

Low serum iron and high TIBC; raised serum transferrin receptor (shed from cells); Absent serum ferritin; Absence of iron in bone marrow🦴

Question 14

Treatment strategies for Iron deficiency (3)

Answer 14

1. Inorganic iron salts🧂
2. Ferrous sulphate 200mg 3x day on an empty stomach💊
3. Intravenous iron replacement💉

Question 15

Name sources of B12 in the diet

Answer 15

Meat🍖, fish🐟, liver, and dairy🥛

Question 16

Where is B12 absorbed and transported to?

Answer 16

Ileum -> Liver

Question 17

B12 Pathway

Answer 17

B12 Binds IF -> receptor-mediated endocytosis -> lysosome -> binds transcobalamin II -> cytoplasm

Question 18

Pernicious anaemia

Answer 18

Immune attack on gastric mucosa => atrophy -> malabsorption of B12 (Females > Males)

Question 19

Sources of folate

Answer 19

Broccoli🥦, oranges🍊 and liver

Question 20

Where is folate absorbed and transported?

Answer 20

Absorbed in duodenum and converted to methyl/THF

Question 21

Symptoms of megaloblastic anaemia

Answer 21

Jaundice; Glossitis; Purpura; Neuropathy

Question 22

Laboratory findings of megaloblastic anaemia

Answer 22

Macrocyclic anaemia
Macro-ovalocytes
Decreased WBC count
Hypersegmented neutrophils;
Increased conjugated bilirubin and LDH
Decreased Serum B12 or folate
IF or Parietal Cell antibodies

Question 23

Treatment for megaloblastic anaemia(2)

Answer 23

1.Vitamin B12 1000mg/day x6 intramuscular💉
2. Folic acid 5mg per day oral 💊 (once every 3 months for life)